How to Support your Suffering Patient

People don’t tend to come to the hospital when they’re healthy. So as nurses, let’s face it, the patients we take care of are often suffering and it can be difficult to manage their suffering throughout their stay. There are many simple interventions that can be performed to help ease the pain, discomfort, anxiety, and overall suffering a patient may be experiencing while in the hospital and nurses are at the forefront of implementing those interventions and advocating for their patients. In this article, I want to take time to discuss some of the things you can do…whether you’re a student or are already a nurse…to make support your patient in the best way possible. Let’s dive in!

One of the most common sources of discomfort and suffering in the hospitalized patient is pain. So what can you do to help manage a patient’s pain? Of course, there are always interventions that do not require medication administration. These can include repositioning, ice/hot packs, turning, elevation of an extremity, etc. When those aren’t sufficient for pain relief, medications can play a HUGE and important role in managing pain. Look over your current medication orders, obtain additional orders if necessary, and utilize them to the fullest to get that patient’s pain under control and keep it under control. Consider advocating for your patient by requesting a standing order for a non-opioid pain medication such as Tylenol or a transdermal pain patch such as Fentanyl. Also, consider requesting both oral and IV pain medications in case of nausea/vomiting or if a situation should arise making your patient NPO. An IV pain medication could be for “NPO/BTP” use only (BTP = breakthrough pain). Additionally, oral and IV pain meds could have 1st and 2nd line use labels where oral is used first and IV as a back up if ineffective or additional medication is required before the next oral dose is able to be administered.

Another major aspect of comfort promotion concerns nausea/vomiting and anxiety management. First let’s discuss nausea and vomiting. In this case, it’s always better to treat at the onset of the nausea…BEFORE it gets to the point where the patient vomits. Prophylaxis is always the best method, so consider administering it with medications that tend to cause nausea (Ex: strong pain medications, chemo, etc.). Also, I would suggest making sure you have a first, second, and even possibly a third line medication for nausea in the event that one isn’t effective for the patient or they have a history of uncontrollable nausea (Ex: Zofran, Phenergan, and Compazine in that order). Lastly, IV medications or sublingual medications tend to work best for nausea because the GI tract can be temperamental and an oral medication may further agitate the nausea. For anxiety, think in terms similar to pain management…keeping in mind oral and IV medication options, first and second line options, and also utilizing non-medicinal methods of anxiety management such as reducing stimuli, providing explanations, setting expectations, etc.

Aside from managing pain, anxiety, and nausea, there are other interventions nurses can implement to improve a patient’s comfort and ease their overall suffering. Again, positioning, turning, and utilization of pillows and wedges can improve physical comfort. At times, patient’s need assistance with regulating their temperature either by using ice packs or utilizing equipment such as a Bair Hugger blanket for warmth. Heat and cold therapy can also be used on places where there is localized pain. Hygiene care can truly help elevate a patient’s mood and general comfort. This can include simple interventions such as shampooing their hair, providing a bed bath, shaving their face, brushing their teeth/hair, etc.

There are also a lesser apparent set of interventions a nurse can do to help their patients be more comfortable. For instance, avoid making promises or giving false hope. It may seem like this can provide comfort, but you have NO way of knowing how a patient will do even within the next hour, so avoid any promises or provisions of hope. Always advocate for their needs and comfort, as far in advance as possible to prevent further suffering and complications. Many times, providing an explanation regarding their care, a procedure, or medication can go a long way in easing anxiety and promoting peace of mind. Along with this comes setting expectations appropriately. By this, I mean explain the timeline of your shift and any planned events and consider explaining medication order parameter, especially when it regards PRN and pain medications (Ex: how often you can give the medication, tiers for pain med use, etc.).

A last set of interventions you can implement as a nurse to ease discomfort and provide care to the suffering patient includes more “common sense” actions. For instance, include family in updates, conversations about care, and decision making…as the patient allows, of course. Similarly, you’ll want to make sure you have family contact information so you can keep them updated should the patient’s status change or they get transferred. Make sure to respect the patient’s religious and/or spiritual beliefs, even if you don’t share them. And finally, try not to take things personally. Understand that your patient has the right to refuse care, medications, and interventions if desired. You are their nurse, not their mother. Patients maintaining their autonomy is one way they are able to feel in control, which can go a long way in helping ease their suffering.

Andra Alyse