Originally Posted by earle58
yeah, you can't force anyone to do something against their will nor try to mix it in a drink, ice cream etc.
Originally Posted by earle58
i've always believed in (1) establishing a trusting relationship w/the pt/family; i make myself available and approachable.
Originally Posted by stevielynn
I said this on the other thread, but death, even in Hospice, is not always peaceful and beautiful.
Originally Posted by earle58
so to me, as a hospice nurse, i always address the various forms of fear and pain that people endure. those that die fighting, stick w/me for a long time.
Originally Posted by aimeee
There are many reasons for patient's refusal to take their pain meds. You need to find what it behind the refusal before you can deal with it. For instance, the patient may have a fear of addiction (even if the med is not narcotic!). They may fear that the medication will make them less coherent or groggy. They may fear some other side effect such as nausea. They may equate pain with penance if they feel guilt over things they did in their life. They may equate suffering in silence with virtue. They may feel only weaklings have to take pain medication.
Many people have preconceived notions about morphine that just cannot be dispelled with any amount of teaching or demonstration. Often those folks will readily accept another narcotic, just so long as it isn't the dreaded morphine!
Whole hearteadly concur with my colleagues as have seen all of the above in my 20 years in hospice and homecare.
Two additional things to discuss with your patient:
a. fear that "pain will get so bad, no drug will touch it, so I don't want to take medication too early."
Much education about tolerance, titration of meds, various pain meds, co analgesia effect etc. needs to be done.
b. Cost!
Had developed a pain program for one new client who weakly nodded that wife giving him pain meds as prescribed but noticed quick glance to her during conversation. He had Lung cancer and grimaced with movement and cough. As I sat at dining room table to write my notes, noticed bill from pharmacy amongst others on the table. Since family had declined using our pharmacy, wanted to make sure not being fleced on prices: found $750.00 outstanding bill. I gently confronted pt and wife; they were too ashamed to tell anyone and husband didn't want to leave financial burden to family, so was willing to endure pain. Immediately arranged payment of bill and future bills sent to Hospice.
Another client I had with Lung Cancer had survived scrotal CA 20 years prior. So despite a chest wound that drained 2 + cups fluid into ostomy appliance a day, and wearing 3 -125mg duragesic patches, he resisted Hospice despite $1,000/mo narcotic bill which he paid himself-- Medicare Hospice program would have covered pain meds. Even drove his family to Atlantic City for one last time with BP 70/50 despite me telling family high chance of accident. They all survived and enjoyed that last trip. When HE was ready, transfered to Hospice. He died three weeks later with family administering oral morphine hourly OTC to keep him comfortable last 36 hours.
Aimee, your Mom is just like mine! My mother has list of 16 meds that induce anaphylaxis or severe side effects; unable to take Tylenol and refuses to be "addicted" to Roxalox, which is only pain med can tolerate.
Doctor told Mother she was terminal end of October04 due to severe End Stage CHF and O2 dependent COPD. She was eating about 1 1/2 meals max a day past 4 months and sleeping 20+ hours. So in November 04, I had Hospice RN meet with my parents and myself to allay her fears. I listened to 45 minutes of escalating catholic prayers prior to RN's arrival, told I was evil and trying to take over her life against her wishes and force things on her, take all her money--very delusional thinking. My poor father was overwrought emotionally and requesting help bathing Mom weekly, checking her lungs as unable to get to doctors and DAD need advice how to deal with Mom. I brought 3 copies of living will with me since I'm POA, and showed her in black and white how were following HER WISHES. When asked what she'd eaten past 2 days, gave a nice balanced meal speech---all untrue per Dad. Hospice RN allayed many of mothers fears re meds, honoring living will, Medicare paying for Hospice care, etc. Still Mother refused to sign for Hospice. I didn't force the issue as would be too emontionally traumatic to her as would still be deemed competent.
Two weeks before Christmas she rallied, decided she wasn't dying and got up and started cooking light meals, washing dishes and eating 3 meals/day. Was able to write pages of letters to cousins and nieces regarding family history past 3 months. I call my parents 2-3 times a week, maybe once she'll speak with me. She refuses for me to do any hands on care, cleaning in household and rarely allows me to visit as too tired, in pain, sleeping or doesn't want to miss TV show. Despite proving tons of personal care for my Grandparents and Dad's family, I've come to accept what I'm allowed to do for her: provide advice in times of severe health crisis. On my last visit Monday, Dad stated Mom's sleeping alot, delusional at times but was able to have a nice one hour visit with her.
Hope our collective wisdom will help you care for your patients.
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Please think about what you say. NEVER even THINK about "force".
and sharing your personal experiences. 
