When moving from acute, inpatient nursing to home hospice, nurses have to reshape how they think about morphine. In acute care, there is an emphasis on minimizing narcotics, fear of creating addiction and adverse outcomes for patients after their hospital stay, and nerves around over-sedation and respiratory depression from narcotic use.
It is important for nurses to not let this bias transfer to in-home hospice care. Here, morphine and similar narcotics are commonly used to treat pain and shortness of breath during end of life. As patients, families and caregivers often have their own fears around morphine, the hospice nurse must provide education and support in using morphine in the home in order to maximize patient comfort during his or her final days.
Why Morphine is Different in Hospice
Families report three primary fears around morphine used for at-home hospice: decreased communication, hastening death, and worries around addiction.
Morphine has a positive effect on communication in hospice patients
Try to imagine a time when you were in moderate to severe pain. Did you want to enjoy pleasant moments with loved ones, or withdraw into a ball on the floor? Were you your most open and kind self, or perhaps you became a bit snippy and mean? One of the common symptoms experienced near the end of life is moderate to often severe pain.
Not managing an individual's pain at end-of-life can cause a person to feel angry and short-tempered, making it difficult for meaningful communication to take place, according to the National Institutes of Health. Ensuring someone is comfortable by using morphine, as prescribed by a physician, allows for improved communication between loved ones during final days. When we all think of our final moments, don't we wish for pain-free, love-filled final days or weeks, with shared memories and special moments. For hospice patients, appropriate use of morphine is often the ticket to just that.
In fact, in a study of 4,037 hospice patients using morphine for end-of-life symptoms, 85% saw little to no decline in communication.
Morphine will not hasten death
We as nurses know that morphine can have terminal side effects like respiratory depression that can quicken an individual's death. However, multiple studies done with patients in at-home hospice care have shown no correlation between morphine use in the home and a quicker death. For one, the dosage is often lower in comparison to acute care settings, and the administration route is oral or intramucosal as opposed to intravenous. In-home dosing has low risk for respiratory harm, and in fact, often eases shortness of breath symptoms.
In fact, a 2022 study showed that when an individual's pain was well controlled it benefitted sleep and appetite, improving quality of life and even extending survival.
Hospice nurses can share this information with patients, families and caregivers to assure them they are not harming their loved ones, but rather improving their quality of life and allowing them more enjoyment in final days. When we are not in pain, doesn't food taste better, music sound better, and the voices of loved ones sweeter? And aren't these the things we hold onto life for?
Morphine will not cause addiction in end-of-life care
This one may seem straightforward, but it is still a common fear among individuals providing at-home hospice care. When receiving morphine for end-of-life symptoms, there is simply not enough time to become addicted.
One doctor stated, "at this point the most important thing is comfort.”
Nurse Responsibility
Nurses have a responsibility when providing end-of-life care to educate patients on morphine, quell fears and expel myths to ensure that patients are as comfortable as possible. As there is a lot of contradictory information about morphine use, the nurse must be well educated and confident to share this information with patients, families and caregivers to ensure optimal pain management and comfort during an individual's final days.
References
U.S. Department of Health and Human Services National Institute on Aging. Providing Care and Comfort at the End of Life.
Opiophobia in Palliative Care: Conquering the Last hill by Mamak Tahmasebi
Toward Evidence-Based Prescribing at End of Life: A Comparative Analysis of Sustained-Release Morphine, Oxycodone, and Transdermal Fentanyl, with Pain, Constipation, and Caregiver Interaction Outcomes in Hospice Patients
