Anyone have any suggestions?

introspectiveRN · Feb 5, 2008

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...

BernieRN · Feb 9, 2008

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.

aimeee, BSN, RN · Feb 9, 2008

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.

Hospice Nurse LPN, BSN, RN · Feb 9, 2008

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.

Percy60 · Feb 9, 2008

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

"People have the right to make bad choices"

Hospice Nurse LPN, BSN, RN · Feb 9, 2008

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.

Brightonrn1 · Feb 9, 2008

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.

leslie :-D · Feb 9, 2008

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

BernieRN · Feb 9, 2008

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.

BernieRN · Feb 9, 2008

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

leslie :-D · Feb 9, 2008

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