I have finally worked it out to transfer to hospice. I'll be working part time hours there and still 12 hours at my current job on a heavy med-surg floor.
My question is regarding "pain med seeking" behavior in hospice. Do you get it often? I have the least amount of compassion for these types of patients. That is one of the main reasons I wanted to work at hospice-working with patients who have true need of pain relief, who need me to advocate for them in case they cannot, etc.
Please understand my term "pain med seeker" to be someone who is obviously timing their meds. I know we are to treat each patient as their pain is real to them, but in reality, much abuse is present in the current hospital setting.
Please tell me I won't encounter this as much in hospice. That is my true hope in transfering is that I can care for patients as I wish to-and their pain.
i have finally worked it out to transfer to hospice. .......my question is regarding "pain med seeking" behavior in hospice. do you get it often? i have the least amount of compassion for these types of patients. ...............please understand my term "pain med seeker" to be someone who is obviously timing their meds. i know we are to treat each patient as their pain is real to them, but in reality, much abuse is present in the current hospital setting..............................that is my true hope in transfering is that i can care for patients as i wish to-and their pain.
jacelrn
hello and a big thank you to you all involved in this passionate thread - i
had to say i agree, yes, yes, working in hospice/palliative care is very different from the normal hospital where you have to carefully sort out the genuine with the hypochodriacs. qualifications at the hospice (beside rn, en or ain etc.) should include compassion, patience, a passion for care and a belief or reverence in your own spiritual self. believe you do have something to offer. and be prepared for some unexpected tears from yourself. as i was told many years ago "if you loose the compassion then leave the hospice!". good luck.
mister chris :kiss
"there was a flower beside her as she opened her eyes.
each time it happened it was a wonderful surprise.
midst the pain and anticipation of treatments to come,
that small breath of freshness with warmth from the sun.
so thoughtful and precious yet simple its bloom,
poured out its beauty, all round the room.
during the long night when sleep avoided its call,
someone had delivered it, this choice gift so small.
yes someone so thoughtful popped in through the night,
left the gift from nature a single flower so bright.
as light came slowly through blinds all drawn close.
there it was again, but how? nobody knows.
each morning it happened she never knew who
had felt for her loneliness, knew her heart break too.
the flower gave pleasure and a meaning to live,
but her health now fast dimming, she'd nothing to give.
as days passed by she could no longer speak.
the flower was there, each day, each week.
her fight for life fading, the sickness came fast;
the flowers kept coming, how long could it last?
did she notice these tokens of love and good will?
when she lay on her bed so quiet and still.
the nurses and doctors knew her time had now run.
blinds remained closed yet a fresh flower had come.
very early that morning as her life drifted away.
the kind soul left a token, a red rose for her day.
I kinda thought if patients say they have pain, they have pain, and we are supposed to treat them, not second guess them. If it's ordered and they ask for it because they have pain, who are we do judge whether they are sufficiently sincere in their need? Aren't we supposed to treat the pain before it gets very bad, so that it doesn't get very bad?
I don't know about abuse in a hospital setting. If someone is in hospital, they are likely uncomfortable. Do you truly want to be responsible for making a judgment call on a patient's comfort? What about the "truly needy" patient who is aware enough of time and spacing and understands aggressive pain management, and thus asks for pain medication when they feel they need it, not waiting until the pain hurts? Aren't they doing what a responsible patient should do, taking an active role in their own care?
I would worry about a nurse taking care of me in my terminal illness who might have some issues with whether or not she felt my pain was severe enough to justify medication--or if I was "seeking pain meds."
We learned a lot about the separation of our own issues from those of our patients, when we were in school. It came under the topic of "ethics." We are not here to control the patient's behavior, we are here to help the patient meet their needs, and when they cannot, to meet those needs for them.
I thought "nursing" wasn't about deciding the patient's needs, I thought it was about assessing their needs. How do you assess pain? We were taught to ask.[/quoteI kinda thought if patients say they have pain, they have pain, and we are supposed to treat them, not second guess them. If it's ordered and they ask for it because they have pain, who are we do judge whether they are sufficiently sincere in their need? Aren't we supposed to treat the pain before it gets very bad, so that it doesn't get very bad?
] Hello everyone!
I truly applaude the responses from the nurses who "get" the idea that we should not "judge" someone who calls for pain medicine right on the minute. Do they not teach us in nursing school to give meds thirty minutes before it is due?? I remember being in the role as a surgical patient; and believe me; that clock sure ticks slow when you are in pain.
I worked as a Hospice RN manager for several years and truly loved it! It made me feel like I was doing a "calling" instead of just a "job". I think you will switch into a whole different "mode" if you love it. No more will you think of "time"...you will only want to relieve a person's suffering. I had to educate many doctors to the fact of hospice care and pain management when I worked. So many could not grasp the fact that the patient's pain required levels of medicines they would never have prescribed.
Good luck with your new job, and always talk with other Hospice nurses for support and questions.
If I may echo a previous post: Give them WHATEVER they WANT. If you have a problem with drug-seeking patients, hospice isn't where you should be. If you were dying of a terminal painful illness, I think you would want to be as stoned as possible. Get it?
Specializes in OB, critical care, hospice, farm/industr.
Doesn't matter if they're seeking meds or not. They're dying. Dope them to the gills if they want.
Edit: Didn't mean to sound so harsh. One thing to remember---hospice and hospital nursing are quite different. Hospice patients can comfortably take amounts of Roxinol that would kill anyone else. Know the effects and limits of drugs. Develop confidence. Use your mentors. Keep an open mind. Know yourself...
Specializes in LTC,Hospice/palliative care,acute care.
Med surg nurses-do you really think you can make a difference in the true drug-seeker's behaviors in the few days you will be caring for them? YOU are not enabling or encouraging them-their docs have been doing that...Do yourselves a favor and give them meds as ordered and don't waste your positve energy in a negative manner.These people will suck the life out of you and monopolize you if YOU LET THEM...
I totally agree with everyone. There is no such thing as a "drug seeker" in a hospice setting. Whether they want drugs for pain control, to sleep through their physical or emotional pain, or even if the drugs are meant to help hasten the death. It's their decision. No patient in hospice shoud ever be made to feel guilty about taking pain meds or whatever !
If someone is in the hospice system than I can't imagine why anyone would care how much pain meds they want. If having 6 months or less to live isn't a good reason to be heavily medicated all the time even to the point of being a little high, than what is?
Amen!!!!!! I dont care if my terminal pts drink MS out of a water glass !!!! Lots of the CA pts around here are on heavy duty Fentanyl patches plus MS q4h plus Atiivan/Haldol if needed.
As an aside, I was wondering if a pt with a prior hx of drug addiction, would automatically need a much higher dose of MS to combat pain. Long ago, before I knew to ask. I had a pt (young) that years prior had drug addiction hx. He had cleaned up/gone thru rehab and years later developed terminal CA. This guy got MEGA doses of MS, like towards the end, 10 cc every few hrs. Later, they switched to nebutalized MS rectally, and when that didnt work, they put him in the hospital where he died. Is the huge doses due to the prior drug hx/ or increased tolerance?
I've got to agree, at least in part, with ktw - drug-using inpatients aren't usually in a place where they're going to change their behaviour, unless they're in a detox centre. Working in ER is different, and I have no problem with not providing patients there with meds, but unless we're prepared to follow up withholding/reducing meds with counselling and other support all we're doing is creating an unpleasant situation for everyone. I know I'm not receptive to anything when I've got pain - compound that with withdrawal and some sanctimonious, judgemental nurse getting in my face and the last thing on my mind is going to be cooperation.
Doesn't matter if they're seeking meds or not. They're dying. Dope them to the gills if they want...............................................Keep an open mind. Know yourself...
Yes have to agree with all of the positive input - after all "they are dying" arn't they?
Just hope that some hospice/pal. care nurses still feel that way if and when I ever end up in a hospice/pal. care unit.
I totally agree with everyone. There is no such thing as a "drug seeker" in a hospice setting. Whether they want drugs for pain control, to sleep through their physical or emotional pain, or even if the drugs are meant to help hasten the death. It's their decision. No patient in hospice shoud ever be made to feel guilty about taking pain meds or whatever !
exactly!!!! they NEED drugs, they are dying, and most are in severe pain!!! If a person is in hospice, does it really matter if they are drug addicted or not? its not like we can stop an addiction from happening to a person who is DYING anyway.they are DYING!!!!! who cares what they are seeking......sorry, but even the term "drug seeker" in a hospice setting makes me so mad i sputter my words........
I think it's even scarier that you are attacking her for expressing her thoughts. She needs our support and education, not decapitation.
she's right........her "thoughts" are scary to say the least. "drug seeker" in hospice......rediculous.shes going to work in a hospice setting and asks this question???? come on, people....very scary.how would that go anyway, ....."well we have this end stage bladder ca with mets, does he really need all this medication, or is he feeding an addiction that we must not contribute to?" You bet he has an "addiction" and is SEEKING drugs.thats why he is a HOSPICE pt. They get all they please to get, because they are DYING AND IN PAIN. I feel like this: IF THIS NEEDS TO BE EXPLAINED TO YOU, THAT ADDICTION IS A NON ISSUE IN HOSPPICE, THEN YOU SHOULDN'T BE A NURSE, PERIOD.
Have any that have replied ever worked on the type of floor I currently work? Please don't tell me that you haven't seen these types of patients. There are abusive personalities and it dosen't stop in the hospital. I do not feel comfortable supporting drug habits of patients. Even when my patients ask to go out to smoke, I educate them on the importance of not smoking. I assess their needs to find alternatives.
I turned to this board for advice and from those of you who tried not to judge ME by my response, thank you. I intend to reasearch hospice, palliative care, etc. For those who are less patient to judge a vulnerable poster, please read this and know I was attempting to clarify and educate myself on an important move both in my career and in my beliefs. I was not presenting a case for debate.
I worked in Hospice for several years, then left because our Hospice was taken over by a large hospital corporation. During the 2 years that I was gone from Hospice (I am now working in Hospice again), I worked on an oncology/neurology floor. Most of our neurology patients were there for laminectomies or some other back/neck surgery. We had a contract with the federal prison and the county jail to do all of their surgeries. I can tell you that even though I tried not to be judgemental, there were times when some of the (prisoner and non prisoner patients) would try my patience. I would always give the patients pain medications and never questioned their pain and in fact, I would call the doctor and ask for an increase if the patient was "timing" their meds. I wasn't very popular with the neurosurgeons and many times they would not give me orders to increase the meds. I knew that some of the patients were seeking meds for other reasons than physical pain and because of the unbelievable busy schedule on a med-surg floor, I would find myself feeling very irritated by their constant requests. I was also taking care of cancer patients on the same floor and found myself being more compassionate towards them and angry at the patients who could walk and talk and would be going home to heal after a day or two. I don't think that I showed my anger towards the patients...at least I hope that I didn't. Many of the people we were taking care of on that floor had been abusing drugs prior to coming and I had learned during my hospice years that these people had pain just like anyone else, but require more pain meds to control their pain. Somehow, the MD's that were attending did not understand this principle.
When I worked in Hospice previously, I had a few addicts that came on to service and fortunately their doctors were good to them and would give them whatever they needed to be comfortable. I think that you will find it easier to control a patient's pain in Hospice because most of the time the docs are willing to medicate a patient with a long acting med and increase as necessary. The problems with pain control in the hospital setting are vast. Most of the patients are in there for a short period of time and the docs are just interested in getting them out ASAP and they don't want to think about long acting pain meds.
In the hospice setting, we know the patient is dying and we give them whatever they truly need to help their pain, whether it be physical, emotional, or spiritual. A patient with prior drug abuse history has just as much pain as someone that doesn't. Just remember that they will probably need a great deal more meds than most everyone else.
I hope this helps and does not sound judgmental.
YES , I , AND OF COURSE OTHERS KNOW A "DRUG SEEKER" TYPE......in an acute care setting.....but, let me just say this: HOSPICE PATIENT= LICENSE TO BE A DRUG SEEKER. i AM SORRY TO BE HARSH, BUT I THINK YOU SHOULD KNOW THIS, AND NOT EVEN HAVE THIS ENTER YOUR MIND WITH A HOSPICE PATIENT.
Hello everyone!
Mister Chris, MSN, NP
182 Posts
hello and a big thank you to you all involved in this passionate thread - i
had to say i agree, yes, yes, working in hospice/palliative care is very different from the normal hospital where you have to carefully sort out the genuine with the hypochodriacs. qualifications at the hospice (beside rn, en or ain etc.) should include compassion, patience, a passion for care and a belief or reverence in your own spiritual self. believe you do have something to offer. and be prepared for some unexpected tears from yourself. as i was told many years ago "if you loose the compassion then leave the hospice!". good luck.
mister chris :kiss
"there was a flower beside her as she opened her eyes.
each time it happened it was a wonderful surprise.
midst the pain and anticipation of treatments to come,
that small breath of freshness with warmth from the sun.
so thoughtful and precious yet simple its bloom,
poured out its beauty, all round the room.
during the long night when sleep avoided its call,
someone had delivered it, this choice gift so small.
yes someone so thoughtful popped in through the night,
left the gift from nature a single flower so bright.
as light came slowly through blinds all drawn close.
there it was again, but how? nobody knows.
each morning it happened she never knew who
had felt for her loneliness, knew her heart break too.
the flower gave pleasure and a meaning to live,
but her health now fast dimming, she'd nothing to give.
as days passed by she could no longer speak.
the flower was there, each day, each week.
her fight for life fading, the sickness came fast;
the flowers kept coming, how long could it last?
did she notice these tokens of love and good will?
when she lay on her bed so quiet and still.
the nurses and doctors knew her time had now run.
blinds remained closed yet a fresh flower had come.
very early that morning as her life drifted away.
the kind soul left a token, a red rose for her day.