When family refuses IV pain meds for cancer pt...? - page 5

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 incompetent, has no power of... Read More

  1. 0
    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.

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  2. 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.
  3. 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.
  4. 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.
  5. 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!
  6. 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.
  7. 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.
  8. 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?
  9. 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.
  10. 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.


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