Moral Distress

madwife2002, BSN, RN · Feb 8, 2008

I think leslie hit it right on the head when she said

but when level of comfort has been achieved, totally achieved, where does the rationale for more morphine come in?

The pt is comfortable and when it is time for that pt to die they will do so without suffering. I do not believe that we shoudl speed up the dying process we should make the pt comfortable, and death will come in it's own time.

LadyJRN1 · Feb 8, 2008

Thank you to all of you who have posted your opinions and experiences. I believe my feeling of distress is with the dying patient who I feel God will take in his own time, I don't want them to suffer; however, I don't want to push them into the doors of heaven either. I have left critical care and need to find an area where I am not so exposed to this type of environment.

BlueRidgeHomeRN · Feb 8, 2008

my experience is from the other end of the life spectrum. i was caring for a postpartum mom who had just given birth to 30 week twins (several years ago when this was considered very premature).

the girls had congential cardiac abnormalities, and were being treated very agressively in the nicu. the parents were never consulted about treatment options for these little girls--they were on vents, pressors, ecmo, and finally taken to surgery, where they both died on the table.

mom never got to touch, let alone hold these babies. all the "stops" were pulled out lest there be a lawsuit, despite the almost 0% chance of survival for these children. (sorry, can't remember if it was tetrology of fallot or something similar plus weights of around 700 grams.)

she never stopped crying from delivery to when the babies died days later. all i could think of is how much saner it would have been, at least once ecmo failed, to let these little angels die in their mommy's arms.

StNeotser, ASN, RN · Feb 8, 2008

I'm afraid I felt just awful when my 93 year old patient with pleural effusion, CHF, pneumonia and many more dx went back up to ICU for the third time in a month last night. He is a full code. I don't expect him to be around after today, but I really think his body wanted to go a couple of months ago and his family wouldn't let it go.

Chaya, ASN, RN · Feb 8, 2008

I am writing a paper on the topic of MORAL DISTRESS and would like some feedback from R.N.'s. Please base your response on this question: Have you ever been put in a position morally in your career where you questioned the actions of yourself or other nurses? One example would be increasing a morphine drip on a dying patient to satisfy a family. What did you do about it? Any info will do! Thanks!!

I have felt serious moral distress more than once from when a morphine drip has NOT been increased b/c family not ready to let pt go.

Generally this is a "teachable moment"; these families may be totally unaware of the stages of dying and when different comfort measures are appropriate. Sometimes they need someone to actually state to them that their loved one is so close to death and that the goals of comfort measures are different than those of medical management. (I consider the families of the dying to be me patients, too and a little reality therapy can lead to discussions that revael a lot). Sometimes, as one poster noted there is some factor like family or the patient themself wanting to prolong life until a family member can be present. Often it seems the patient does not slip away until they have received assurance that their family will be alright.

Sometimes, though, the family is in denial or whatever and it makes me crazy to know I'm not giving my patient the care the deserve.:uhoh21:

queenjean · Feb 8, 2008

I had some terrible distress over an incident that still bothers me, many years later.

The doctor's office I used to work for contarcted to provide care for a group home for girls who were in the legal system and were pregnant, parenting, or postpartum.

One day a worker brought in a 15 year old girl on a Friday afternoon to get a Depo shot. I did the usual paper work, had her sign the consent form, and got out the shot. And the girl went ballistic. She started crying and threw up in the sink. She was shaking and pale. I was totally caught off guard.

I put the shot down and asked her what the heck was going on, and she said she was terrified of needles, she didnt' even want to get the shot, but that she wasn't allowed to go on leave if she didn't get it. Her baby was living with her aunt, and she had a weekend pass, but it was contingent upon several stipulations, one of which was that she get a Depo before she went (apparently she had a history of failing to use other methods responsibly).

I told her I couldn't give it to her if she really didn't consent to it. Then it got worse, she was sobbing and begging me to give her the shot so that she could go see her baby. When I said that I didn't think she really wanted me to give it, the girl kept going "Yes I do, yes I want it, give it to me, I want to go see my baby!" I finally did--she was crouched in the corner crying and screaming and dry heaving, her worker was leaning on her to hold her down, and I had to help hold her down while I gave the shot.

I felt HORRIBLE. I was shaking and crying by the end of it. I told the worker that if they ever brought anyone again that was being coerced into getting any type of medication, we would cancel our contract with them. I also told her I was reporting this to SRS--I don't know what the outcome was.

I still to this day don't know what I should have done. Should I have refused? Then the girl wouldn't have gotten to go on her pass to see her baby. All I know is that, when it was all said and done, I felt like I had RAPED her--holding her down, sticking that needle in her while she cried and wretched, oh my god, I will never forget that until the day I die.

SICU Queen · Feb 8, 2008

I had some terrible distress over an incident that still bothers me, many years later.
The doctor's office I used to work for contarcted to provide care for a group home for girls who were in the legal system and were pregnant, parenting, or postpartum.
One day a worker brought in a 15 year old girl on a Friday afternoon to get a Depo shot. I did the usual paper work, had her sign the consent form, and got out the shot. And the girl went ballistic. She started crying and threw up in the sink. She was shaking and pale. I was totally caught off guard.
I put the shot down and asked her what the heck was going on, and she said she was terrified of needles, she didnt' even want to get the shot, but that she wasn't allowed to go on leave if she didn't get it. Her baby was living with her aunt, and she had a weekend pass, but it was contingent upon several stipulations, one of which was that she get a Depo before she went (apparently she had a history of failing to use other methods responsibly).
I told her I couldn't give it to her if she really didn't consent to it. Then it got worse, she was sobbing and begging me to give her the shot so that she could go see her baby. When I said that I didn't think she really wanted me to give it, the girl kept going "Yes I do, yes I want it, give it to me, I want to go see my baby!" I finally did--she was crouched in the corner crying and screaming and dry heaving, her worker was leaning on her to hold her down, and I had to help hold her down while I gave the shot.
I felt HORRIBLE. I was shaking and crying by the end of it. I told the worker that if they ever brought anyone again that was being coerced into getting any type of medication, we would cancel our contract with them. I also told her I was reporting this to SRS--I don't know what the outcome was.
I still to this day don't know what I should have done. Should I have refused? Then the girl wouldn't have gotten to go on her pass to see her baby. All I know is that, when it was all said and done, I felt like I had RAPED her--holding her down, sticking that needle in her while she cried and wretched, oh my god, I will never forget that until the day I die.

OMG that is just awful. I don't know what I'd have done in that scenario, but I can guarantee you it would've haunted me too.

BIG ((((hugs)))) to you... :redbeathe