MORPHINE and Dying Patients

Nurses General Nursing

Published

Curious about the administration of pain medication (Morphine) and possibly speeding up a patient's death.

Ok I have read all of these posts, and I have to disagree with suespet and others who agree with her. Like many others have said before me, it is our job to assess pain. However, it is subjective. Therefore, VS, and pts may not verbally tell us what their pain really is. I am an oncology nurse -- I work on a Med Surg unit. I see post ops to the terminally ill. Many of my walkie talkies (post ops mostly) will under rate their pain, suck it up and deal because they dont want to take the medication for side effects, dont like how it makes them feel, or fear of becoming addicted. Education is key here. If they still refuse, I always let them know that it is available to them whenever they want it. And if I give it to them, I also tell my pts to let me know if it doesnt help them, because maybe it might not be the right drug for them. I will go as far to call a pt out when they are under rating their pain, if they are wincing, hunched over, grimacing, whatever. I will tell them you appear to me to be in pain. Why?!? Because I want them comfortable. It is a JCAHO (in the US) standard to maintain a level of comfort for our pts. For the terminally ill, pain control is even more important. For those who are unconscious, youre non verbal cues and assessments are what will tell you if your pt is in pain. I would give all the pain meds I could, if it made my pt comfortable and not suffering.

What bothers me the most is this idea of beliefs (religious or otherwise). I am christian as well, however, as nurses, we need to put those aside and do what is right for that pt. If we can not then it is our responsibility to advise our charge nurse. You can not with hold medication from a pt because you dont believe it is right. Im sorry. If the pt is snowed, by all means that is a different story. But if you believe it is wrong, then you are mistreating your pt. Think of the pt who is the Jevoah's witness. They do not receive blood products. In a child or adult who has a Hgb of 5 or 6, and all they need is a transfusion and it will help the immediate problem at hand, I may disagree with my pt's wishes, however, I must respect it and leave my own beliefs at the door. I need to treat my pt in other ways to help minimize bleeding, etc. I do not say, well i dont agree with them so Im not going to give this med at q3h, i will give it at q6h instead. As nurses, we cant do that. We need to treat and maintain a pt's pain and comfort level no matter what we believe.

Ok I am off the soap box...sorry for the long winded response

Thank you. I'm not slamming suespet, but please, please, please, give the meds! I also work with a population with chronic pain (RA, SLE, MS) and when they tell me of the pain, and the crying and sobbing and what they've gone through with their doctors NOW just to get appropriate pain relief to function, it really frosts my cookies (ha) when people want to withhold meds from nonresponsive people who can't speak up for themselves. I educate patients nearly every day about pain management because they are so afraid of becoming addicted. I am a Christian too, but I have to remember that God does not want his children to suffer, and therefore I have no problem giving the pain meds. If I was in that situation, I'd want all the medication I could take to keep the pain under control.

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feelin bad that i can't get some people to understand how i feel in this issue.i have never knowingly withheld pain meds from pts in pain.when i said i might give it q6 hr,i meant one dose,cuz the pt(btw,non-cancer)had been getting it q3, even unconscious, so i would skip 1 dose,essentially.i still feel nobody can really leave his/her belief system at the door.to me, thats living 1 depressed life,going against your values.i am familiar w/ the" feel the pain,cuz it's the lords will"thing.not one of my beliefs.i have gained some food for thought from some of these entries .will explore further. I realize even agnostics can share my feelings on this matter(not bringing christianity to it) btw:what is a 'frequent flyer',or a 'walkie talkie'?or crna?

The point is, if the patient had been getting it Q3, then your not giving it very likely would plunge them into a withdrawal syndrome, and then at the 6 hour mark, they would need even more medication than whatever dose you would have given them which is what they were using to stay on top of the pain. That's the point. If you can't see that .... oh dear. This has nothing to do with beliefs (at least from my point of view). Well, maybe it is, because my BELIEF is that you need to give whatever they need to stay comfortable....and I'd rather err on the side of caution than having to deal with people in severe pain, conscious or not.

P.S. sorry for the 3 posts in a row, but this is something I really feel very strongly about.

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I have been a Hospice nurse over a year now and have been a part of literally a hundred deaths. I have never, never, never seen morphine kill someone. I have, however, seen it make people comfortable and relaxed. I have noticed that instead of screaming out for me to kill them, they are able to exspress to their loved ones their feelings. I have seen them go from 48 breathes per minute to 20 after a few doses with a lot less distress.

Please read Myth #4

http://www.hospicenet.org/html/pain_myths.html

Thank you for this post.

I have never seen anyone die from being properly medicated for pain and symptom mgmt. Many doctors and nurses are ignorant concerning palliative care. I've seen nurses who refuse to be educated on the subject. I've heard them say "I am not giving that much morphine." Even when its a dose a pt has been on for several days and is tolerating well.

I once attended a pain control seminar with a DON from a LTC facility. A few months later, her own grandmother was put on hospice, and continued to live in the facility where the DON worked. The DON refused to let us give her grandmother more than 2mg of MS q 4 hrs. She was her grandmother's DPOA. The whole family trusted in her that she knew what she was doing, but her own grandmother suffered for her ignorance, and her refusal to accept education on palliative and end-of-life care.

Like you, I've seen pts so in pain they were unable to speak. After their pain was controlled through medications, I've seen the same pts be able to talk and laugh with their family members , then die quiet, dignified, peaceful, and comfortable deaths.

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Many doctors and nurses are ignorant concerning palliative care. I've seen nurses who refuse to be educated on the subject. I've heard them say "I am not giving that much morphine."

this is so, very true.

regardless of countless inservices, many remain indignant in their misconceptions.

the irony is, fear and ignorance are far more lethal, than any amt of morphine.

leslie

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lantanaRn: there's no med error when decideing to not give a prn morphine . if a med it scheduled,u can also hold a dose and alert physician esp. if 3 doses held for good reason, in this state anyway.

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Specializes in Emergency, Trauma, Flight.
no if they are actively dying then you are only making them comfortable, they are going to die whether or not you give them morphine. Can you live with yourself knowing they suffered and died, or they were comfortable and died.

exactly.....

:cool:

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Specializes in geriatrics and hospice palliative nursin.
lantanaRn: there's no med error when decideing to not give a prn morphine . if a med it scheduled,u can also hold a dose and alert physician esp. if 3 doses held for good reason, in this state anyway.

You are correct on withholding a prn dose, however I am referring to a routine dose, and as many of the other posters have stated, that routine dose that you choose to withhold could cause my patient who appears to be pain free to be right back in pain again and harder to control because the point was to keep on top of the pain and not let it escalate.

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Specializes in Community, OB, Nursery.

Please please, if I am ever dying and in your care, crank up the morphine and let me go peacefully.

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Specializes in nursery, L and D.

I would have a A VERY HARD TIME with my dying pt being in pain. It all depends on what the pt wants. I expect most want to be as pain free and at peace as possible. I know I would want that.

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Specializes in rehab,geriatrics.

in 50 years nursing I have seen morphine use go from very little to quite common for end of life pain the patients comfort is the main goal here.my current position is in long term care and in it I have really seen a significant increase in use here due to doctors and hospice who seem to finally realize that end of life no matter what the cause should be comfortable!as supervisor I often have to deal with this question as new grads are afraid to use morphine even when ordered by doctor and hospice.I think some nurses forget that it not only is for pain but the anxiousness and air hunger that comes with that time.While I don't believe every nursing home resident should have roxanol,I do believe anyone who hospice has evaluated and believe is in end stages of life deserves to have their wishes to die with diginity and comfort met and that is our job to do that for them.

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Specializes in Med/Surg - Pain Management.

How do I do that? I am kinda new to this site.

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One of the great experiences I have had as a student nurse is working with a hospice home care unit for my community nursing rotation. This amazing group of professionals (including nurses, social workers, spiritual counselors, and expressive arts therapists) has taught me a tremendous amount about helping patients and their families live the end of their lives well. The most important lesson I've taken from them is that the dying process is part of living - and patients have the right to live that part of life with dignity and as free of pain as possible.

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