Pain – Entry 2

Dear Diary:

After several unsuccessful attempts at trying to talk with Hattie about what might be bothering her, reading her health record, and talking with staff about her change in condition, I stopped by team conferences today and asked to talk about Hattie. Everyone expressed some concern after I told them that I have observed that she is more withdrawn and is not progressing well in therapy. The physical therapist suggested a conference with Hattie and her daughter to explore what might be happening.

We had the conference this morning and it went very well. Prior to the conference, the social worker shared with Hattie some of the concerns the team was observing: she appeared more withdrawn, seemed more tired, wasn’t participating in activities and seemed to be having trouble walking in therapy. Hattie responded that her hip hurt and she felt she couldn’t do much. When the social worker asked if she had discussed her pain with the nurse, Hattie said, “I don’t want to take pain pills. They make me feel funny. I always tell them the pain is ok.” The social worker asked if she could share this information with the team, and invited Hattie and her daughter Carol to attend a conference to see if the team could come up with some suggestions to help her feel better. Hattie agreed.

At the conference, I was so proud of Sherry, the nursing assistant, and Anna, the charge nurse. Sherry told Hattie that she wanted to help her get stronger and was concerned about her not wanting to walk much. Anna said that she thought Hattie was having some pain, but didn’t want to push her to try the pain pills the doctor had ordered. I think Hattie and her daughter were reassured by how much the staff cares about Hattie.

The team, including Hattie and Carol, came up with a plan to help Hattie feel better. Her daily schedule will be changed so she gets rest time with ice on her hip a couple of times throughout the day. Hattie’s agreed to try Tylenol three times a day to help relieve her pain. It’s scheduled before she gets up in the morning, half an hour before therapy in the afternoon, and before going to sleep at night.

The therapist has some pillows and positioning devices she wants to try with Hattie to see if she can help her be more comfortable in bed. She’ll make sure to take pictures of how to place the pillows and put them where the nursing assistants can access them. Hattie agreed to try the plan for two days and then we’ll have another conference to determine what has been effective. We plan to continue to make changes until Hattie feels more comfortable. Hattie seemed really relieved that we’re going to help her without making her take any strong pain pills. She left the conference smiling and said “thank you” to the team. We’re making progress. How can we be assured that these kinds of positive conversations take place with other residents?

Signed, Donna


  • The team approach is very important, as well as having team members talk individually with the resident. Each team member has a different level of rapport with the resident, so the resident may be willing to share more with a different team member. For example, at our facility, we have had different team members approach a resident about her headaches. One member was unsuccessful at obtaining any new information or approaches with her, but another was able to get the resident to try aromatherapy and heat packs. It takes commitment, from an already busy team, but the outcome is worth it!

  • Keeping everyone informed about resident changes (and excited about the benefits of these changes & how they help our residents) is indeed a challenge. Sometimes instead of feeling motiviated & excited the staff feels like they are being weighed down with yet another task, so we must keep them focused also on the benefit not only to the resident but to their workload also. Letting them know how a happier, pain-free resident will no only lighten their workload as the resident will be able to do more for themselves, but the resident will be in a much better mood! Happy resident should = happy staff!!

Share your nursing home perspective on this quality improvement issue.