No pain meds for you, mother

[ZootRN]

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.

[Katnip, RN]

Have the doc talk with the family. Do keep medicating. The woman indicates she's in pain.

[nursejohio, ASN, RN]

How horrible! Why on earth don't they want her to be medicated for the pain she's obviously in??? I can't imagine how frustrating that must be for you.

[babynurselsa, RN]

How about activating the ethics committee?

[lauralassie]

That is horrible. I agree the Dr. needs to step in , (but good luck with that one ). Sound like the faimily could use a social worker or clergy to council with them. Ask around, but if the pt is answering questions appropriatley and that is well documented ,(even a pt with dementia can be well enough to make their own decisions). Then , the faimily can't make that decision for the pt. I know in ICU, we have had a Dr, a couple nurses, social worker and clergy in a room when we asked a pt if they wanted DNR status or other such difficult questions, (when there is disagreement in the faimily and we wern't sure what way to go). If everyone was in agreement that the pt answered appropriatley, then we went ahead with the pt's wishes. The family wasn't always happy but that's the way the cookie crumbels. But, keep in mind, we had multiple staff members there to witness the whole thing. Good luck. You can take care of my family any time. (sorry this is so scattered, I'm bushed)

[UKRNinUSA, RN]

they are probably scared that she will be "euthanized" by the morphine. Maybe you should approach their fears directly.

[Cattitude]

that is so sad especially since we know that 1 mg of mso4 q6h is practically nothing. is the pt. getting any relief after receiving med?

[ZootRN]

they are probably scared that she will be "euthanized" by the morphine. Maybe you should approach their fears directly.

Thank you guys, for your responses. I personally think they are afraid of the label attached to the Morphine. I tried to ask them directly what are their concerns, and they just say "She is not in pain, she does not need it". I told them numerous times, that it is very small dose and won't harm her, but result is the same. I know that pain control is legal and ethical issue, but how far will hospital go, risking lawsuit from the family, I don't know.

[RunningWithScissors]

Obviously, this patient is getting other meds IVP; can you give the morphine along with another med, saying it is a flush (or better yet, don't say anything, as everyone in the room doesn't need to know EVERYTHING).....whatever happened to HIPAA?

Surely you can sneak it in somehow.

Does the pt have an advance directive and does it say she wants to be kept comfortable?

[ZootRN]

Obviously, this patient is getting other meds IVP; can you give the morphine along with another med, saying it is a flush (or better yet, don't say anything, as everyone in the room doesn't need to know EVERYTHING).....whatever happened to HIPAA?

Surely you can sneak it in somehow.

Does the pt have an advance directive and does it say she wants to be kept comfortable?

No, she does not have advance directives; according to family, never said anything about her wishes. They question everything you do to the point I just can't deal with it anymore. Once her son told me: I think, she had a BM, can you LISTEN to check it out? He seemed to be very surprised when I asked him to leave the room for a moment so I can uncover her and SEE if she had a BM.

[snowfreeze, BSN, RN]

Educate the family through the doctor, social worker, ethics committee and be a patient advocate. Document your teachings, the patients responses to questions, and the families response to teaching. Vital signs and patient behavior are quite substantial observations to show the patient is in pain, medicate the patient and document those responses. If the patient has NG tube or feeding tube you could use that access for meds that the family may accept acetaminophen, ibuprophen, etc. SL morphine, roxanol is very effective and short acting, that may not be as offensive to family.

It has got to be painful to be bedridden for months, the muscles start to atrophy and ache, movement is painful, laying still is painful. Ask family if they remember the pain of having the flu and being in bed for 3 days, how much they ached.

[Chaya, ASN, RN]

It must be heartbreaking to see this. What's the matter with some of these families?-I can only assume they're not thinking clearly due to the stress of the situation. I agree with other posts that they need a dose of reality therapy and that it needs to come from someone impartial AND further up the food chain; case manager or charge nurse at least if there isn't an ethics committee.