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Ref No: 2007

Description of the event

Reflection post operative pain management: While working as a nurse in one of the best hospitals in my city I came across a case that I still believe could have given a better outcome. I was handed over the file of this patient along with 10 patients under my duties in the ward. All the patients were stable and most of them recovering well except a female around 45 years of age vitally stable but the patient was received in the ward around two hours prior and was doing fine according to her. Reflection post operative pain management It was a simple case of laparoscopic cholecystectomy.

Feelings

As the hours passed, I went to the bedside and tried communicating with the patient while examining her through the charts in the file showed her to be vitally stable and no other complaint which was mentioned in the last recorded data of her post-operation recovery phase.  She showed some kind of distress in her expressions while communicating to me and which was not the usual kind of stress I could suspect due to medication and surgical stress.

Pain is a personal and subjective experience that involves sensory, emotional, and behavioral factors associated with actual or potential tissue injury strategies to meet the needs of special patient groups which includes; children and the elderly (McFadden, 2013; Tsimoyiannis, et al, 2010).

Evaluation

It has been stated that effective postoperative pain management has a humanitarian role, a number of factors contribute to effective postoperative pain management including a structured acute pain management team, Reflection postoperative pain management patient education, regular staff training, use of balanced analgesia, regular pain assessment using specific assessment tools and adjustment of doses (Alexander, Fawcett, and Runciman, 2010). There is individual variation in response to pain,

which is influenced by genetic makeup, cultural background, age, and gender (Maguire, et al, 2006; McFadden, 2013).

The ward boy came with an answer no pain complaints vitals normal and that’s what she entered in her file, but she said she wanted to see a nurse so I went back to her and tried communicating with her for ten to fifteen minutes thinking I will be able to bring the out of the fear of surgical process which could be one of reason to her distress.

I kept asking if and minor pain at the sites of the incision. She said no it is not pain but distress and that she repeatedly complained of thrice in my 8 hours of duty which gave me a kind of not well situation idea.

Analysis

I informed her son and asked him to make the arrangements and look into billing matters he was reluctant to do so and asking me my mom still complaining of distress since her surgery and they did not have any place in the town and were suppose to travel to the distant place they had come from for the surgery so he requested not to discharge her mother and keep them under observation for next two to three days. Therefore, I personally did not feel like discharging such patients and kept waiting till my duty hours to end. According to the NMC code of conduct (2016),

it is the duty of the nurse to recognize patients suffering from pain, anxiety. or distress and the nurses are advised to respond polity and compassionately with them.

I discussed with the doctor about her condition and she said the consultant visited the patient and they have already decided and were informed of her complaints which were considered to be minor and as per rule since stable could be discharged so all is according to the ethics. However, the NMC code of conduct (2016) stated that it is the duty of the nurse the colleagues, managers, or the doctors about any suspicious act of the patient.

I could not still gather the courage to make her discharge and made an excuse for my duty and left the work. The next morning, the very first question to my colleague I asked was related to that specific patient. I got to know that, she expired on the way to her home in the taxi.

I asked how she knew if she was discharged all well she said her son kept calling the hospital and asking about medication and consult a doctor for his mother’s deteriorating condition and after around two hours of constant yells for help he was left with no option of seeing her mother ending this worldly journey…