Pain – Entry 1

Dear Diary:

Yesterday while stopping by resident rooms to visit with a few people, I stopped by to see Hattie. She was sitting in her wheelchair, staring out the window. When I knocked on the door, she turned toward me and grimaced. I asked if she was ok and she said yes. I asked if I could speak with her for a few moments and she agreed. It was an odd conversation because I couldn’t really get her to talk to me. I asked about how she was feeling, what she was noticing out the window and about her family, but she only said a few words. That really isn’t like Hattie, so I suggested that she might like to rest or lie down and she immediately said she wanted to lie down. I asked Sherry, the nursing assistant, to help Hattie lie down. I was headed to the nurse station to talk with Hattie’s nurse, Anna, but was paged for a phone call and forgot about Hattie.

Later, I stopped by the therapy gym. Hattie recently broke her hip and I was curious to see how she was doing. Hattie was there walking with the therapy aide. Hattie only took a few steps, said she couldn’t do any more, and asked to stop. The aide helped her to sit down in the wheelchair and started to push her out of the gym. I asked Hattie if she was having any pain or if anything was wrong. She looked down into her lap and shook her head no.

I then went to talk with Anna. She said that Hattie never asks for pain meds. She has a PRN pain medication ordered which Anna offers, but Hattie rarely takes it. She said that Hattie has seemed a bit more withdrawn recently. In team conferences this week, the physical therapist said that Hattie hasn’t been trying very hard to improve her walking. I asked what the plan was and she said she is going to continue to try and engage Hattie for a few more days. She also said they’d have to stop therapy if Hattie doesn’t show signs of improvement.

I’m worried about Hattie. If she stops trying to improve her walking at this point, she’ll be pretty dependent on others. I really want my team to think more broadly about what we can do collectively to figure out what’s wrong with Hattie. It doesn’t seem like we’ve done a very good job assessing her pain. Maybe that’s the problem? As a team, we need to determine what assessment we can use to try to get figure that out. I guess the next question would be who should be involved in the discussion?

Signed, Donna


  • We are addressing this issue with our charge nurses here in regards to residents comfort here. Often as in other nursing homes we have medications for our residents to take on a prn basis for pain, however they never receive them because as our staff have stated “they never asked for them” “they never told me they had pain”. It is now one of our goals that we as staff (interdisciplinary) ask the resident if they are having any pain. We have a couple superstar charge nurses who I have heard asking residents as they are “visiting” or doing cares with them this questions. Our therapy department is very good about touching base with nursing about pain meds prior to treating our residents.

  • We are going to review each new admit to see if have dx which would invovle pain, review hospitalization notes for pain and then see at admission if a resident could be on a regularly scheduled pain medication for 2 weeks and then review if should be continued, decreased or discontinued.

Share your nursing home perspective on this quality improvement issue.