MORPHINE and Dying Patients - page 10
Curious about the administration of pain medication (Morphine) and possibly speeding up a patient's death.... Read More
Dec 4, '07Occupation: Student Joined: Sep '07; Posts: 5; Likes: 19Quote from milnerI am so happy to see your response. I am not only a nurse but a chronic pain patient. Let me tell you, it is very difficult to get people to truly understand what we experience on a daily basis. I have had chronic excrutiating lower back pain for 14 years, actually since the day my daughter was born. It has gotten progressively worse, I have tried everything, including the fluroscopic S/I Injections. My doctor has me on vicodin and I have taken it for years now, I worry all the time about the amount of tylenol in it, so I have been weaning myself off it. I would rather deal with the pain I guess than the liver damage that can happen with that much tylenol. I certainly wish they would treat chronic pain patients with the same respect they do cancer patients. I have no choice, I have to work, take care of my family and live life, no matter how much pain I am in, so good pain mgmt would be helpful. I can't just lay around in bed. Kudos to those nurses that are working in the field of pain mgmt. I could never do that, because I would empathize too much and it would be too hard to see people suffer and know there's not much you can do for them. Just so no one starts to think I am working as a nurse while taking vicodin, I'm not. I am now working as a travel agent because spending so much time on my feet was too painful for me, so due to my chronic pain, I have not been able to do the job I love, was trained to do and thought I would be doing for the rest of my life!As pain management is a particular interest of mine I am very happy to see the replies to this thread. If a patient is dying then make them comfortable. That is what pallative care is all about. However, don't forget the other patients...those not dying but with moderate to severe pain. They too deserve pain management. I am constantly frustrated with nurses who say they don't believe the patient is in as much pain as they state. For those of us in acute care we need to start believing and medicating accordingly. Note I don't refer to detox or drug rehab issues...the point is for acute pain & chronic pain in the patient without a history of addictive disease to be believed. But....even the patient with addictive disease deserves pain management. If they are dying or not they will be more likely to be tolerant and need even higher doses due to their addictive process .Last edit by mgerrity on Dec 4, '07
Dec 4, '07Occupation: RNCase Mgr for Hospice patients Specialty: 10 year(s) of experience in Hospice, Psych, Geri, LTC ; Joined: Nov '07; Posts: 9I do Hospice in the home, NF, inpt settings and use Morphine alot. It is the drug of choice for extreme SOB esp if the pt is dying. If the pt is actively dying it only gives them comfort so they may die comfortably and with some dignity. If they are in distress, alot of pain, active I say go for it..get the order from doc to give the pt some peace.I have never felt like I was killing someone by using Morphine and have never been accused of it by the families or facilities.We are pt advocates.
Dec 4, '07Occupation: Pediatric Staff Nurse, Disease Manager Joined: Dec '04; Posts: 94; Likes: 47Quote from Sabby_NCSuespet I respect your opinion but just because a patient 'looks' comfortable does not necessarily mean this.
If a patient was in pain and receiving regular pain medication before the active dying, non communicative phase, then they still have pain. Pain does not miraculously stop once they are unconscious.
Pain medication still must be given to ensure their pain is controlled as best we can.
That is what we do being their advocate and care giver. We remain one step ahead and vigilant of all we can do.
The Lord certainly knows where our hearts are and that is doing the very best we can in our comfort measures of those patients put in our care until their (we pray) comfortable death that they request.
Amen sister! I have worked with a pediatric population who also (the little ones) cannot always communicate their issues, so I gave them regular doses of meds to relieve their pain, even though they couldn't tell me. It's not the same, exactly, but same principle. Just because they 'look' comfortable does not mean they are.
Dec 4, '07Occupation: Pediatric Staff Nurse, Disease Manager Joined: Dec '04; Posts: 94; Likes: 47Quote from JennaRN1006Thank you. I'm not slamming suespet, but please, please, please, give the meds! I also work with a population with chronic pain (RA, SLE, MS) and when they tell me of the pain, and the crying and sobbing and what they've gone through with their doctors NOW just to get appropriate pain relief to function, it really frosts my cookies (ha) when people want to withhold meds from nonresponsive people who can't speak up for themselves. I educate patients nearly every day about pain management because they are so afraid of becoming addicted. I am a Christian too, but I have to remember that God does not want his children to suffer, and therefore I have no problem giving the pain meds. If I was in that situation, I'd want all the medication I could take to keep the pain under control.Ok I have read all of these posts, and I have to disagree with suespet and others who agree with her. Like many others have said before me, it is our job to assess pain. However, it is subjective. Therefore, VS, and pts may not verbally tell us what their pain really is. I am an oncology nurse -- I work on a Med Surg unit. I see post ops to the terminally ill. Many of my walkie talkies (post ops mostly) will under rate their pain, suck it up and deal because they dont want to take the medication for side effects, dont like how it makes them feel, or fear of becoming addicted. Education is key here. If they still refuse, I always let them know that it is available to them whenever they want it. And if I give it to them, I also tell my pts to let me know if it doesnt help them, because maybe it might not be the right drug for them. I will go as far to call a pt out when they are under rating their pain, if they are wincing, hunched over, grimacing, whatever. I will tell them you appear to me to be in pain. Why?!? Because I want them comfortable. It is a JCAHO (in the US) standard to maintain a level of comfort for our pts. For the terminally ill, pain control is even more important. For those who are unconscious, youre non verbal cues and assessments are what will tell you if your pt is in pain. I would give all the pain meds I could, if it made my pt comfortable and not suffering.
What bothers me the most is this idea of beliefs (religious or otherwise). I am christian as well, however, as nurses, we need to put those aside and do what is right for that pt. If we can not then it is our responsibility to advise our charge nurse. You can not with hold medication from a pt because you dont believe it is right. Im sorry. If the pt is snowed, by all means that is a different story. But if you believe it is wrong, then you are mistreating your pt. Think of the pt who is the Jevoah's witness. They do not receive blood products. In a child or adult who has a Hgb of 5 or 6, and all they need is a transfusion and it will help the immediate problem at hand, I may disagree with my pt's wishes, however, I must respect it and leave my own beliefs at the door. I need to treat my pt in other ways to help minimize bleeding, etc. I do not say, well i dont agree with them so Im not going to give this med at q3h, i will give it at q6h instead. As nurses, we cant do that. We need to treat and maintain a pt's pain and comfort level no matter what we believe.
Ok I am off the soap box...sorry for the long winded responseLast edit by tiggerforhim on Dec 4, '07 : Reason: clarification
Dec 4, '07Occupation: Pediatric Staff Nurse, Disease Manager Joined: Dec '04; Posts: 94; Likes: 47Quote from suespetsfeelin bad that i can't get some people to understand how i feel in this issue.i have never knowingly withheld pain meds from pts in pain.when i said i might give it q6 hr,i meant one dose,cuz the pt(btw,non-cancer)had been getting it q3, even unconscious, so i would skip 1 dose,essentially.i still feel nobody can really leave his/her belief system at the door.to me, thats living 1 depressed life,going against your values.i am familiar w/ the" feel the pain,cuz it's the lords will"thing.not one of my beliefs.i have gained some food for thought from some of these entries .will explore further. I realize even agnostics can share my feelings on this matter(not bringing christianity to it) btw:what is a 'frequent flyer',or a 'walkie talkie'?or crna?
The point is, if the patient had been getting it Q3, then your not giving it very likely would plunge them into a withdrawal syndrome, and then at the 6 hour mark, they would need even more medication than whatever dose you would have given them which is what they were using to stay on top of the pain. That's the point. If you can't see that .... oh dear. This has nothing to do with beliefs (at least from my point of view). Well, maybe it is, because my BELIEF is that you need to give whatever they need to stay comfortable....and I'd rather err on the side of caution than having to deal with people in severe pain, conscious or not.
P.S. sorry for the 3 posts in a row, but this is something I really feel very strongly about.
Dec 4, '07Specialty: 19 year(s) of experience ; Joined: Dec '07; Posts: 2,366; Likes: 4,417Quote from ShayRNThank you for this post.I have been a Hospice nurse over a year now and have been a part of literally a hundred deaths. I have never, never, never seen morphine kill someone. I have, however, seen it make people comfortable and relaxed. I have noticed that instead of screaming out for me to kill them, they are able to exspress to their loved ones their feelings. I have seen them go from 48 breathes per minute to 20 after a few doses with a lot less distress.
Please read Myth #4
I have never seen anyone die from being properly medicated for pain and symptom mgmt. Many doctors and nurses are ignorant concerning palliative care. I've seen nurses who refuse to be educated on the subject. I've heard them say "I am not giving that much morphine." Even when its a dose a pt has been on for several days and is tolerating well.
I once attended a pain control seminar with a DON from a LTC facility. A few months later, her own grandmother was put on hospice, and continued to live in the facility where the DON worked. The DON refused to let us give her grandmother more than 2mg of MS q 4 hrs. She was her grandmother's DPOA. The whole family trusted in her that she knew what she was doing, but her own grandmother suffered for her ignorance, and her refusal to accept education on palliative and end-of-life care.
Like you, I've seen pts so in pain they were unable to speak. After their pain was controlled through medications, I've seen the same pts be able to talk and laugh with their family members , then die quiet, dignified, peaceful, and comfortable deaths.Last edit by Valerie Salva on Dec 4, '07 : Reason: typos
Dec 4, '07Joined: Apr '00; Posts: 24,611; Likes: 35,453Quote from Valerie Salvathis is so, very true.Many doctors and nurses are ignorant concerning palliative care. I've seen nurses who refuse to be educated on the subject. I've heard them say "I am not giving that much morphine."
regardless of countless inservices, many remain indignant in their misconceptions.
the irony is, fear and ignorance are far more lethal, than any amt of morphine.
Dec 5, '07Joined: Oct '07; Posts: 246; Likes: 101lantanaRn: there's no med error when decideing to not give a prn morphine . if a med it scheduled,u can also hold a dose and alert physician esp. if 3 doses held for good reason, in this state anyway.
Dec 5, '07Occupation: Flight/ER Nurse Specialty: emergency and trauma ; Joined: Apr '07; Posts: 320; Likes: 252Quote from jmgrn65no if they are actively dying then you are only making them comfortable, they are going to die whether or not you give them morphine. Can you live with yourself knowing they suffered and died, or they were comfortable and died.
Dec 5, '07Occupation: case manager for Hospice of Palm Beach County Specialty: 15 year(s) of experience in geriatrics and hospice palliative nursin ; From: US ; Joined: Aug '07; Posts: 24; Likes: 31Quote from suespetsYou are correct on withholding a prn dose, however I am referring to a routine dose, and as many of the other posters have stated, that routine dose that you choose to withhold could cause my patient who appears to be pain free to be right back in pain again and harder to control because the point was to keep on top of the pain and not let it escalate.lantanaRn: there's no med error when decideing to not give a prn morphine . if a med it scheduled,u can also hold a dose and alert physician esp. if 3 doses held for good reason, in this state anyway.
Dec 5, '07Joined: Nov '06; Posts: 20,715; Likes: 23,951Please please, if I am ever dying and in your care, crank up the morphine and let me go peacefully.
Dec 5, '07Occupation: newborn nursery Specialty: 8 year(s) of experience in nursery, L and D ; Joined: Feb '07; Posts: 1,020; Likes: 341I would have a A VERY HARD TIME with my dying pt being in pain. It all depends on what the pt wants. I expect most want to be as pain free and at peace as possible. I know I would want that.
Dec 5, '07Occupation: supervisor-12 hr shifts Specialty: rehab,geriatrics ; Joined: Feb '06; Posts: 30; Likes: 9in 50 years nursing I have seen morphine use go from very little to quite common for end of life pain the patients comfort is the main goal here.my current position is in long term care and in it I have really seen a significant increase in use here due to doctors and hospice who seem to finally realize that end of life no matter what the cause should be comfortable!as supervisor I often have to deal with this question as new grads are afraid to use morphine even when ordered by doctor and hospice.I think some nurses forget that it not only is for pain but the anxiousness and air hunger that comes with that time.While I don't believe every nursing home resident should have roxanol,I do believe anyone who hospice has evaluated and believe is in end stages of life deserves to have their wishes to die with diginity and comfort met and that is our job to do that for them.