I know so many nurses that are afriad to use morphine to help pain. Especially in hospice patients!
Today I had a woman dying of cancer and very restless but otherwise unresponsive. I found out that the patient did not recieve her MS at all because the nurses on the previous shifts were to afraid of the med, and causing her death! The patient was breathing normally (except when she was painful) at 18...and was in pain!?!?!? No, instead they were doing dressing changes and manipulating her body without any analgesic at all!!!! I was floored, how kind is that!?!?!
I had a few days off, found out the situation and contacted hospice right away. By the looks of my dear sweet patient whom I have known for 3 years...I knew she had only hours if that! I got orders for 1 ml roxinol q 30m if I wished (which I did), and called the family and hospice to come in. She died with no s/sx of pain and was very peaceful looking with her family and caregivers and hospice at her side.
However I was very displeased with my fellow nurses. I have told them time and time again the reasons, use, contraidications, side effects and what not of this medication and they still won't touch it! Because of their fear...she suffered till I got there!
So, I am trying to think of someone that can come into a inservice to education my entire staff on the use of MS. I was thinking hospice but they are so busy and understaffed as of late....a pharmasist perhaps?
Just throw the ideas out folks! I even thought of paramedics or ER docs but try to get one of them to volunteer...LOL!
Thanks! We really do need more education about this issue!
(btw...one nurses excuse was that 'snowing' a patient at this time is cruel and pain is expected..it is part of death...I about fainted!).
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."
omg!
that's awful.
if a fellow rn said that to me, i would look them straight in the eye and ask them what the board of nursing and the lawyers would say about such a thing!
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
Same here, if there is a scale. I mean if there isn't. If the doctor's order is for 6mg q2h (it isn't a PRN) then 6mg should be given q2h unless a call is made to the doc to change it. That's why I like scheduled medications for pain.
Right - I mean some people will consistantly give only 2mg on a 2-10 scale, even though this is not the most effective dose for the patient. It's like they feel like they're doing their job, "well, I'm giving the pain medication" even though the patient's restlessness, grimacing, HTN, increased HR etc do not decrease - so obviously 2mg is not an effective dose.
Of course it's always best to START at the lowest dose, but don't STAY there if it doesn't work!! Then there are the people who have an order of, say, MS 2-10mg q2h prn. They give 2mg. The patient says 30 minutes later "My pain is still an 8/10!" "Sorry, my order is q2h, you will have to wait another hour and a half." ??? Witnessed this too many times to count.
Specializes in MICU for 4 years, now PICU for 3 years!.
WOW! I can't believe the thoughts of some nurses out there! I am currently in a nursing ethics class, and a big portion of the class is about death/dying and pain management. We have also had two other classes taught by the same prof, and a big portion of each was pain management. She is a pain specialist and an end of life specialist. She is awesome, and she doesn't want all of us to get out there in the real world of nursing and not give pain meds to dying pt's bc 'they might get addicted'!! So what if they get addicted.... they're dying! DUH! But anyway, hopefully more school are teaching students like my school is and the breed of nurses that think too much morphine might kill a dying patient will be phased out.
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
WOW! I can't believe the thoughts of some nurses out there! I am currently in a nursing ethics class, and a big portion of the class is about death/dying and pain management. We have also had two other classes taught by the same prof, and a big portion of each was pain management. She is a pain specialist and an end of life specialist. She is awesome, and she doesn't want all of us to get out there in the real world of nursing and not give pain meds to dying pt's bc 'they might get addicted'!! So what if they get addicted.... they're dying! DUH! But anyway, hopefully more school are teaching students like my school is and the breed of nurses that think too much morphine might kill a dying patient will be phased out.
I hope you're right! I do think that with the new push in the last 3-4 years about patient's rights to pain control, nursing education will change to keep up with it. I'm really glad to hear that your school is doing a good job of making it a part of nursing education. This will produce a whole generation of nurses who are well educated on pain management from the beginning of their careers. There are just SO many deeply ingrained myths out there about pain medications in general, addiction, so-called "drug-seekers" etc that it is like beating a dead horse sometimes to get nurses to not be AFRAID of administering appropriate amounts of narcotics to anybody in pain, dying or not.
Specializes in Education, Acute, Med/Surg, Tele, etc.
I want to thank all of you for your stories and suggestions! This is a common issue that crops up and just infuriates me to no end. Alas, I am trying to educated the other nurses instead of being angry (but I know they know I am angry, can't hide that from my eyes when I talked to them after this last issue).
The greatest thing was that we had an AWESOME hospice nurse! She and I communicate so well, and I know I can depend on her (and she me) to answer calls fast and get things going on with pain control.
When I called on this patient, she arrived within minutes and we got her pain in control quickly just before she passed...and a blessing to her, her family, and the CNA's who were begging for better pain management (but knew if it wasn't me on duty she wouldn't have gotten it...I reminded them CALL HOSPICE..they can get it done fast! They complained that the nurses don't like them to call hospice, and I told them that the hospice nurse is their primary, that if the floor nurse isn't responding well...talk straight to the primary! ).
I was very fortunate enough to have had a very wonderful end of life class in my school (grad of 2000), and it was the best class in the entire RN school. We looked at issues and searched deep within our own selves about our feelings of death and how to use them to help even more, or point out where you may run into some weak spots (that was the most important to me!). It was a full semester..and very worth every single second.
We had lecturers from pain management facilities...and if I can get one of these folks to do an inservice I am grabbing them...they were so logical and took the fear right out of you and drilled in the point of how very very important pain managment is!!!!!!!
I don't know if it is just my state...but now all nurses and MD's must have 7 hours of pain managment hours by the year 2008 (one time only...for now) and while so many nurses groaned, I was estatic! I will be signing up for that next year and looking forward to it!!!!! Hopefully we will be on the same page soon, and with the information we all need to handle pain managment :).
AND YES, I think...especially in assisted living or LTC's that routine is the way to go (with PRN if needed but the routine should be titrated to cover first!). Patches are awesome but rarely used in my facility...I have been advocating for them quite a bit!
We also have some of our hospice nurses use analgesic cream mixtures that have been doing wonders! We have a special pharamacy in the area that does these mixtures and it has been a blessing! I was kind of sceptical..but they work!!!!!! Also, I have seen several cancer patients lower nausea by using those bracelets that have pressure point balls (seabands or something like that). WOW, I was very impressed!
I know so many nurses that are afriad to use morphine to help pain. Especially in hospice patients!
Today I had a woman dying of cancer and very restless but otherwise unresponsive. I found out that the patient did not recieve her MS at all because the nurses on the previous shifts were to afraid of the med, and causing her death! The patient was breathing normally (except when she was painful) at 18...and was in pain!?!?!? No, instead they were doing dressing changes and manipulating her body without any analgesic at all!!!! I was floored, how kind is that!?!?!
I had a few days off, found out the situation and contacted hospice right away. By the looks of my dear sweet patient whom I have known for 3 years...I knew she had only hours if that! I got orders for 1 ml roxinol q 30m if I wished (which I did), and called the family and hospice to come in. She died with no s/sx of pain and was very peaceful looking with her family and caregivers and hospice at her side.
However I was very displeased with my fellow nurses. I have told them time and time again the reasons, use, contraidications, side effects and what not of this medication and they still won't touch it! Because of their fear...she suffered till I got there!
So, I am trying to think of someone that can come into a inservice to education my entire staff on the use of MS. I was thinking hospice but they are so busy and understaffed as of late....a pharmasist perhaps?
Just throw the ideas out folks! I even thought of paramedics or ER docs but try to get one of them to volunteer...LOL!
Thanks! We really do need more education about this issue!
(btw...one nurses excuse was that 'snowing' a patient at this time is cruel and pain is expected..it is part of death...I about fainted!).
It sounds like you work with some real winners! So now nurses are letting patients suffer. Sounds like something new to me! Mel :)
I mean if there isn't. If the doctor's order is for 6mg q2h (it isn't a PRN) then 6mg should be given q2h unless a call is made to the doc to change it. That's why I like scheduled medications for pain.
unfortunately, i haven't met a whole lot of doctors willing to prescribe on a scheduled basis. i find it to be a cya situation, which only serves to show their ignorance and fear, similiar to the nurses that hesitate giving mso4.
I'm a hospice case manager, so I can see what you are saying. Trust me, if hospice has the oprotunity to talk to a new batch of students and educating them at the start of their careers rather than allowing other patients to suffer. . .Every Hospice RN would make the time to do that. And they are the most educated and experienced in pain management in terminal patients.
Morphine in terminal cases is used differently then in non-terminal patients. You won't cause her death. . .
CALL THE HOSPICE TO MAKE A PRESENTATION!
I know so many nurses that are afriad to use morphine to help pain. Especially in hospice patients!
Today I had a woman dying of cancer and very restless but otherwise unresponsive. I found out that the patient did not recieve her MS at all because the nurses on the previous shifts were to afraid of the med, and causing her death! The patient was breathing normally (except when she was painful) at 18...and was in pain!?!?!? No, instead they were doing dressing changes and manipulating her body without any analgesic at all!!!! I was floored, how kind is that!?!?!
I had a few days off, found out the situation and contacted hospice right away. By the looks of my dear sweet patient whom I have known for 3 years...I knew she had only hours if that! I got orders for 1 ml roxinol q 30m if I wished (which I did), and called the family and hospice to come in. She died with no s/sx of pain and was very peaceful looking with her family and caregivers and hospice at her side.
However I was very displeased with my fellow nurses. I have told them time and time again the reasons, use, contraidications, side effects and what not of this medication and they still won't touch it! Because of their fear...she suffered till I got there!
So, I am trying to think of someone that can come into a inservice to education my entire staff on the use of MS. I was thinking hospice but they are so busy and understaffed as of late....a pharmasist perhaps?
Just throw the ideas out folks! I even thought of paramedics or ER docs but try to get one of them to volunteer...LOL!
Thanks! We really do need more education about this issue!
(btw...one nurses excuse was that 'snowing' a patient at this time is cruel and pain is expected..it is part of death...I about fainted!).
I was reading your entry, and I understand what you are speaking of. I believe that using the Wong Baker Scale of Faces is extremely important when administering medications to people who are verbally unresponsive. I teach a Skills Enhancement Course for Nurses related to all aspects of nursing care, but one specific part of my instruction is regarding exactly what you are speaking of. I am brought in by facilities to offer education regarding specific areas of instruction that administration feels is needed. There are very few companies that you can call upon to do what I do, but they are out there. Better yet, you can ask them to teach about that and maybe some other skills that your nurses are lacking. My company is fairly new, but we are aware that some facilities need just what we have to offer.
I know so many nurses that are afriad to use morphine to help pain. Especially in hospice patients!
Today I had a woman dying of cancer and very restless but otherwise unresponsive. I found out that the patient did not recieve her MS at all because the nurses on the previous shifts were to afraid of the med, and causing her death! The patient was breathing normally (except when she was painful) at 18...and was in pain!?!?!? No, instead they were doing dressing changes and manipulating her body without any analgesic at all!!!! I was floored, how kind is that!?!?!
I had a few days off, found out the situation and contacted hospice right away. By the looks of my dear sweet patient whom I have known for 3 years...I knew she had only hours if that! I got orders for 1 ml roxinol q 30m if I wished (which I did), and called the family and hospice to come in. She died with no s/sx of pain and was very peaceful looking with her family and caregivers and hospice at her side.
However I was very displeased with my fellow nurses. I have told them time and time again the reasons, use, contraidications, side effects and what not of this medication and they still won't touch it! Because of their fear...she suffered till I got there!
So, I am trying to think of someone that can come into a inservice to education my entire staff on the use of MS. I was thinking hospice but they are so busy and understaffed as of late....a pharmasist perhaps?
Just throw the ideas out folks! I even thought of paramedics or ER docs but try to get one of them to volunteer...LOL!
Thanks! We really do need more education about this issue!
(btw...one nurses excuse was that 'snowing' a patient at this time is cruel and pain is expected..it is part of death...I about fainted!).
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 .
hi, i'm a 3rd yr rn student... i've studied that mgso4 toxicity can lead to resp depression. so my silly question is with a dying patient in pain, would you still continue on giving MS going on to resp dep? i mean, it would kill the pt. i'm a bit confused with this medication...
).
tridil2000, MSN, RN
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