MORPHINE and Dying Patients

Nurses General Nursing

Published

Curious about the administration of pain medication (Morphine) and possibly speeding up a patient's death.

Specializes in cardiac/critical care/ informatics.
i'm hearig examples of people who, for instance, were in dior pain, or who had vss.india\cating possible pain:i'm talking about neither.i read the article ,and i wonder how you prove someone is in pain,when they are unconscious?it's interesting to note,who wrote these articles, pharmacuetical companies, or what is the agenda? also, i'm a great believer that the lord planned that his people would find pain relieving drugs.i just don't believe in snowing pt's for fam. closure, or so staff can say"next".iv'e doubted studies before,that have been shown latter ti be wrong.

Ok understood but I don't think anyone here is talking about snowing a patient just for the sake of making them quiet, or to say "next" which by the way is a horrific thought. But you do need to give a patient that is in known pain (terminal from ca, chf, copd etc) regualarly scheduled dose of pain to keep the pain in check. If your patient rr is good there is no need to think that the morphine you are going to give them will send them over.

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Anyone who has worked with patients w/chronic pain (terminal or not) or even suffers from chronic pain themselves, can tell you that it's far more difficult to get pain under control than it is to keep it controlled.

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Once a pt's pain is out of control it is much harder to get it back under control, that is the reason for giving the medication ATC even if they "look" comfortable. If they are in pain that is not our choice whether or not we think they look in pain. There are many people who do not have a jump in vitals or any other obvious signs of pain, it does NOT mean they are not in pain. This has nothing to do with being a "christian" nurse or not, witholding pain medication in playing God much more so that giving them a dose to make them comfortable. JMO.:nono:

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Specializes in ICU, currently in Anesthesia School.
i'm hearig examples of people who, for instance, were in dior pain, or who had vss.india\cating possible pain:i'm talking about neither.i read the article ,and i wonder how you prove someone is in pain,when they are unconscious?it's interesting to note,who wrote these articles, pharmacuetical companies, or what is the agenda? also, i'm a great believer that the lord planned that his people would find pain relieving drugs.i just don't believe in snowing pt's for fam. closure, or so staff can say"next".iv'e doubted studies before,that have been shown latter ti be wrong.

Allow me to say two things to the above post:

1.) In the OR, I can render you unconsious, immobile, and leave you in total agony. The pain your body could feel will be seen via continuous VS monitoring,signs might be subtle, but I could tell if you were feeling it. However, to an observer without my toys, you would appear to be resting comfortably. It is entirely possible to experience pain without consiousness or external signs. And unless you are standing there with a continuous monitor and comparison baseline VS, providers will be completely ignorant of the pain.

2.) It is reeeaaaallllyy hard to kill someone with a single bolus of 10-20mg of MSO4, particularly if they already have chronic exposure to opiods (No other drugs administered concurrently, add a Benzo, or other CNS depressant and we may have more of a problem).

When working in healthcare, and I think everyone will agree with this statement- People die only for two reasons: Severe neglect (healthcare infliction) or it is just thier time. The former is under our control as providers the latter is just fate. Either way, pain must be absolutely and completely controlled.

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as i said ,"not to a pt. who is in noooooooodistress whatsoever!no vs sign prob, no crying out, no dyspnea!!!!!!!!!!!!!!you become hospice,your talking ,you walking,your eating,your in moderate pain, you get ordered ms04,abhr& u become unconsious, getting ms04 round the clock,so the family can feel closure???when did i become god, (or the devil)?btw, i work in a christian home.

you definitely need to treat the "moderate pain", and know how to treat it effectively.

1 dose q6h, is not going to cut it.

not only is the nurse to treat the pain, the nurse must try to stay ahead of it.

it sounds like you would benefit from an inservice, or two, on effective pain mgmt.

if you feel your pt is getting snowed and has no pain, then spread the dosages.

instead of q3h, try q4h.

it takes very careful and astute assessment.

i agree, you shouldn't be administering meds for the sake of the family.

at the same time, you shouldn't withhold meds for fear of acting like God/satan.

it's the same premise.

nurses should not treat pts r/t outside agendas.

it's solely about the pt's needs...

not the family, not the nurse.

so by all means, be the very best Christian nurse that you can be.

and that means to ensure your pt dies a peaceful and painless death.

please keep in mind, this is not about you and your beliefs.

you do the very best you can, for your pt only, and everything else will fall into place.

i pray on a daily basis.

it is through these conversations, that i can/do medicate, judiciously and compassionately.

i pray, you do the same.

with peace,

leslie

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Easing of pain and providing comfort are core nursing responsibilities. I have no doubt at all about the importance of helping patients achieve pain relief with proper medication. Allowing a patient to suffer physical pain and psychological anxiety as they die seems barbaric to me.

As students we have had "pain is what the patient says it is" drummed into our heads.

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Specializes in Med-Surg, Trauma, Ortho, Neuro, Cardiac.
Once a pt's pain is out of control it is much harder to get it back under control, that is the reason for giving the medication ATC even if they "look" comfortable. If they are in pain that is not our choice whether or not we think they look in pain. There are many people who do not have a jump in vitals or any other obvious signs of pain, it does NOT mean they are not in pain. This has nothing to do with being a "christian" nurse or not, witholding pain medication in playing God much more so that giving them a dose to make them comfortable. JMO.:nono:

Good point. The fact that they "look comfortable" is testimony that the current regimine is working and perhaps should be left alone. After all isn't that the goal.....comfort?

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ISometimes it's just as much about treating the family when you're treating the patient. No family member wants to remember their dying loved one as having suffered in the end.

As much as I dislike the ROY nursing model, I think you hit the nail on the head. Proper pain relief for the patient eases the families adaptation to the dying process.

One other thing that I thought of as I read this thread. Nausea/vomiting is a sign of moderate pain. Appropriate pain relief may head off really unpleasant events for the patient.

My great aunt died last summer from kidney failure. In the 2 years prior to her death she was put on hospice several times. She was given acetaminophen which relieved her pain and made her more comfortable. (She was nonverbal and would just cry.) She was taken off hospice and the nursing home staff would stop the acetaminophen. She would experience pain again. My mother was constantly working with the home to improve her pain regimen. This wasn't morphine but it does speak to how analgesics contribute to comfort care.

My wife's grandmother died of liver failure about 10 years ago. The doctor refused to increase her pain medications to increase her comfort level with additional morphine because of some personal religious belief that pain should be experienced as part of the dying process. This was in a catholic hospital but I think that his beliefs were a distortion of religious teachings. I don't buy that any patient should be allowed to suffer.

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Specializes in Jack of all trades, and still learning.
i don't agree w/ giving more morphine,just cuz all the other nurses are,when a pt. doesn't appear in any distress whatsoever(gen hospice pt's)then i know my dose ended their life,& vatican or not,i don't like interveneing in the"HIGHER PLAN"

I don't agree with this, but....

Nurses that withhold morphine to dying patients. Have no understanding of end of life processes and issues, dying with dignity, and generally show a lack of compassion that a NURSE should have! They are prolonging a humans suffering for their own individual agendas whether it be THEIR religous beliefs, fears, and /or ignorance. Enough said!:nono:

Where were you in school when they taught that the patients pain is what they say it is not what you think it is? Going by your theory I have a lot of patients I would not be giving pain med to because I didn't think they looked like they were in pain. Used to be that way too and we had a lot of people suffering unnecessarily.

...I don't think it is fair to categorise ppl who have a different point of view to be "lack[ing] in compassion". Suespets has a right to hold her own opinion; I'm sure she is a very competent person, and uses her values in her nursing care, as we all do. Just because she holds a different point of view doesn't mean we should villify her.

Perhaps God's "Higher Plan" was to provide for medication to relieve their suffering and compassionate nurses to care for them in their final days.

Interesting concept. That Vatican directive may support this...

Allow me to say two things to the above post:

In the OR, I can render you unconsious, immobile, and leave you in total agony. The pain your body could feel will be seen via continuous VS monitoring,signs might be subtle, but I could tell if you were feeling it. . And unless you are standing there with a continuous monitor and comparison baseline VS, providers will be completely ignorant of the pain.

Never thought of it like that. But the converse argument is; we don't have the monitors etc. so we have to base our judgements on knowledge, assessment and beliefs. My belief is that pain should be controlled, despite the risk of hastening death. No matter what we do, we will never know if what we have done will prolong or hasten it.

It is a risk. But so is oversuctioning (as someone mentioned), or administration of IV fluids, or PEG feeds. Personally I'm dead against the other two.But at what point do you decide you stop that sort of active treatment? Some schools of thought now say you shouldn't administer hyoscine/atropine to reduce secretions.. What about the route of administration of medications at end of life? They differ to that of ppl who are not for comfort care.

Allow ppl to hold their own points of view; from this we can all learn, and give the best care we can...

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Specializes in Medical.
I didn't know that if you deep suction a dying patient it will hasten the process. I thought that deep suctioning would make them more comfortable but I didn't realize it was either not a good idea or... probably rather pointless really?

In my experience suctioning in these situations is sometimes done more for our (or the family's) distress than the patient's - it can be awful hearing them gurgling away, and it seems like something you can actually do to hlp when there's so often nothing else much you can do.

Suctioning can be really unpleasant, especially if you need to insert a guedels or nasopharyngeal airway, and for patients with air hunger and related issues... Where I work we prefer to use 'drying up' meds to reduce the secretions instead.

As for it hastening their deaths - if they're that close anyway it'd be a marginal contribution.I've had terminal patients who died during or shortly after being turned, and it's hard not to feel that it contributed, but the alternative would be to worsen their suffering by leaving them in one position for an extended period of time.

As with so much of terminal care, it all demands experience and individualised judgement - what do you think is best for this patient at this time?

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Specializes in Orthopedics/Med-Surg, LDRP.

One nurse told me that she's had a lot of patients deaths hastened after she had swiftly turned them to their left side.

I did find, however, that breath sounds were often less labored when pt's were on their left sides.

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Specializes in Med/Surg, Psych..
One nurse told me that she's had a lot of patients deaths hastened after she had swiftly turned them to their left side.

I did find, however, that breath sounds were often less labored when pt's were on their left sides.

My co-workers also told me about it....do you know whats the reason behind it??

I am really afraid to turn my dying patients to their left side...does it help them or hurt them??

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