Anyone have any suggestions?

I have a patient with ES Bladder cancer, probably met to stomach. This patient has MSSR 60mg q 12 hours and MSIR Q4 prn prescribed for pain management. Patient refuses to take the MSSR due to his religious belief that he has to suffer some in order to go to heaven. I dont want this man to be in pain and he does take the MSIR. However I believe he wouldnt need the MSIR if he would take the MSSR. We have had our chaplin talk with him, I as the case manager and the LVN have talked to him. Any suggestions would be greatly appreciated!

I know you won't like it but I say...it is his life as much as it is his death. Let him choose. You only have his best interests at heart- I know however, this is truly up to him. Have you communicated directly with his pastor/priest/etc? Maybe the chaplain could give this person a call and ask them to meet with your pt. - I know this is not easy to accept- have been through this as well. I just try to be matter-of-fact and them tell them "this is your body, this is your party/process/experience etc...just let me know what you want and I am here for you."

God Bless you dear...

Hi

I am in Nursing school and Hospice was just brought up this week. It was impressed on us that we are to be an advocate for the patient. It is what the client wants, not what we want.

Before that particular discussion, it is in the readings that different people have different beliefs. They own these beliefs and we should not step in and deny them because we have our own.

It is hard, yes. But it is also necessary. It is their death.

Maybe, think about alternatives to help him such as quiet music, massage, anything holistic that might be of benefit. There are lots of therapies out there that don't require meds to help. They might not take care of the pain (and yet they might) but help the mind and the mind can do amazing things.

I'll be thinking of you.

Good advice above. Another alternative to offer is a low dose duragesic patch to take the edge off. For some reason, there are people who will accept the patch when they won't take the meds.

I remember a pt. I had a couple of years ago with ES cervical ca. I KNEW she was in pain, but refused anything but Lortab. It was hard for me to accept, but I had to honor her wishes. Her belief was that "Jesus suffered for me, so I must suffer for Him." We have to advocate for the pt., but ultimately we do have to respect and honor their wishes.

Our hospice has a mantra that helps with situations like this....

"People have the right to make bad choices"

Our hospice has a mantra that helps with situations like this....

"People have the right to make bad choices"

I like that! Thanks for sharing it.

I have learned from experience recently, that we can only make recommendations for pain relief. Sometimes, we have to step back and continue to let people have control over their death. That being said, we can continue to listen. Giving them an open ear is one of the best medicines. I hope this helps.

as aimeee said, a fentanyl patch is often an acceptable method of pain control.

there is something very passive about a patch staying on x 3 days...

no interventions needed inbetween.

you can also increase the strength of the lortabs.

at least the pain would be better managed...

and likely, she will not be completely relieved of it.

but it will enable her to manage her death w/more focus and resolve.

leslie

Hi

Percy's message that people have the right to make bad choices is really not in line with the thinking that acts that are ethical reflect a commitment to standards beyond personal preferences. To say that the persons thinking is wrong, that their belief is wrong because it isn't in line with your own belief is not being an advocate for the pt.

Personal beliefs and biases aren't supposed to be part of the advocacy for the pt. The best you can do is give the pt information of options available and let them decide what to do in their death.

I know for sure that it is hard to watch when you know you can do things to make them more comfortable physically, but mental comfort to many people is a whole lot more important. Being able to live with themselves and their decisions in dying.

I feel I have to add to this some hopeful suggestions for nonpharm tx for pain. At the very least, maybe one of these would help.

Acupressure

Acupuncture

Hot/cold packs

Hypnosis

Imagery

Massage

Music

Relaxation Therapy

Baths

Touch (Reiki and such)

Maybe a noise machine with the sound of the ocean or stream or rain

Hope this helps

diana,

i appreciate your enthusiasm as a student nurse, as well as your evident passion for hospice.

of course we hospice nurses know that pts ultimately make their own decisions.

but there is a lot more to dying, than merely treating symptoms.

yet, if the physical symptoms cannot be adequately managed, the remainder of the dying process goes unattended and unresolved.

it is for this reason, that physical pain be stabilized.

that can and should involve addressing the pts fears and reluctancies:

and, educating them in why their pain should be managed.

it is not just about physical comfort.

if there are creative ways in managing one's pain, this s/b encouraged.

and of course, there are some who just will not budge, no matter how many interventions.

that is to be respected.

it doesn't mean, however, that the nurse/doctor stops encouraging the cessation of physical pain.

an experienced hospice nurse/doctor recognizes the journey in dying, and wants their pt to transition with peace of body, mind and spirit.

there is nothing cut and dry when it comes to death.

best of luck in your studies.

leslie

I don't think nursegirl is making a judgment. She is assisting this patient in comfort and I thought it was wise that she brought this question to us. She offered him options and allowed him to make the choice. I also do agree that some people do make bad (unwise, if you will)choices. It's not judging them, it's realizing you offered the option and they decided against it. For instance, one of the patients in our hospice refuses to allow the nurse or home health aides to clean her body, which she cannot do by herself. She has wounds that need to be cleansed. Is she making a bad decision? I think so and she could quite possibly develop a nasty infection, but it is her right to refuse as she is alert, oriented and competent and was educated on the consequences.

I think that nursegirl will probably develop a relationship with this patient and perhaps he will mull over the information she provides and change his mind. He may or may not.This situation may also pave the way for this patient communicating some issues with his nurse that he may not be able to articulate with significant others. Either way, she has given him all the options, but remained non-judgmental and his advocate. I doubt anyone here would say or do anything to make the patient feel they did not have this control. This is yet another aspect in the art of hospice nursing.