APS nursing team offers comfort, support while managing pain
Pain is complicated. It feels different for each patient.
Acute pain, due to surgery or a sudden illness, can be intensified by an existing, chronic medical condition or a substance abuse disorder. In addition, options to help manage pain vary from traditional medications and patient-controlled infusions to alternative therapies such as massage, movement, meditation and aromatherapy.
“It can be a challenge for a care team to determine what to manage first and how to integrate pain treatments into their care plan,” said Jember Bekele, the Acute Pain Service (APS) nursing supervisor.
This is where APS nurses step in. They are available 24/7 to help patients and care teams understand treatments and manage pain.
The 10-member nursing team is part of the APS consult service, which includes physicians and pharmacists. They collaborate with other support services (i.e., Physical Therapy, Gifts of Art) as needed to provide pain relief.
They also work closely with the Rewrite the Script team, which is focused on reducing the impact of the opioid crisis and caring for patients with substance abuse disorder through their Addiction Consult Team (ACT).
A ‘patient first’ approach
The APS nurses begin the day with multidisciplinary patient care rounds in the morning. With this team approach, an individualized pain management plan is established for each patient.
“It can be difficult for a patient to continually repeat their pain story for every practitioner or specialist they see,” Bekele said. “We are moving forward in developing a pain profile for each patient within the MiChart system, which will allow everyone who cares for that patient across the organization to have a common understanding of how that patient relates to pain and responds to treatments.”
From this pain profile, the team develops a pain management plan unique for that patient, which can require a lot of innovation, caring and teamwork from the nurses.
“I love how APS is constantly evolving,” said Rachel Wirth, R.N., when asked what drew her to this specialty. “We don’t shy away from new ideas for controlling pain. For example, we recently started lidocaine infusions as an option to more traditional ways of controlling pain. I am always eager to see and learn what will come next.”
The APS nurses are a constant support to nurses at the bedside. The team is working to implement a new nurse-to-nurse consult which will empower bedside teams to use additional comfort measures and become more aware and comfortable with managing their patient’s pain management.
“As a nurse for 16 years on the surgical floor, I saw that managing pain was a challenge,” Bekele said. “I cared for the patients but was told very little about how to help them through their pain. I wanted to learn more, so I joined APS. We really partner with the nurses in the units, and I can sense their relief to receive additional help with a follow up plan.”
One patient who benefited from this nursing partnership was treated with an epidural therapy for post-surgery acute pain and was successfully transitioned to a home medication care plan by the team.
“The pain management nurses were fantastic, as were all the nurses who were with me the whole time,” the patient said. “They made all pain adjustments right on schedule and they were very clear about the process they were following.”
Standing out from the crowd
Developing a pain management plan and being available to follow up with it at any time of the day is one reason Michigan Medicine’s APS team stands out. We are one of the few hospitals that offer 24/7 pain management services. “We are everywhere,” Bekele said.
“Our role is remarkably broad,” added team member Bob Viviano, RN-BC. “Even when we aren’t actively visiting patients, we continually monitor them with meds, labs, vitals and more to assure safety and optimal pain control. We support nursing education, shape various policies, assist in developing new therapies and coordinate care. There is a lot happening under the hood that is not easily seen from the outside.”
Giving comfort and support
The team also looks for ways to ease the emotional anguish associated with pain.
“One young lady who had postpartum depression harmed herself. The pain was most challenging for her, but it was a trauma for the whole family,” Bekele said. “So, we decided to focus on the family. We suggested we take her out of her dark room and ways to improve the home environment. We got the social worker involved. APS is not just about explaining how medication works, but how to give comfort and support.”
This team of nurses doesn’t always see positive results first-hand, so they watch for small impacts to measure their success.
“It’s common for patients to never see full relief from their pain, so it can be hard to comfort these patients, especially if they are young,” Viviano said. “Sometimes the role becomes one of displaying positivity while encouraging coping and engagement.”
Wirth agreed. “For some patients to get their pain significantly, or even slightly, lowered is asking for the impossible,” she said. “Just knowing that whatever we did as an APS team helped give them even a few minutes of sleep, that means we made a difference.”