No pain meds for you, mother - page 2
I've been taking care of this 80 years old women for total of 4 or 5 shifts now. Diagnosis of ARDS, intubated on the vent, FiO2 from 70 to 100%, off sedation, alert, awake and somewhat appropriate,... Read More
Jan 30, '07Joined: Apr '04; Posts: 361; Likes: 192Could the use of narcotics be a religious issue?
Jan 30, '07Joined: Feb '04; Posts: 386; Likes: 151Quote from bookwormomit's a good question. They are white middle class Americans. No cultural or religious issues noted so far, but I could ask.Could the use of narcotics be a religious issue?
Jan 30, '07Joined: Feb '04; Posts: 842; Likes: 576Be an advocate! Involve the ethics committee, the MD involved. Do you have a palliative care MD in your facility? If so suggeest to the primary that he/she consult with them. Another option is to get the doc to order x mg. Morphine q whatever as a continuous order not prn. Keep fighting! I know that I would want someone like you to care for my family.
Jan 30, '07Specialty: LTC ; From: US ; Joined: May '06; Posts: 412; Likes: 108Fear of losing a loved one can interfere with the ability to make rational decisions. The poster who brought up euthanasia may be on the right track. The family may feel that pain meds will just make her sleep for the rest of her life.
Jan 30, '07Occupation: Happily in Nursing Education! Specialty: 13 year(s) of experience in Education, Acute, Med/Surg, Tele, etc ; From: US ; Joined: Oct '04; Posts: 2,757; Likes: 415Been here many times, so many times my blood no longer boils but goes into advocate mode right away. I get my MD's involved and explain to them that they need to have a sit down with the family, or get hospice involved straight away if possible...even if it is just for the family to hear what they have to say in order to make a decision.
I also know the meds well, and explain the actions of the low dose of Roxinal (I don't call it morphine if I get roxinal because of the stigma of morphine). Lower doses actually help the lungs and hearts vessels to open helping with oxygenation and hindering hypoxia,(hypoxia is what I call dry drowning! Very uncomfortable, very terrifying, and makes you restless and painful!). Roxinal is also absorbed quickly and has a short time of action because the body has receptors that use a similar pain inhibitor as morphines...so the body understands it, uses it, and can process it easier than other pain medications. I mean think about it...we use morphine to help heart attacks...that is exactly why!
I also am kind enough to get literature for the family about the medications, reminding them to give side effects a grain of salt because in trials anyone that experienced anything has to be put on there due to federal rules. Also that RN's are trained to spot probelms and avoid probelms, and if problems arise, know what to do!
I feel the more they know...I mean the FACTS, the more likely they will be to let you do your job. Sometimes that takes MD's or management...ethics commitee if you can get to them easily.
And bottom line, if the family is keeping you from your tasks, or not following hospital protocol or MD orders...then they must go to another facility...that is a huge liablity hanging there! Yes a patient has the right to not do a treatment or meds etc. but hindering a nurse to a point is a liablity and shows that another facilty maybe better for all concerned. (like a hospice house).
Jan 30, '07Joined: Jan '07; Posts: 167; Likes: 176Quote from mystic_fish0526You know, I've been in the same situation before with one of my patients. Except, it was the opposite of yours. This patient did not want pain medicine because she was being overmedicated previous to my shift. The nurse before me was afraid to stand up to the family and explain to them that it is the patient's decision. The family got mad, but I told them, "Look, I am asking Mrs. So-and-so what SHE wants. I'm sorry, but the decision is hers to make, and I must respect that." From then on out, when the family asked for something for pain, I always went directly to the patient before giving it. It's just not right when some family members want to speak for someone that is capable of speaking for themselves. And it is not right that we be backed up against the wall for doing what the PATIENT, not the family, wants us to do. I just stand tall and firm and I usually don't hear anything else about it.I've been taking care of this 80 years old women for total of 4 or 5 shifts now. Diagnosis of ARDS, intubated on the vent, FiO2 from 70 to 100%, off sedation, alert, awake and somewhat appropriate, on tube feedings, with a chest tube, with a rectal bag on, having wrist restrains on. Very little chance of recovery. Finally made DNR by the family after weeks being like that, but family wants "everything" to be done. Family is very skeptical of her being uncomfortable, even when she is getting restless or nods "yes" when asked about pain, and objects when I try to medicate poor woman for pain. Night shift tells the same story. It got to the point that we try to medicate her when family is not around so you don't have to fight with them over 1 mg of Morphine every 6 hrs, but they are in the room almost 24 hours a day.
It looks like they are in denial of reality that it IS uncomfortable to be in a position she is now. We all try to educate them about pain control, but they still argue she does not need it. I even heard them discussing it with RT who came in to check on the vent.
What would you do? I want to be an advocate for the patient, who is not able to speak for herself, but I am running out of ideas what else to do, beside educating and emphasizing that pain issue is very real.
I undestand that the family has the best intentions, but for them to want this woman to stay doped up all the time so she wouldn't worry them, is not a good reason to overstep the patient's wishes.
Jan 30, '07Specialty: ED, PACU, OB, Education ; Joined: Sep '06; Posts: 43; Likes: 8To my way of thinking, an alert patient who is expressing pain in any mode (verbal or nonverbal) has the right to medication for that pain and you have the duty to provide it. This family needs to be honest about why they want to interfere with mere comfort measures. They want "everything done" except pain med? She's dying faster because of being in pain. You need to take this to a higher level because my concern is they will turn on the nursing staff -- "You didn't do anything for her and she was in agony!" Family can be so irrational at times of crises. They sound so totally oblivious to the real situation. Get Risk Management, Ethics, the physician, Spiritual Care, Hospice, whomever can help involved.
Jan 30, '07Joined: Apr '04; Posts: 361; Likes: 192I know that some Seventh day Adventists want to avoid narcotics. It also seems to me a possiblity that the family may have had some traumatic experiences with an addicted member in the past-- even the patient herself. None of this is to say that the pain medication you are trying to give is not appropriate, but it might make it a little easier to see where the family is coming from.
Jan 30, '07Occupation: home health Specialty: med/surg, geri, ortho, telemetry, psych ; Joined: Oct '06; Posts: 693; Likes: 30Right now the family doesn't accept her pain even as she admits it. It's only going to get worse after she cannot tell you anything. They are never going to believe the nonverbal signs of pain. If I was you I would get the ethics comittee involved. Don't give up. Don't let that woman be in pain. Good luck to you.
Jan 30, '07Joined: Sep '03; Posts: 6,885; Likes: 12,486Quote from nurse_nanITA. Your responsibility is to the patient. If this case were reviewed/litigated, could you defend the decision not to medicate this patient? Have family members actually interfered with administration of ordered meds?To my way of thinking, an alert patient who is expressing pain in any mode (verbal or nonverbal) has the right to medication for that pain and you have the duty to provide it. This family needs to be honest about why they want to interfere with mere comfort measures. They want "everything done" except pain med? She's dying faster because of being in pain. You need to take this to a higher level because my concern is they will turn on the nursing staff -- "You didn't do anything for her and she was in agony!" Family can be so irrational at times of crises. They sound so totally oblivious to the real situation. Get Risk Management, Ethics, the physician, Spiritual Care, Hospice, whomever can help involved.
A DNR order ... but family wants "everything done" ... but no pain meds??
A meaningful discussion with this family is in order, pronto. They will be well-served by gaining a clearer understanding of advance directives and appropriate, ethical end-of-life care.
Jan 30, '07Occupation: RN Specialty: 20 year(s) of experience in ICU, PICC Nurse, Nursing Supervisor ; From: TX, US ; Joined: Apr '04; Posts: 5,001; Likes: 1,902This is a situation that just burns me up..... I would involve anyone I could to get some sense into them. I also would consider looking into a pain patch and placing it on her back (out of sight) then doing some supplemental pain med work until that kicks in..It is my thought that if the patient has indicated she is in pain, then that's all I need. She gets what she needs to be pain free.
Jan 30, '07Occupation: Jack of all trades Specialty: 20 year(s) of experience in Med/Surg, Geriatrics ; From: US ; Joined: May '01; Posts: 4,438; Likes: 3,919Geez nurses, I'm very disappointed in all of you whose first response was to "call the doctor". As a patient advocate and the professional who is on the front lines of this patient's care you are empowered to take action other than "call the doctor". Is there a clinical nurse specialist on your area? Contact him or her about your concerns and perhaps they an set up a meeting. OR you can get with the charge nurse, call a meeting with some of the family members yourselves and get to the bottom of it. It need not be a huge formal meeting, you can start off with "It seems to us that you have some concerns about your mother receiving pain medication. Let's discuss this." You can also at that time assess what their understanding of what a DNR really means. If your discussions do not bear fruit, you may then go on up the food chain, possibly your nurse manager, ethics committee or whomever but you should be the ones to handle this. By all means, let the physician know what is going on since it is his/her patient, but you really don't have to wait for someone else to handle it. This is within your scope of practice.
Jan 30, '07Occupation: ICU Nurse Specialty: 21 year(s) of experience in Newborn ICU, Trauma ICU, Burn ICU, Peds ; From: US ; Joined: Jun '04; Posts: 265; Likes: 32Quote from SharonH, RNI agree that this is within the nursing scope of practice (and certainly should be handled by us if at all possible). But we need to be honest, we all know that many, many people do not believe things unless it comes out of the mouth of someone with a long white coat and an MD after their name. I can educate until the cows come home, provide printed materials, cite my experiences and studies I'd read and still have people not "grasp" some concept until it comes from an MD. Even from an intern who was still in middle school when I got my first job!Geez nurses, I'm very disappointed in all of you whose first response was to "call the doctor". As a patient advocate and the professional who is on the front lines of this patient's care you are empowered to take action other than "call the doctor". Is there a clinical nurse specialist on your area? ...
What about Pain Service, does your institution have one? Perhaps a consult with them would help?