When family refuses IV pain meds for cancer pt...? - page 4

What do you do when a pt's spouse refuses to allow you to administer IV pain medications as ordered? Pt has end stage cancer w/ brain mets. DNR. Confused most of the time. Has not been deemed... Read More

  1. Visit  BiohazardBetty} profile page
    0
    Quote from Esme12
    morte was being facetious.....hospitals press ganey surveys are the facilities bible these days.....sad.

    He could sue for anything that will cost the hospital time and money....not that he would win. Forcing a patient to take a med she doesn't want...(her saying no no no no all the time) is assault. Now we all know she is confused and is in pain but that doesn't mean he can't sue later just to cause a stink.

    People are crazy....and do weird things.

    For example.....I had a patient that survived a horrible fire and lengthy hospital stay and sued for a breakdown over the right ear for O2 tubing.....it wasn't bad never needed plastic surgery like their burns...but it did get red and blister. He got a settlement from the facility. It never went to court.
    That's good info... I was worried that I had already done something that may invite a law suit! The spouse is kinda crazy... SUPER attentive when staff are present- rubbing her feet & talking sweet, singing to her- but when we aren't in the room he sits in the corner & ignores her. We have observation type windows where we can see into the room without disturbing the pt, so I've noticed this frequently. Now that I think about it, I've actually never seen him showing her any attention when we weren't in the room... But then again, my 4 seconds 4 times an hour is hardly a good judge of what they do the rest of the time.

    I don't feel like its a cultural/religious thing- they're southern baptist just like most of the staff. Even used to go to church with one of our CNAs. It feels more like a control issue to me, sadly.
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  3. Visit  rumwynnieRN} profile page
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    Quote from helloberry
    That's good info... I was worried that I had already done something that may invite a law suit! The spouse is kinda crazy... SUPER attentive when staff are present- rubbing her feet & talking sweet, singing to her- but when we aren't in the room he sits in the corner & ignores her. We have observation type windows where we can see into the room without disturbing the pt, so I've noticed this frequently. Now that I think about it, I've actually never seen him showing her any attention when we weren't in the room... But then again, my 4 seconds 4 times an hour is hardly a good judge of what they do the rest of the time.

    I don't feel like its a cultural/religious thing- they're southern baptist just like most of the staff. Even used to go to church with one of our CNAs. It feels more like a control issue to me, sadly.
    ...that sounds a lot like a crappy home dynamic, if this is a mirror of their home life.

    People are strange.
  4. Visit  dishes} profile page
    0
    Cancer pain managment has come full circle, I remember a time when some nurses would refuse to give end stage CA patients PRN morphine, telling the family members your just trying to knock them right out.

    Maybe the husband is frightened about his wife dying, maybe his wife expressed a strong fear of being too confused by the side effects of the medication to talk before she goes into a coma and dies, maybe the way he sees it, he is just trying to keep a promise he made to his dying wife.
  5. Visit  BiohazardBetty} profile page
    0
    Quote from dishes
    Cancer pain managment has come full circle, I remember a time when some nurses would refuse to give end stage CA patients PRN morphine, telling the family members your just trying to knock them right out.

    Maybe the husband is frightened about his wife dying, maybe his wife expressed a strong fear of being too confused by the side effects of the medication to talk before she goes into a coma and dies, maybe the way he sees it, he is just trying to keep a promise he made to his dying wife.
    That would be a nice thing to do, if that were the case... Neither the patient or the spouse has mentioned anything like that & today I specifically said "I feel like I'm not doing a very good job managing her pain since she's been yelling out for the past 2 hours. What do you think?" & he said "She's fine. I'll let you know when she's hurting." She's already so confused from the brain mets that medication probably wouldn't change much.
  6. Visit  dishes} profile page
    0
    Just because the spouse and patient never mentioned a promise they made to each other, doesn't mean it doesn't exist. His manner is bossy and intimidating and preventing the pain medication is an ethical dilemma, but it doesn't necessarily mean he doesn't want what's best for his wife, from his perspective.
  7. Visit  DeLanaHarvickWannabe} profile page
    6
    Quote from Altra
    I cannot wrap my head around not medicating a patient because spouse might show up and be upset.
    Exactly. If he's not around and she's clearly in pain from my nursing judgement...(all sorts of pain scales exist - and a lot of neuro-impaired patients will say "no" and mean "yes") well, he has left her in my care and she is getting her pain medication!
  8. Visit  chrisrn24} profile page
    0
    I think you have to balance family wishes with patient needs. Sometimes patients' relatives will say "could you hold off on giving her pain medication? It makes her loopy/agitated whatever." But if the person is clearly in pain I will still give it.
  9. Visit  jadelpn} profile page
    6
    Quote from helloberry
    That would be a nice thing to do, if that were the case... Neither the patient or the spouse has mentioned anything like that & today I specifically said "I feel like I'm not doing a very good job managing her pain since she's been yelling out for the past 2 hours. What do you think?" & he said "She's fine. I'll let you know when she's hurting." She's already so confused from the brain mets that medication probably wouldn't change much.
    With all due respect, the husband is not your patient. He has absolutely no say in whether his wife needs pain medication or not. You need to treat the patient, and not the husband. I am not sure why you are debating this. I can not stress enough that as a patient advocate, you really do need to try and meet the patients' needs. And if you have no one else on board with you regarding this, it is not a good thing to say the least. To be quite blunt, this patient is not suffering because of any other reason but her own declining of pain med, or the inability and/or unwillingness of staff to appropriately medicate the patient based on the order, and if the order is not working, then you need to obtain alternate orders.
    Elinor, Munch, GrnTea, and 3 others like this.
  10. Visit  Glycerine82} profile page
    0
    Not a nurse so shouldn't be piping in but I can't help it.

    Can you re-word it when he isn't around? Like say "would you like me to give you something to make you more comfortable"? So that she says yes?
  11. Visit  MunoRN} profile page
    9
    Many states have laws that specifically state even a POA cannot refuse pain meds for a patient on comfort care, the advantage to this is pretty much bullet-proof lawsuit protection. But even when a patient is not officially on comfort care, a terminally ill patient with an incurable condition has been considered in court to reflect the spirit of which the comfort care laws were intended, providing similar protection. There are well established pain assessment tools for patients who are unable to take part in the traditional verbal scales, you've got an order to treat pain and the husband doesn't have the legal or ethical right to refuse that. Proceed until apprehended.
  12. Visit  dishes} profile page
    2
    helloberry Is it possible for your unit to include the MD, SW, manager and nursing staff in a team meeting to discuss the situation? The team needs to be in agreement and not send you around in circles to talk to each of them separately.
    canoehead and nrsang97 like this.
  13. Visit  OCNRN63} profile page
    6
    Quote from morte
    devil's advocate....he will out live her, and he will be filling out the press ganey form. also, the dead don't sue, but the living do.

    Let him try to sue me for doing my job. I wouldn't care one fig what he'd say on a Press-Ganey.
    wooh, KelRN215, GrnTea, and 3 others like this.
  14. Visit  morte} profile page
    0
    Quote from OCNRN63
    Let him try to sue me for doing my job. I wouldn't care one fig what he'd say on a Press-Ganey.

    but the hospital may....we have all read the stories here at AN about persons that should have been DNR, in fact had made that decision for themselves, but when they failed sufficiently that they could no longer voice their opinion the family said that they were now to be a full code, "do everything". And docs have acquiesced because they were afraid of being sued, hence the saying the dead can't sue, but the living can.


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