[Hellllllo Nurse]

Originally Posted by fab4fan

Please, please get the pain mgmt manual by Margo McCaffery and Chris Pasero. You really need to educate yourself on pain mgmt to be effective in hospice.

Please don't allow pts to suffer; get some good references, join HPNA, and listen to your colleagues with more experience.

Not to hurt your feelings, but this post alarms me. Just that comment about having no compassion...sorry, that scares me. It's really not appropriate to be deciding whose pain is "real" and whose is not.

I agree. I was alarmed by the original post, as well. I worked inpt hospice full time for 4 years. I never remotely suspected that any pt was a drug seeker. And even if they were, so what? It's HOSPICE. If a pt with a huge brain tumor wants ms04 for something other that physical pain- maybe fear, spiritual pain, anxiety, or if they just like the way the ms makes them feel, so be it. Whatever the pt says is pain really is pain. Only in hospice have I seen this actually taken seriously.

I have been falsely accused of being drug seeking by ER personnel and a pharmacist in the past. I was really angered that the unfounded suspicions of cynical staff prevented me from getting pain relief that I desperately needed.

[JacelRN]

First let me clarify.

I have not yet worked in hospice. All my experience is based in Med-Surg. I am moving to hospice so that when I do need to give round the clock meds I can have a clear conscience. And so that I do not feel that the pain meds are abused like it is done so often in my area of current work.

I hope that you can see my true question. I am looking foward to the nursing care of those in need of pain meds to be free of that burden. I believe in it whole-heartidly. That is the reason I am moving to hospice and I wanted a little support from any of those who might have experieced some of what I write.

What you most probably thought from my post was that I was talking about those patients in hospice. I was not. I was directly comparing those in the med-surg setting who are A/O, walk the halls 15+ times a shift, get their Phenergan, Benadryl, Vistaril, and then ask for their IM Morphine because it hurts when they move. Those are the patient's I am directly referring to. On the other hand, those patients who are in pain and don't ask for it but lie moaning in the beds, I educate on the importance of controlling the pain early so as it dosen't get too intense. I am the type of person to advocate FOR pain meds when they are ordered correctly, for the correct reason, for the valid diagnosis, etc.

Have any that have replied ever worked on the type of floor I currently work? Please don't tell me that you haven't seen these types of patients. There are abusive personalities and it dosen't stop in the hospital. I do not feel comfortable supporting drug habits of patients. Even when my patients ask to go out to smoke, I educate them on the importance of not smoking. I assess their needs to find alternatives.

Lastly, I understand that pain is an issue we as nurses are not to judge. I began my nursing career knowing that and I work with that theory every day. Even the "pain med seeking" patients I medicate when they ask for it, every hour if it is ordered and requested. The night I posted I was doing exactly that. I am not one to turn it away. But frankly, it is tiring me out and my compassion for those I work with is slowly deteriorating. I am looking for greener pastures.

I turned to this board for advice and from those of you who tried not to judge ME by my response, thank you. I intend to reasearch hospice, palliative care, etc. For those who are less patient to judge a vulnerable poster, please read this and know I was attempting to clarify and educate myself on an important move both in my career and in my beliefs. I was not presenting a case for debate.


JacelRN

[earle58]

i think we have all dealt with those med-seeking patients.

i also think what we're trying to tell you is if a hospice patient doesn't appear to be in pain or is continually asking for more, just give them whatever they want....

am i missing something?
i've read and reread your post.
and i don't think anyone is debating.
but when you come to a forum with a question, you need to be prepared for answers that you may not expect.

but just for the fact that everyone that answered your question, had the same responses, then we all perceived your question the same way.

lesie

[Traveler]

People suffering with chronic long term pain can act very different than people in acute pain from a surgery, etc. Those with chronic lt pain are less likely to physically show the pain- that is why it is important to believe what they say and look to vague signs that may indicate pain. Are they moving around less, doing less than they normally do, just acting differnt. Also, these patients don't follow textbook dosage guidelines. From their lt pain they may have built up a tolerance and require a much higher dosage, or their pain may be so severe that they require 10x's the recommended dose. It is so important to remember that each patient, each day, and each situation is unique. Especially in hospice- the nurse is the patient advocate.

[RNPATL]

Originally Posted by JacelRN

First let me clarify.

I have not yet worked in hospice. All my experience is based in Med-Surg. I am moving to hospice so that when I do need to give round the clock meds I can have a clear conscience. And so that I do not feel that the pain meds are abused like it is done so often in my area of current work.

I hope that you can see my true question. I am looking foward to the nursing care of those in need of pain meds to be free of that burden. I believe in it whole-heartidly. That is the reason I am moving to hospice and I wanted a little support from any of those who might have experieced some of what I write.

What you most probably thought from my post was that I was talking about those patients in hospice. I was not. I was directly comparing those in the med-surg setting who are A/O, walk the halls 15+ times a shift, get their Phenergan, Benadryl, Vistaril, and then ask for their IM Morphine because it hurts when they move. Those are the patient's I am directly referring to. On the other hand, those patients who are in pain and don't ask for it but lie moaning in the beds, I educate on the importance of controlling the pain early so as it dosen't get too intense. I am the type of person to advocate FOR pain meds when they are ordered correctly, for the correct reason, for the valid diagnosis, etc.

Have any that have replied ever worked on the type of floor I currently work? Please don't tell me that you haven't seen these types of patients. There are abusive personalities and it dosen't stop in the hospital. I do not feel comfortable supporting drug habits of patients. Even when my patients ask to go out to smoke, I educate them on the importance of not smoking. I assess their needs to find alternatives.

Lastly, I understand that pain is an issue we as nurses are not to judge. I began my nursing career knowing that and I work with that theory every day. Even the "pain med seeking" patients I medicate when they ask for it, every hour if it is ordered and requested. The night I posted I was doing exactly that. I am not one to turn it away. But frankly, it is tiring me out and my compassion for those I work with is slowly deteriorating. I am looking for greener pastures.

I turned to this board for advice and from those of you who tried not to judge ME by my response, thank you. I intend to reasearch hospice, palliative care, etc. For those who are less patient to judge a vulnerable poster, please read this and know I was attempting to clarify and educate myself on an important move both in my career and in my beliefs. I was not presenting a case for debate.


JacelRN

I think you need to continue to ask the questions that are important to you. People are going to have their own opinions ... and sometimes we are going to agree or disagree. From my perspective, yes, I have worked with those MS patients that are very frustrating to deal with .... I am sure many of the nurses here that posted have worked with them also.

You are correct, there is a big difference working with HOSPICE patients over MS patients. SOme of the MS patients are dealing with acute life events and acute pain related issues. However, in HOSPICE, you are dealing with chronic pain issues and end of life transition. I am a true advocate that regardless of the patient's drug history, if they are dying and in pain, then they need to be medicated for their comfort and for the peace. I have been witness to nurses that have under medicated patients that were dying and I thought it was horrible. I am so thrilled that Hospice is available to the dying patient (oh no, am I dating myself .... perhaps).

Like you, I have valued the opinions of so many of my nurse friends here at allnurses. Sometimes I don't like what they say and sometimes I get irritated at the way they may have read my post, but all in all, I know they mean well and I know I can rely upon them for a truthful and real answer to my question. I hope you get the benefits of that also.

By the way ... good luck with your new HOSPICE venture. Have you taken the position yet?

[maggiechan]

Originally Posted by Brickman

If someone is in the hospice system than I can't imagine why anyone would care how much pain meds they want. If having 6 months or less to live isn't a good reason to be heavily medicated all the time even to the point of being a little high, than what is?

This is a really interesting topic. I agree 100% with other posters that terminal patients receive their pain meds without question. However, I'm a new grad, and in four weeks on the floor, I've encountered at least one bonafide drug seeker on average each week. This can be evidenced by the fact that they watch the clock, and call me in for pain meds, usually prior to the allotted time. "I must be due now, drool, drool." WHen I ask them to tell me about their pain. " Oh, it's not too bad just now.", or " I can offer you some Tylenol?" " No, don't bother."
I so believe in pain meds, but I do not believe in blindly feeding an addiction. We need to assess the patient's pain, and explore all avenues of pain relief including non-narcotic and relaxation techniques, and I'm not talking in the case of fresh surgical or chronic cases. Just the obvious ones, that are more totally anxious and nothing but the full dose of narcotic is going to do them.
That sounds worse than I mean it to sound, but I've had them regularly since graduation, and these patients just don't compare!

[earle58]

Originally Posted by maggiechan

This is a really interesting topic. I agree 100% with other posters that terminal patients receive their pain meds without question. However, I'm a new grad, and in four weeks on the floor, I've encountered at least one bonafide drug seeker on average each week. This can be evidenced by the fact that they watch the clock, and call me in for pain meds, usually prior to the allotted time. "I must be due now, drool, drool." WHen I ask them to tell me about their pain. " Oh, it's not too bad just now.", or " I can offer you some Tylenol?" " No, don't bother."
I so believe in pain meds, but I do not believe in blindly feeding an addiction. We need to assess the patient's pain, and explore all avenues of pain relief including non-narcotic and relaxation techniques, and I'm not talking in the case of fresh surgical or chronic cases. Just the obvious ones, that are more totally anxious and nothing but the full dose of narcotic is going to do them.
That sounds worse than I mean it to sound, but I've had them regularly since graduation, and these patients just don't compare!

maggie- are you working on a hospice floor?

if so, you might want to ignore any med seeking behaviors as their time left on earth is very ltd....

and that is the difference between working hospice vs. any other type of nursing. you tend to overlook any undesirable behaviors and grant them what they wish for.

peace,

leslie

[JacelRN]

Thank you Patrick and Traveler,

You eased my mind.

I also spoke to a veteran Med surge nurse tonight at work and she helped me to see what the other posters were meaning with their replies.

I do understand that we as nurses must look at pain objectively and treat each patient as an individual. I am more at peace with what the others have replied to me and you're right, not everyone is going to agree.

Because I am also a new nurse, 6 months out, I am just beginning to realize all the ethical dilemas nursing has to offer daily. Thank you for taking the time to answer.

I guess overall, I was hoping I could be candid here, not textbook like I was taught in school, but truly honest with other nurses like me, who hopefully felt the way I did about these addictive personalities. It is very difficult for me to be feeling so burnt out already and it scares me. That is why I am moving to hospice; in hopes I can cling to the compassion I feel wanning from me every day I go into work. My post was regarding that issue.

When I shadowed with my nurse, she barely touched the patient, only looked over him and tried not to wake him (11-7am). She counted his respirations and noticed he was tachypneic. She told me she was going to give him some Roxanol. I though "wow this nurse is very intuitive. Will I be able to learn this?" It seems simple perhaps to those hospice nurses who have worked long enough for this to be first nature, but for me, it was a whole different world than Med-Surg.

I completely agree that dying patients should have their pain controlled. I would never argue with that point. It is just going to be a difficult transition for me to make and I suppose I'm a little anxious.

Perhaps Med Surg just isn't my cup of tea. I am hoping Hospice will be better. I start orientation at the end of September. I will have three weeks on the floor and classroom time as well.

Thanks for the virtual ear,
JacelRN

[earle58]

jacel,

i think you are going to be an excellent hospice nurse.
i say that because once you start dealing with the dynamics of dealing with one's mortality and all the issues involved, you can't help but be humbled.
things that you once thought notable, you will now find seemingly trivial.
just remember in hospice, the pain one endures is not limited to physical.

unfortunately, we all know too well about those patients that can deplete every ounce of energy from you....as well as family members.

being a new grad, yes, there's much to learn.

but even for veteran nurses, they too, still have much to learn as it's ongoing; the new and varied experiences that we encounter due to the uniqueness of each patient and situation; new technologies; new theories....you just never stop learning.

and as an aside, the nurse that gave the pt. roxanol for his increased respirations, that wasn't intuition but just a knowledge base of knowing that the morphine would lower his rate; and that when someone breathes that fast, there is a stressor occuring.

trust me, you will learn all of this and so much more.

do not hesitate to come to this forum once you begin your hospice experience. we are all here to help.

wishing you peace,

leslie

[mercyteapot]

I don't know. I used to think some patients were med seekers when I worked M/S. Then I had a C-section and experienced the pain of the first couple of post-op days. Those nurses would come in with my iron pills right on schedule, but I'd need to ring three times for my Percoset. I needed it. The pain was hellacious. I went home with a scrip for Vicodin, but only took 2 of them, because they made me sleep and obviously, I had a baby to care for. Within a couple days after discharge, the pain was bearable without meds. I tried to be open minded after that experience.