I gave the last dose...

[pedsrnjc]

It was a rough night last night. The resident was one I had worked with for years and I loved that resident. I had never seen that much mottling. Family was at bedside. Resipirations 60. Unresponsive. Eyes looked pained, not normal dying. No Morphine order, just oxycodone and tylenol rectally. Gave tylenol and 10mg oxycodone per prn orders. 50 minutes later resident dead.

I know I didn't kill him, the disease did, but my heart hurts. I feel responsible. An elevation in vital signs can indicate pain in an unresponsive person, right? Right? He was also twitching his eye brows and occasionally clenching his fists. After working with him for years, I loved this one. He suffered as many years as I worked with him, he needed to go, so why am I grieving?

Just needed to debrief. Thanks.

[TonyaM73, ASN, RN]

You were there and you CARED for him...that is all we can ask. I would love for when my time comes that not only would I be with someone who cares for me, but also that someone be the person that can give me pain relief at the very end. YOU DID GOOD! Greive and then remember this person and how they have improved your life and be happy that you are in a field to make a difference in someone's life and death.

[Flare, ASN, BSN]

You treated pain, as indicated by vitals and symptoms per order. You didn't go out of your scope and you didn't violate your order. You cared for the patient very well. All too often i have seen unresponsive patients be denied pain simply because they cannot physically ask for it. Kudos to you for seeing the entire picture. My deepest symptahies to you as well, it is difficult to lose someone that you become close to, even if it is via a professional relationship.

[OttawaRPN]

When I was a bright-eyed and bushy-tailed student, I gave a scheduled Morphine dose to a palliative patient and within 20 minutes, he took his last breath in front of me. My first thought? A fleeting moment of panic, "OhmyGawd, I frickin' killed him!"... then reasoning sunk in and I was fine.

Let that moment come and go, then remind yourself: he would have died anyway, you just made the transition to the other side as painless and peaceful as you could.

[Sparrowhawk]

Ya did good mate. *hugs* You loved him, cared for him, took good care of him right to the last...made his transition painless...You're crying because you cared. Deepily. Good on ya.

[littlemammanurse, BSN, RN]

I was working on a palliative floor and the same thing happened to me.The patient was unresponsive was making moaning noises, and vitals and O2 sat were very low.Family wanted to try and keep her alive as much as possible and refused to give her pain medications.It was awful.On the 3rd day of this going on, and their refusal of pain medications for her I had had enough of it.I told family that she needed medications,they refused again.I advocated for my patient though and knew that she was suffering from pain and I didn't want to let her die in pain, I wanted her to die in peace.I charted that family refused and my charge nurse asked how the patient was doing.She then asked if I had given pain medications for her, and when I told her that the family had refused pain medications for the patient she went in and talked to them about this.They finally agreed to let her have some prn tylenol as well as morphine for the pain.After I gave her the medications, she stopped moaning, and died peacefully and not in pain.I felt horrible for having to do this, but I knew that she died free from pain.The family never forgave me for it, and I know they wanted her to stay on this earth as long as it was physically possible but she was already slipping away.

I cried later because I felt so bad that they were angry with me, as well as I missed this dear sweet old lady.My charge nurse assured me that I was doing everything to ease the pain of that patient and that I advocated on her behalf.

[PoetOfMyHeart]

Good job! Don't question your nursing judgment..you recognized those nonverbal signs of pain, and you provided relief and comfort to your pt. When pain/discomfort/restlessness is controlled in an imminent person, the natural dying process can take place. You DID NOT kill your beloved pt.

Those moments are so hard in LTC. I pray you find reassurance in the fact that you provided quality TLC to that person and that you remember his/her life more than their death.

~Sara~

[NamasteNurse, BSN, RN]

" He suffered as many years as I worked with him, he needed to go, so why am I grieving?"

You are grieving because you're human. It's very hard, especially if you are a younger nurse to understand that death can be a welcome state for these very sick very old people.

Death is part of life. As a nurse in LTC you must know that people pretty much come to the nursing home and die. It's what we do. We take some of the pressure off their loved ones, we help the family get through it. we help the patient with drugs and love. It's all we can do.

Some of these people are very sick and have been for years. They are in much pain. Their loved ones are in pain of seeing that and their lives are disrupted with the bills, the visits, the worry. If that seems harsh, I don't mean it to be, it's just reality.

Death can be a blessing for all involved. You made it easier. Don't make it about you, for you are just a bystander to this very normal part of life. It can be sad, especially when we love a patient, but it also brings so much comfort to the family to know that at the end their loved ones nurse also loved them. What a beautiful gift you gave. You will be sad, but you will go to work and see the ones who are still there, you will fall in love again and care for those you love.

Be peaceful. Love to you...you beautiful nurse!

Namaste

[ChristaRN]

God Bless You for being the kind of nurse everyone needs. This man was blessed to have you care for him. Now when I was a new nurse and was giving pretty hefty doses of PRN morphine to a palliative care patient I originally was worried too - what if I would give that last dose? My viewpoint has changed honestly. My goal is to provide comfort to my patient and if that dose of Morphine I give is the one who stops his heart my goal is still met - either they are alive and more comfortable or they pass away (comfortably) and will never feel pain again. That might sound a little morbid but I really do feel that death is sometimes the best option and I no longer worry if I am going to be the one to "cause" it when giving an appropriately prescribed med. Take care and keep up the great work for your residents!

[Esme12, ASN, BSN, RN]

You are grieving because you cared! Have a good cry and allow yourself to grieve. You treated his pain because you cared and eased his mind.

You did GOOD!!!!! YOU cared and treated your patient.

Hugs and a :kiss. Prayers for you to find peace.

[CrunchRN, ADN, RN]

When I was in clinicals many moons ago I had 3 peeps i gave MS to die in that one week.

My instructor who was usually a total dog assured me I had not knocked them off. One of them i gave the MS and went to lunch and came abck and she was gone...

You gave excellent care. Be happy the patient had a nurse like you and know that he can now rest without any pain or discomfort

[rdsxfnrn]

i gave my dad his last doses of morphine/haldol/valium. he had stage 4 lung CA and he had a great 10 months at home, and the last cpl days were the only time i saw him in pain. his heart literally stopped beating when i was trying to get an apical pulse rate. i have really thought about this and I know that I did not do anything to hurt him, only to help him. you did the same thing. kudos for caring................