Quote from MrRNman
I am just wondering what others think about this situation? Withholding pain medication definitely falls under the patient neglect catagory. But, on the other hand, the patient verbalized a concern about becoming addicted very easily.
I did give the morphine, times three doses through the night. I personally felt that pain control was in the patient's best interest at the time, but on my way home from work I was heavily thinking about this patient's near future upon discharge.
Should I actually feel guilty about doing the "right thing" for my patient?
I personally, don't see where the confusion lies. You don't have the legal right to withhold a medication that has been ordered, the patient is pain, just because they say they have a "concern" with regards to receiving an opiate re-triggering addictive behavior. That isn't a nursing decision.
If the patient is awake, alert and oriented, your job is to tell the patient what is ordered, what they can have, educate the patient, but THEY GET to make the decision whether to accept it or not. There is nothing that says a patient cannot stay in pain if they choose to be and I have SEEN patients choose to not have pain meds after surgery because they refuse...that is their right as a patient.
The patient had a valid concern. You were incorrect in saying, "There is a difference between opiate use as recreation versus pain control". The patient was concerned about re-triggering his addiction.
I have a friend who had a horrible time recovering from alcoholism....it took him two years to stop drinking...we went to a fondue restaurant and he took one bite of the cheese fondue and immediately asked for water (as in a panic) and I watched him down an entire glass in seconds. When I asked what had happened, he said, "The fondue had wine in it...I could taste it. I can't take a chance on it." It was because the taste triggered an instant desire for another drink. He said he had not thought about drinking in a long time before that evening...but then was obsessed with it for several days after.
I would have told the patient that the body processes opiates differently when there are real pain receptors vs none, but would have also told them, "I understand your concern, it's a valid concern. However, the decision is up to you...I have the morphine if you feel like you need it or I can see if the doctor can prescribe you an alternative medication."
I wouldn't have given my personal opinion or advice and would have told them to make the decision.
Addiction and dependency are very different...addiction is a drug seeking behavior. A couple of doses of morphine are not enough to re-trigger dependency...but addiction, is very different.