[DianaJH]

I feel I have to add to this some hopeful suggestions for nonpharm tx for pain. At the very least, maybe one of these would help.
Acupressure
Acupuncture
Hot/cold packs
Hypnosis
Imagery
Massage
Music
Relaxation Therapy
Baths
Touch (Reiki and such)
Maybe a noise machine with the sound of the ocean or stream or rain

Hope this helps

[earle58]

diana,

i appreciate your enthusiasm as a student nurse, as well as your evident passion for hospice.

of course we hospice nurses know that pts ultimately make their own decisions.

but there is a lot more to dying, than merely treating symptoms.

yet, if the physical symptoms cannot be adequately managed, the remainder of the dying process goes unattended and unresolved.

it is for this reason, that physical pain be stabilized.
that can and should involve addressing the pts fears and reluctancies:
and, educating them in why their pain should be managed.
it is not just about physical comfort.

if there are creative ways in managing one's pain, this s/b encouraged.
and of course, there are some who just will not budge, no matter how many interventions.
that is to be respected.
it doesn't mean, however, that the nurse/doctor stops encouraging the cessation of physical pain.

an experienced hospice nurse/doctor recognizes the journey in dying, and wants their pt to transition with peace of body, mind and spirit.
there is nothing cut and dry when it comes to death.

best of luck in your studies.

leslie

[Em1995]

I don't think nursegirl is making a judgment. She is assisting this patient in comfort and I thought it was wise that she brought this question to us. She offered him options and allowed him to make the choice. I also do agree that some people do make bad (unwise, if you will)choices. It's not judging them, it's realizing you offered the option and they decided against it. For instance, one of the patients in our hospice refuses to allow the nurse or home health aides to clean her body, which she cannot do by herself. She has wounds that need to be cleansed. Is she making a bad decision? I think so and she could quite possibly develop a nasty infection, but it is her right to refuse as she is alert, oriented and competent and was educated on the consequences.
I think that nursegirl will probably develop a relationship with this patient and perhaps he will mull over the information she provides and change his mind. He may or may not.This situation may also pave the way for this patient communicating some issues with his nurse that he may not be able to articulate with significant others. Either way, she has given him all the options, but remained non-judgmental and his advocate. I doubt anyone here would say or do anything to make the patient feel they did not have this control. This is yet another aspect in the art of hospice nursing.

[Em1995]

Diana...hospice nursing is very much about "thinking outside of the box". Your suggestions are excellent and are those that all hospice nurses utilize amongst a myriad of other creative interventions. I have found one "intervention" that works extremely well. I love to bake. I love it so much that I bake almost every night(I'm a nightowl from working many years in the ER, so I stay up late writing, reading and...baking). I often bring my patients my baked goods...lately it's been pumpkin bread and blueberry muffins or scones. And, I have to say, that this small offering oftentimes means the world to them. It has such an effect that many times, those who are reluctant to try a particular intervention, often relax while nibbling on the baked goodies, and are able to express feelings and issues they might not have, had it not been for some nibbling time.
By the way, this has worked exceptionally well with doctors....not a one has ever refused any recommendation I have asked for....and, I attribute that to my pumpkin bread!

[RNandlovingit]

I so appreciate Everyones input. And No I was not making a judgement. At no time has anyone on the patients team tried to talk him out of his beliefs. I was just concerned because he has both meds and I have educated him as much as possible about the Sustained release and that he cant just take the SR like he can the IR's. As long as he is comfortable with his pain level I am okay with that. He is very good about calling when he needs us. All I can do is just keep educating him. He knows at some point he is probably going to have to start taking the SR's on a more regular basis but he doesnt want to right now! And you guys are right he has every right to make that decision!

[introspectiveRN]

Originally Posted by Percy60

Our hospice has a mantra that helps with situations like this....

"People have the right to make bad choices"

All in all, that is a profound statement my dear....I need to post this on my fridge as a reminder to myself. Reminds me of the serenity prayer.

[introspectiveRN]

Originally Posted by Em1995

Diana...hospice nursing is very much about "thinking outside of the box". Your suggestions are excellent and are those that all hospice nurses utilize amongst a myriad of other creative interventions. I have found one "intervention" that works extremely well. I love to bake. I love it so much that I bake almost every night(I'm a nightowl from working many years in the ER, so I stay up late writing, reading and...baking). I often bring my patients my baked goods...lately it's been pumpkin bread and blueberry muffins or scones. And, I have to say, that this small offering oftentimes means the world to them. It has such an effect that many times, those who are reluctant to try a particular intervention, often relax while nibbling on the baked goodies, and are able to express feelings and issues they might not have, had it not been for some nibbling time.
By the way, this has worked exceptionally well with doctors....not a one has ever refused any recommendation I have asked for....and, I attribute that to my pumpkin bread!

(standing at the front of the group meeting) "My name is Deanna, and I too am a bake-a-holic."

[introspectiveRN]

Originally Posted by nursegirl1014

I so appreciate Everyones input. And No I was not making a judgement. At no time has anyone on the patients team tried to talk him out of his beliefs. I was just concerned because he has both meds and I have educated him as much as possible about the Sustained release and that he cant just take the SR like he can the IR's. As long as he is comfortable with his pain level I am okay with that. He is very good about calling when he needs us. All I can do is just keep educating him. He knows at some point he is probably going to have to start taking the SR's on a more regular basis but he doesnt want to right now! And you guys are right he has every right to make that decision!

Hey nursegirl, how have things been going with this particular pt (if he is still with us)? How are you? I really appreciated your post.