Brainstorming, End of life and Morphine use.

pricklypear · May 13, 2005

Geez....No wonder you're miffed at your fellow nurses. That kind of thing really burns me up, too. A couple of years ago I attended a terrific series of lectures on end-of-life issues. It was led by the MD who heads up the largest hospice in the area. Have you considered contacting any of the doctors/NPs/Pas with hospice? Or a pain specialist? Those people are usually VERY responsive to questions about these issues and ready and willing to dispel some of the myths that persist. Good luck!

All I can say about your last comment made by one of your co-workers....never mind, we're not allowed to cuss on this board!!:angryfire :angryfire :angryfire Pain is expected??????

Nesher, BSN, RN · May 14, 2005

Perhaps a pain CNS? Do you have one?

leslie :-D · May 14, 2005

your staff developer should be able to give an inservice or at least provide the resources.

but i'll warn you now, when i worked as a hospice nurse,the unit was attached to a ltc/subacute facility. there were a few inservices on mso4/pain mgmt. and it didn't change a darned thing. those nurses that were afraid to give mso4 were still afraid to do so.

and the worst part (other than the pt suffering)? they would write in their nurse's notes about pt. groaning, grimacing yet no interventions!!! or worse, tylenol given w/poor effect. :angryfire

we had this lady come back from the hospital to her old bed (not the hospice unit) w/a dx of breast ca w/mets. she had always been a highly stoic and strong-willed woman w/mod dementia.

according to the discharge summary, her pain had been well managed with fentanyl and mso4, and prn percocets.

the nm called her pcp stating she WASN'T in pain so the md dc'd all the narc orders.

when i went to assess this pt., she cried out "louise, louise help me. i hurt"

since i was doing charge that day, i called up her md stat- had him paged and relayed the conversation of the patient. he immediately resumed her 75 mcg td of fentanly and 15mg of roxanol q2h prn. even though i wasn't doing meds, i told the med nurse (and my DON) that i wanted to take full responsibility for this patient. i finally got her pain undercontrol and once she was pain-free, she looked up at me and said "thank you louise....i love you". her dtr had been present all along and she had been furious that all the pain meds had been dc'd. i told her to speak to the nm about that.

and this patient died very peacefully that noc.

but what aggravates me, is that often i can't depend on my colleagues to ensure that our pts. pain needs are attended to....

anyway triage, go to your staff developer; and good luck. thank God for you.

leslie

barefootlady, ADN, RN · May 14, 2005

No matter how many inservices you give on this subject, some nurses will never change their minds about giving mso4, duragesic patch, robonal, and other meds to the dying patient. There has to be a change in the mind set of these nurses, they have to become more committed to helping the patient be as pain free as possible. They have to lose that fear of being sued for following orders. Most families are happy when the nurse actually helps the patient be more comfortable and peaceful when death is near. I wish you luck, this is an ongoing issue .

LPN_mn · May 14, 2005

Some people are not going to agree with me on this but I feel the reason some nurses do not give pain meds is because they don't want the person to die on their shift. Don't want to do the paper work. I too have been in a situation where the nurses wouldn't give pain med to dying resident and when asked about it the reply was " I don't want them to die on my shift." Needless to say the person did die but was not always pain free except for when a couple of us nurses were there to give the resident meds. I just don't get it. If it was their loved one I am sure they would not be concerned about what shift she/he died on as long as their loved one was not in pain.

stidget99 · May 14, 2005

Even w/ short staffing, your best bet would be hospice staff/nurses. Planning in advance should allow them to manage a great in-service. Hospice in conjunction w/ staff development at your facility might be able to change ppls minds. If hospice could find family members who are willing to tell the stories about their loved one's passings. (i.e. "I would much rather have mom go peacefully sooner than have her stay around longer in extreme pain" or "I would rather dad die w/ dignity and not cry like a baby". Both of these statements have been made to me by family members...one while I was working hospice and one while I was working in a hospital.)

I also think that schools need to do a more thorough job of teaching nursing students end of life issues. All students should be mandated to a clinical rotation in hospice.

pricklypear · May 14, 2005

I also think that schools need to do a more thorough job of teaching nursing students end of life issues. All students should be mandated to a clinical rotation in hospice.

You are so right!! What a great idea. I would be happy to see an entire class devoted to end of life issues. The tide is changing these days in regard to pain control, especially for people with chronic pain and surgical pain. But who's there for the dying patients? The newer nurses I work with seem far more willing to give pain medication to dying patients than the older ones. I think the mentality is "if they don't ask for it, and they aren't "obviously" in pain, they don't need anything" This is such a sore spot with me, can you tell? I hate to think that some in the nursing profession are allowing people to die in pain and agony. My ultimate goal in life is to become a CNS in pain/symptom management because I see such a need for education and review on this subject. No dying patient should have to suffer.

nursemike, ASN, RN · May 14, 2005

Uh, what's a CNS? I'm guessing not a central nervous system. I'll even venture to guess the N is for nurse.

So many abbreviations!

BTW, my class had a guest lecturer from hospice, and we each shadowed a hospice nurse for a day, so at least one school is addressing the issue. It's one I care about, a lot. Death is inevitable, but unmanaged pain is not.

begalli · May 14, 2005

what's a CNS?

Clinical Nurse Specialist. One would hold a Master's degree in a chosen area of expertise and usually work in the hospital setting.

fergus51 · May 14, 2005

I've found the only way pain meds can be assured to be given reliably is if they are NOT PRN. Scheduled meds get given. PRNs often don't.

nursemike, ASN, RN · May 14, 2005

Clinical Nurse Specialist. One would hold a Master's degree in a chosen area of expertise and usually work in the hospital setting.

Thanks. DAGN, here. (Dumb-*** Graduate Nurse)