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Do you ever second guess yourself


I am not a hospice nurse but I had a hospice patient liver lung bone cancer they were sleeping but I could hear the rattling in the lungs without my stethoscope I gave a dose of rox, 20mg q3 hrs was the order pt had none in the last 12hours after I gave the dose within an hr pt was gone. Was I wrong in giving med? My gut says no I made pt comfortable but maybe I need to hear from the pros that are with hospice Thanks.

I understand how you feel. I see a lot of end of life patients and the first time I gave "comfort" drugs, my patient died within 30 min. I felt guilty and was pretty upset. I was talking to the other nurses and doctor about it and the doc said "I would never order a medication I thought was going to kill someone, the patient is going to die soon and it is our job to make sure they are comfortable, without pain, fear, air hunger, or anxious". Yes the meds can slow breathing but would you rather them struggle and gasp for their last breaths? I like to think of it as helping them to relax and pass peacefully. Also I read some articles about end of life meds and that helped ease my mind too.

Of course you weren't wrong to give an ordered drug if you thought the patient was uncomfortable. There are a lot of studies demonstrating that morphine at end of life does not hasten death in the terminally ill, but even if it does, it is an unintended effect of a medication given to promote comfort (the intended effect) and that is ethically permissible. My own view is that if a patient is non-responsive and very close to death (minutes, hours), even if I am hastening death by some short period of time in making that person comfortable, that is an appropriate trade-off.

I agree with 87RN. I work on an inpatient hospice unit and have been in the same situation. They were made comfortable enough to be able to let go.