Hospice Care

[280090]

I am an RN student and there is a lot of converstation about hospice care and pain management during end of life care. I was just wondering how many of you feel about when to medicate and when you are giving too much pain medication that could actualy be what is stopping the pt respirations. Where is the line and how do you deal with it?

[Anggelica]

1. Know you patients wishes. If your pt wishes to be comfortable and would have you push those medication. I will do it within doctors orders.

2. In time, you will recognize pain in pt that are in the process of dying. Normally grimacing, yelling non-sense, trashing and putting a fist to your face. I will give them pain meds.

3. Knowing the etiology of the disease. Pt dying of old age, where everything is just starting to deteriorate, they do not normally feel pain. Just do the standard care for dying pt. If it is cancer, especially bone cancer, I will give them their pain meds because this is the most painful way to die. If they have COPD, I will give them morphine, this will actually help them breath.

I found that is if you let the body do its natural shut down process, it is not normally painful. I also found that the soul will leave the body when everyone is ready for that person to leave.

[VioletKaliLPN, LPN]

For *me* there is no line. If my hospice patient requires morphine q hour, then I will gladly give it. Yes, it decreases resps, however, my patient's comfort is KEY. Comfort measures may hasten death, but I have zero moral qualms about it.

[SaoirseRN]

For *me* there is no line. If my hospice patient requires morphine q hour then I will gladly give it. Yes, it decreases resps, however, my patient's comfort is KEY. Comfort measures may hasten death, but I have zero moral qualms about it.[/quote']

This. Yes, a consequence of comfort is respiratory depression, but comfort outweighs respiration in hospice care (in Canada we call it palliative care).

[MoopleRN]

If the clock says I can give it according to the order I have, I'm going to give it based on the pt's/family's request, my nursing judgment. I would NEVER feel I'm giving "too much" and as a result my (don't let's forget it's a hospice) pt's respers stopped because of my administration. Hospice patients should (and do) die comfortably at peace. Many terminal patients die when you roll them to provide care regardless of hospice/meds.

You ask "where is the line". My answer is the line is the doctor's order/my nursing judgement. You ask "how do I deal with that". My answer is I don't have anything TO deal with. I'll feel empathy for the family, relief for the patient. I care but I don't have anything I need to "deal with". The outcome was expected. I didn't expedite it; I eased it.