This diary addresses two connected medical topics: the role of opioids and medically induced pain, along with the challenges in moving disabled patients.
To start, aside from the pain stemming from illnesses and injuries, modern medical practices often inflict additional pain on patients.
Moreover, current methods for patient mobility and transfers are not only inefficient but also invasive and stressful for patients, and they demand significant effort from nurses and caregivers.
Let’s look at pain first. Medical treatment and rehabilitation often come with the expectation of pain. Yet, the belief that patients must endure medically-induced pain isn’t always valid. Until recently, healthcare professionals tended to overlook various types of patient pain, focusing primarily on curing and healing.
This oversight has contributed to a major issue—the Opioid Crisis. The cumulative pain from healthcare processes, accidents, and ailments has been significant, resulting in 47,000 fatalities in 2017, with 36% linked to prescribed opioids.
Recently, pharmaceutical companies and healthcare providers have been compelled to confront several shortcomings in medical practices that amplified this dire situation.
The National Institute of Health’s HEAL initiative has allocated $945 million towards research aimed at reducing opioid addiction. Researchers in pain management are trying to identify and mitigate sources of pain that contribute to addiction.
The 2019 final report from Health and Human Services on pain management highlights “gaps” in how the medical community addresses pain, which have played a role in the opioid epidemic.
However, their findings point to an unquestioning acceptance of painful patient care devices and methods commonly utilized by nurses and caregivers.
Most studies concentrate on external factors (like injuries and illnesses) as causes of pain, often overlooking the painful “best practices” employed in daily patient care in hospitals, nursing homes, and home settings.
The main safe patient handling (SPH) device, introduced in the 1950s, is modeled after equipment used to lift engine blocks in auto shops. Although newer electric models with improved slings are lighter, they function similarly to their predecessors and are often disregarded as sources of notable patient discomfort and caregiver frustration.
What are some of the contributors to medically induced pain during patient transfers?
Devices like sling lifts and methods such as stand-and-pivot transfers and manual lifting (typically needing 3 to 6 caregivers) involve a combination of bending, twisting, stretching, and hoisting patients. These approaches are invasive, and the latter two can pose risks for caregivers as well.
Such common patient care actions often result in pain and anxiety for many individuals.
These repetitive sources of acute pain can occur during activities like transferring from bed to wheelchair, toileting, and showering. In hospitals, patients frequently dealing with post-operative pain also face discomfort during transfers to radiology, surgical, or examination tables.
In home care, where sling lifts are challenging to use, many patients in Hospice or palliative care can remain bed-bound for extended periods, which puts immense pressure on home care nurses and family members. This condition leads to concerns such as bed sores, urinary infections, pneumonia, and depression.
The reason for this is the lack of cost-effective devices capable of mobilizing highly dependent patients at home, partly due to resistance from Physical Medicine physicians and rehab specialists regarding improved methods.
Pain researchers are now looking to reduce reliance on medications for both acute and chronic pain. Outdated SPH practices provide clear examples of inefficiency in a healthcare system that sometimes resorts to unnecessary drugs (like anti-anxiety meds and opioids) to offset painful, slow, and labor-intensive patient care procedures.
These lifting devices can be slow (requiring 3-6 minutes for a transfer), bulky (awkward shapes that complicate storage), painful (due to hoisting and compressing patients), inefficient (often needing two trained caregivers), and anxiety-inducing (especially for dementia or elderly patients).
They do help prevent nursing-related back injuries, but this comes at a high cost to patients and institutions in terms of extensive nursing resources.
It’s surprising that there has been almost no government-funded research on innovative devices in decades, and medical companies appear stagnant, likely due to fears of lawsuits regarding new technology.
There has to be a better solution. Yet, experts from the American Nurses Association, the National Institute of Health, the VA Patient Safety Center, and similar organizations seem unwilling to recognize this challenge, continuing to endorse outdated devices and practices.
The public needs to understand that this is a complex public health crisis impacting patients, caregivers, therapists, nurses, and the financial sustainability of Medicare and Medicaid. Inefficient SPH devices and techniques waste tens—if not hundreds—of billions of dollars during the care of patients who are dying, disabled, or have mobility issues.
For example, care for dementia patients is projected to increase from $200 billion in 2013 to $1.1 trillion by 2050, according to the Alzheimer’s Association’s website ( www.alz.org). Slow and inefficient daily activities for these patients threaten the financial health of care organizations while swiftly draining nursing resources.
Baby boomers, whether caring for aging parents or facing their own mobility challenges, may be in for a surprise when they discover the limitations of medical options available after someone loses independence.
Change in this area of physical medicine, where innovation has largely been absent for the last 60 years, will depend on informed patients, caregivers, health professionals, nursing advocacy groups, and public demand.
