Over the many years I have read AJN, I have been impressed by the range of articles you publish, their pertinence, and their clarity. Hence my disappointment with "Overcoming Movement-Evoked Pain to Facilitate Postoperative Recovery" (July).

First, the "rest is best" notion had been thoroughly discredited when I started nursing school in 1958! Is there a nurse on this planet who subscribes to it?

Second, the notion of ambulating postoperative patients is quite simple. It doesn't need to have wordy theories hung all over it. And we always manage pain and treat our patients holistically, don't we?

Third, I cannot imagine a busy surgical unit where any nurse has the time to fully implement all the recommendations described in the article. All of us must trust our clinical intuition and good judgment to do the best we can for our patients in challenging circumstances. There is ideal care and then there is the care we can actually provide in the real world.

Burden S. Lundgren, PhD, MPH, RN

Norfolk, VA

Authors Paul Arnstein, Rianne van Boekel, and Staja Q. Booker respond:

Thank you for your comments. Our article, while focused on the postoperative patient, is intended for all nurses, not only surgical nurses. Assessment of pain and best practices in mobility are not consistently applied across acute and post-acute care settings. Our goal was to encourage nurses to assess movement-evoked pain and apply tailored interventions. We would like to clarify your interpretations and offer an opportunity for continued discussion.

While much has changed since 1958, the management of pain remains suboptimal across the continuum from assessment to treatment and follow-up. We agree that "rest is best" has not traditionally been a common perspective in decades past, but more recently, and especially since the COVID pandemic, there has been a hesitancy to keep hospitalized patients fully active and at the highest level of permitted functional capacity. In fact, many patients with pain are hesitant to mobilize and, depending on cultural and generational beliefs, may prefer to delay ambulation in the initial postoperative period for fear of more bodily harm or exacerbating pain. Further, even when we do ambulate patients, are we helping them maintain their strength, stamina, balance, and range of motion to prevent deconditioning? We believe improved physical movement and avoiding the harms of disuse and deconditioning are steps in the right direction.

Our article did not imply that ambulating patients is difficult. Our key objective was to say: once you have assessed for movement-evoked pain, how can you best manage this type of pain? For the past 10 to 20 years, particularly as pain was touted as the fifth vital sign, many RNs slipped into the habit of assessing pain by simply asking, "On a scale of 0 to 10, how would you rate your pain?" This is woefully inadequate as a basis for determining the treatment to provide, but the reality is it has become commonplace and has resulted in the overuse of opioids. A multidimensional assessment that includes movement-evoked pain is needed to improve patient comfort and functioning. Although managing pain holistically does seem intuitive and aligned with good judgment, unfortunately, for two decades the treatment of pain has been reduced to an opioid-centric approach: first, administering opioids based on pain intensity, then minimizing exposure to opioids. Clinicians strongly want to move away from a pain intensity-based system of treating pain and evaluating the outcomes of pain interventions.

As nurses, we are all busy ensuring that our patients receive the highest quality of care. All nurses, regardless of their specialty, should base their practice on the foundational nursing process: assessment, diagnosis, planning/goal setting, intervention, and evaluation-which is what our article modeled. The issue is when nurses are left to their "judgment" and fail to incorporate best practices that can benefit patients or have inadequate knowledge of the numerous ways to manage a complex symptom such as pain. We never stated that nurses should implement every recommendation in the article, but hopefully the article serves as a checkpoint for nurses to identify areas where they can improve their care.