Hypothetical, yet sticky situation for a new grad - page 2

by defyinggravity2009

2,273 Views | 17 Comments

Hi All, This morning, I woke up to the awful news that a neighbor of mine passed away early this morning. He had been diagnosed with stage IV stomach cancer, and had begun hospice care earlier this week, and his standing... Read More


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    No, I wouldn't have done it. There is liability in caring for a non-family member and a situation you don't need,.

    However, I would have gone over to their house if asked and and sat with him/gave moral support, but no meds.

    In hospice, the families have SL MS and SL Ativan readily available and its easy to give. There is no reason to give shots.
    wooh and Multicollinearity like this.
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    I had very limited information on the client, and unfortunately all was through a third party. Since he was only on hospice for a few days prior to his death, I couldn't say for certain how much teaching (if any) was done regarding administration of morphine, nor do I know if a nurse was scheduled to be there around the clock. I was told that a nurse who was there earlier had left, and they were waiting for another to come, but again, I am not certain of the details.

    Quote from azhiker96
    IMO, the morphine did not kill the patient. Cancer killed him. The morphine just helped ease his pain during the process. A hospice nurse once told me, "We all have to die, we just don't have to die screaming."
    I totally agree with this, too... but not every lay person understands that the morphine is there to ease the pain, and blaming others for the death of a loved one is a very real part of the grieving process.

    Had the question been posed to me yesterday, I probably would have declined to administer the med for a lot of the reasons mentioned, whether the issue was no chart, no nurse-patient relationship, unclear orders, or whatever. To be honest, even with the suggestions, I would probably have sought non-pharmacological pain relievers while awaiting the nurse. Nursing school has put the fear of God (or the Board of Nursing - whatever your higher power beliefs are) into me, and I worked too hard to lose my license privileges.

    I can only hope that in the years to come, I develop the knowledge, wisdom, and nerve to be able to successfully navigate through life as a nurse by helping others and still making sure to CYA.
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    Quote from Hospice Nurse LPN
    Why in the world would the hospice nurse need to make a visit to give morphine. At end of life, shots aren't given. We use morphine sulfate SL. The family is instructed how to give it. I always have the caregiver do a return demostration. If morphine isn't being used in the beginning, I refresh the teaching from time to time so that when the pt needs it, the caregiver has the knowledge. Poor little man! I'm sad that the hospice nurse didn't do enough teaching, but then it sounds like the pt wasn't on services long. I'm thinking teaching should have been accelerated if he was actively transitioning on admit.




    Yes, the morphine would have been just lying around (probably in a kitchen cupboard) The only time we lock up narcs in the home is if there is a problem with diversion or confused pts having easy access.

    This whole thing just really breaks my heart.
    I've had friends work hospice, and in my state, the narcs for hospice are in a lock box.
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    Regarding your original hypothetical situation, here's how I would answer; with another hypothetical situation . . . if you were visiting your friend in the hospital, and the friend was in pain, and you saw a carpuject of some analgesic med on the counter, would you administer it? I would guess, your answer would be, "Are you crazy????" So, that's my answer to the original hypothetical situation, too.

    BTW, I won't even silence an IV pump when visiting a friend/relative in the hospital. But, I will look for the nurse (for both the pain and the pump alarm!)
    wooh likes this.
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    I cannot, under my license, legally give him the shot unfortunately. I would've taken him to the closest ER, should he be willing to go.

    Or call the agency and see if another nurse would be willing to come out.
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    I would have talked to the hospice nurse seen as there was anything i could have done as a supportive friend, not in the role of nurse. (Hospicecare supports family in their care of their family as well, so family often adminsters medication, sometimes family is sooo paniced they can't remember what their suppose to do, so being a calming force be all they need to support them). At the end of life we want to control pain even if that inadvertantly shortens the life by a small amount. Our nursing code of ethics supports this. Im sorry that he did not have his pain controlled at the end, but what an honor that it was you that they thought of as someone that could help them. but i agree sublingual morphine should have been available for the family to administer.
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    [If in weighing risk versus the depth of your friendship you decided to help, here's how I would have approached it. Do an assessment of the patient. Call the hospice nurse and find out what medication (dose, route, etc) should be given. Then give the med. IMO, the morphine did not kill the patient. Cancer killed him. The morphine just helped ease his pain during the process. A hospice nurse once told me, "We all have to die, we just don't have to die screaming."]
    It's a tough call for a new grad. I'm glad you knew that, it speaks well of your judgement. The quote I copied above from azhiker really says all I'd say. You sound like a good nurse. Via con Dios.
    defyinggravity2009 likes this.
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    i faced a similar situation several years ago. i was a hospice volunteer but not a hospice paid insured rn, in the house where the spouse was a colleague of my husband's and i was a childhood friend of her husband, the patient. they were best friends and i felt like a skunk refusing to give his morphine gtts,
    but his older sister was also there. she had been a very difficult kid and had been nasty, belittling, sarcastic, threatening, and generally obnoxious for the week she had visited, with her brother, in-laws, the hospice rns, and me, the lowly volunteer.

    she had told everyone within earshot that she was watching and would sue hospice if she saw anything at all she thought was questionable. she had the hospice staff on edge while the wife appreciated absolutely everything we did for her husband. if his sister hadn't been there, after checking the order, being asked by the wife, i would have done it. no, none of his meds were locked up.
    but had the sister of the patient not been there criticizing her (and everything else) the wife would have been able to do it herself. the sister did not believe in the size and frequency of his pain meds dosages so she refused to administer any of them.

    he died later that evening.
    wooh likes this.


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