Does "snowing" really exist?

[heyday]

I'm in my first year of nursing school, and I just learned about the underground issue of "snowing"--giving patients enough morphine to keep them out of pain but ultimately totally depressing their respiratory centers. I have never heard of this euthanasia-like thing before, and I wondered if the decision comes up for most people. And what could you do if asked to do this but did not feel comfortable with it?

Thanks!

[babynurselsa, RN]

The term snowing is not necessarily a term about euthanizing someone. The time is often used for someone who becomes sedated after medication. I can take Benedryl and am snowed for at least 12 hours.

I have worked in the hospital and as a Hospice nurse. I will treat a patient's pain(especially someone who is terminally ill) so that they can achieve the most comfortable state possible. It is not my intent to hasten someone's demise. I will be generous as my physician's orders allow me to alleviate someone's suffering.

[Tweety, BSN, RN]

Good question. ?

"Snowed" means sedated.

People who are dying are in horrible pain. It's a dreadful way to die. Sometimes we as nurses are called to give them pain medicine until they are sedated and no longer moaning in pain, and thus their respirations are lessened.

In my opinion, withholding pain medicine from a dying patient just because their reputation will be decreased is cruel.

[Nemhain]

babynurselsa said:

The term snowing is not necessarily a term about euthanizing someone. The time is often used for someone who becomes sedated after medication. I can take Benedryl and am snowed for at least 12 hours.

I have worked in the hospital and as a Hospice nurse. I will treat a patient's pain(especially someone who is terminally ill) so that they can achieve the most comfortable state possible. It is not my intent to hasten someone's demise. I will be generous as my physician's orders allow me to alleviate someone's suffering.

Good post babynrselsa. I'm just here to join the choir and say that everyone who is terminally ill does deserve to have their pain alleviated, even though it may ultimately hasten their death.

For the OP, For example, my friend's father was terminally ill with cancer, and the doctor said he'd only live for two weeks tops if he was to receive no pain meds. He explained that my friend's father had the right to have a pain-free death, but the number of meds it would take to rid him of his pain and make him comfortable would probably kill him in 2-3 days. Would anyone make this cancer patient suffer in excruciating pain so he could live in agony for two more weeks? Hopefully, no.

It would be unethical and illegal, however, to give a morphine bolus to grandma to send her on her way tonight when she only needed a little Vicodin and was thought to live another two mos. Do you see the difference?

Oh, as far as the term "snowing" in the hospital, it would be what Babynurselsa said, but I think I heard the term "snowed" on the show "The Sopranos"!?!? I think they meant it as "kill". Tony "snowed" someone last night. Hmm.

[Nurse Valium]

I fully support treating a patient's pain and feel it is immoral not to do so. Whatever the amount or the drug to achieve patient comfort.

It was once proposed to me by co-workers at an LTC facility that since "Ms. M." was going to go anytime that perhaps I could help her along the way with the sliding scale morphine order. I adamantly declined to euthanize her purposefully but did treat her pain throughout my shift that night & kept her comfortable to the best of my ability.

I have never been confronted again with that 'idea,' so I cannot answer how prevalent the practice is.

I hope that answers your question.

[rogramjet]

What you are talking about, I have heard is called the "Rainbow Effect". You give them enough pain meds to stop the pain, and it suppresses the respiratory system. My Mom was in amazing pain when she died of cancer, and the doc warned us about this, but her systems were all shut down anyway. Sometimes you have to give enough narcs to kill the pain, and yes, sometimes, that hastens a death which is usually inevitable anyway.

[JentheRN05, RN]

I had this with both my mom-in-law and my grandfather. Both were in hospice, and both, ultimately died from an overdose when death was inevitable anyway. I remember my grandfather distinctly. He was moaning quite a bit; we had to continue giving him morphine (SL) because of it. He possibly would've lived a couple more days, but no one wanted to prolong his agony due to the risk of respiratory depression. So we gave it to him. He died quietly, in no pain, I'm sure ?

[Laurell28]

There is a perfect statement on the HPNA website regarding opioids at the end of life, particularly regarding respirations. It says no conclusive proof exists that opioids at the end of life will hasten death. I'll try copying the link, but honestly, I'm not exactly sure how to do it.

http://www.hpna.org/pdf/Providing_Opioid_at_the_End_of_Life_Position_Statement_PDF.pdf

[Grace Oz]

Isn't language and terminology intriguing and sometimes funny?

Here in Oz, we have a saying, "snowed under," meaning you are overloaded with work, trying to catch up, and busy.

[purplemania, BSN, RN]

Read up on palliative care. A website by palliative care nurses (and others) gives insight into this question. http://www.nhpco.org

[Gail-Anne]

We also used the term "snow them" in psychiatry. When someone was acutely agitated, we would "snow" them with meds. (I'd say "put them to sleep," but I'd have to explain that I don't mean that in the veterinary sense!) It was shown in many studies that you used less sedating and anti-psychotic meds at the end of 2 weeks if you strike them, rather than upping meds off and on when they were trying to beat the staff, elope, etc.

This wasn't for all episodes, of course; it meant for the lady that took six police to wrestle her out of the church, for example!

[NotReady4PrimeTime, RN]

Then there's the snowing for the convenience factor. That would be the overuse of narcotics and benzos to anesthetize an ICU patient so that the nurse can look after more of them. It's hard to care for more than one intubated awake and agitated patient picking at their lines, whipping their heads back and forth, and trying to climb out of bed. I wouldn't say I like that method of dealing with staffing problems. :angryfire Then, of course, when the patient is getting better, they suffer horrible withdrawal and need a methadone and lorazepam program to get through it.:smackingf