Mr. Jones, a patient who had foot surgery 3 days ago, has asked Donna D., a youn
ID: 305766 • Letter: M
Question
Mr. Jones, a patient who had foot surgery 3 days ago, has asked Donna D., a young nurse on a surgical ort Donna D.'s assessment of Mr. Jones leads her to believe that he is not having that much pain. Although the patient does have an oral medication order for pain, Donna D. independently decides to administer a placebo by subcutaneous injection Mr. Jones does not receive any relief from this subcutaneous medication and when the 12-hour night nurse relieves Donna D., Donna D. gives the nurse a report of her intervention concerning Mr. Jones's pain. The following morning, the night nurse reports Donna D.'s medication intervention to you, the nurse manager. You will have to address Donna's ethical decision to withhold pain mediation when the patient had an order for pain relief. hopedic unit, several times during her 12-hour day shift for some medication for pain. and documents her medication intervention. 8. What will you do? 9. What resources will you use to handle Donna D.'s behavior? 10. How will you demonstrate professionalism?Explanation / Answer
8. What will you do?
ANS: I would first question Donna’s reason for doubting the claims of pain from the patient. Sometimes there may be a valid reason to withhold a medication from a patient, however, in this circumstance that does not seem to be the case. I would explain to Donna that pain is a subjective experience that is different for everyone and is based on many factors, from gender, culture, physiologic differences, etc. Further, depending on the person, they may be in excruciating pain, while still maintaining a stoic appearance. I would explain to her that as nurses it isn’t ethical for us to pass judgment on a patient based on our subjective interpretations of them, instead, especially when it comes to pain, we have to believe what they say and do our best to provide relief in a safe manner.
9. What resources will you use to handle Donna D.’s behavior?
ANS: I would give a quick in-service lesson on how to conduct a complete pain assessment, that way a clear picture of a patients’ pain can be obtained. Then I would teach her about alternative and non-pharmacologic methods that may help to relieve pain, such as guided imagery or music. I would also like to assess and address Donna’s own perceptions and feelings about pain to better understand her viewpoint on the subject. In addition, a lesson on how to identify and deal with drug seeking patients may also be beneficial to help her better differentiate between such situations.
10. How will you demonstrate professionalism?
ANS: I would talk to her in a non-confrontational manner. In this case, she simply did what she felt was right and safe for the patient at the time, however, pain management is always a nursing priority. I would present the teaching information in a calm and constructive manner to better foster a healthy working relationship and to ensure that she doesn’t feel as though she is being disciplined. Perhaps providing a pain assessment and intervention to the entire unit staff would be more effective instead of one on one training with Donna only, as to get all of the nurses on the same page.
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