The 6th Vital Sign

Hey readers! It’s been quite awhile since I have posted. I would say that that’s a good sign! So much has happened in 8 months and hopefully a post will come soon about it đŸ™‚ As for this post, it’s more nursing fun! Some random ponderings one night at work. Enjoy!

Pain sucks. That much is obvious. No one likes to be in pain. As a RN in an ICU, pain is one of the top priorities for the majority of my patients. Which makes sense. During a stressful, possibly life altering, situation, who would want pain to complicate it more?

What could be worse than pain?

I had a patient that made me think about this a few nights ago. He is in no obvious pain but “freaks out” about being in pain. What could be worse than pain? Maybe…the potential for pain to exist?

I have had many patients who are completely fine one moment and then the next they turn into complete jerks. It takes me a bit to realize what’s happening… They were just sitting there, fine, talking with me, probably laughing, maybe texting on their phone. Then, it happens: they see the clock or someone says something about it – they are reminded of their masked pain. Then, all of a sudden, a 3/10 pain becomes a 10/10 pain with a half hour left to go before the next dose. They’re writhing in pain. They are no longer laughing. Their speech becomes curt. And they start the blame game. They start to take it out on whoever they can think of. They start to lash out at those closest to them…even at those who are going to be giving them the pain medicine (yes, the nurses. Don’t lash out at the nurses. C’mon man!).

My heart goes out to them, I swear. “Pain is always where the patient says it is, when the patient says it is, and how bad the patient says it is.” (a quote nurses live by). But something gets me thinking when you were just chatting it up with a someone on your phone and 2 seconds later you’re rating your pain a sharp 9/10…

…It’s hard for me to say “this is not pain” because of that pain mantra. However, as nurses we have also been trained in critical thinking skills. And my critical thinking skills and nursing judgment call shenanigans on your 10/10 pain in the fingers your were just using to text. AND THEN, as soon as the medicine has been swallowed/pushed the patient magically becomes normal again đŸ™‚ I’m not jaded at all, am I?

What is this then? I’m stuck between a hard place and a rock, no? Pain is called the “5th Vital Sign.” It is assessed frequently in the hospital especially in the critical care setting. I cannot go around saying “No, actually, you’re not in pain because you were just sleeping”

I believe there is a “6th Vital Sign.” I call it: “The Potential for Pain.” ..We already script for pain management: “I cannot guarantee pain free but I can work with you to help manage your pain.” We already do the work of attempting to identify the potential for pain. However, my question is could that pain be even more controlled if we work with the patient to manage the “potential for pain”?

“I want to work together to minimize the potential for pain”

Would that simple phrase ease anxieties when it comes “time for medicine”?

Healthcare is quickly, and rightly, becoming insistent on being proactive and taking preventative steps to improve your health care. However, the nature of the intensive care unit is tertiary healthcare – trying to fix a problem that is way past a “Band-Aid.” However, there are many things ICU RNs can do – should do – have to do! – to prevent things from happening while patients are with us and to better their care. Just changing a few words in a script may help prevent pain and change the perception of pain just enough to help patients with pain control.

Just a random thought đŸ™‚ I’m going to try it out and see what happens!

‘Til next time!



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