No pain meds for you, mother

Tweety, BSN, RN · Jan 30, 2007

I think a gentle meeting with managment, the doctor or the Chaplain is in order.

bookwormom · Jan 30, 2007

Could the use of narcotics be a religious issue?

ZootRN · Jan 30, 2007

Could the use of narcotics be a religious issue?

it's a good question. They are white middle class Americans. No cultural or religious issues noted so far, but I could ask.

blueheaven · Jan 30, 2007

Be an advocate! Involve the ethics committee, the MD involved. Do you have a palliative care MD in your facility? If so suggeest to the primary that he/she consult with them. Another option is to get the doc to order x mg. Morphine q whatever as a continuous order not prn. Keep fighting! I know that I would want someone like you to care for my family. :)

natrgrrl · Jan 30, 2007

Fear of losing a loved one can interfere with the ability to make rational decisions. The poster who brought up euthanasia may be on the right track. The family may feel that pain meds will just make her sleep for the rest of her life.

Antikigirl, ASN, RN · Jan 30, 2007

Been here many times, so many times my blood no longer boils but goes into advocate mode right away. I get my MD's involved and explain to them that they need to have a sit down with the family, or get hospice involved straight away if possible...even if it is just for the family to hear what they have to say in order to make a decision.

I also know the meds well, and explain the actions of the low dose of Roxinal (I don't call it morphine if I get roxinal because of the stigma of morphine). Lower doses actually help the lungs and hearts vessels to open helping with oxygenation and hindering hypoxia,(hypoxia is what I call dry drowning! Very uncomfortable, very terrifying, and makes you restless and painful!). Roxinal is also absorbed quickly and has a short time of action because the body has receptors that use a similar pain inhibitor as morphines...so the body understands it, uses it, and can process it easier than other pain medications. I mean think about it...we use morphine to help heart attacks...that is exactly why!

I also am kind enough to get literature for the family about the medications, reminding them to give side effects a grain of salt because in trials anyone that experienced anything has to be put on there due to federal rules. Also that RN's are trained to spot probelms and avoid probelms, and if problems arise, know what to do!

I feel the more they know...I mean the FACTS, the more likely they will be to let you do your job. Sometimes that takes MD's or management...ethics commitee if you can get to them easily.

And bottom line, if the family is keeping you from your tasks, or not following hospital protocol or MD orders...then they must go to another facility...that is a huge liablity hanging there! Yes a patient has the right to not do a treatment or meds etc. but hindering a nurse to a point is a liablity and shows that another facilty maybe better for all concerned. (like a hospice house).

Good luck

Kanani_Ikike · Jan 30, 2007

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.

You know, I've been in the same situation before with one of my patients. Except, it was the opposite of yours. This patient did not want pain medicine because she was being overmedicated previous to my shift. The nurse before me was afraid to stand up to the family and explain to them that it is the patient's decision. The family got mad, but I told them, "Look, I am asking Mrs. So-and-so what SHE wants. I'm sorry, but the decision is hers to make, and I must respect that." From then on out, when the family asked for something for pain, I always went directly to the patient before giving it. It's just not right when some family members want to speak for someone that is capable of speaking for themselves. And it is not right that we be backed up against the wall for doing what the PATIENT, not the family, wants us to do. I just stand tall and firm and I usually don't hear anything else about it.

I undestand that the family has the best intentions, but for them to want this woman to stay doped up all the time so she wouldn't worry them, is not a good reason to overstep the patient's wishes.

nurse_nan · Jan 30, 2007

To my way of thinking, an alert patient who is expressing pain in any mode (verbal or nonverbal) has the right to medication for that pain and you have the duty to provide it. This family needs to be honest about why they want to interfere with mere comfort measures. They want "everything done" except pain med? She's dying faster because of being in pain. You need to take this to a higher level because my concern is they will turn on the nursing staff -- "You didn't do anything for her and she was in agony!" Family can be so irrational at times of crises. They sound so totally oblivious to the real situation. Get Risk Management, Ethics, the physician, Spiritual Care, Hospice, whomever can help involved.

bookwormom · Jan 30, 2007

I know that some Seventh day Adventists want to avoid narcotics. It also seems to me a possiblity that the family may have had some traumatic experiences with an addicted member in the past-- even the patient herself. None of this is to say that the pain medication you are trying to give is not appropriate, but it might make it a little easier to see where the family is coming from.

jill48, ASN, RN · Jan 30, 2007

Right now the family doesn't accept her pain even as she admits it. It's only going to get worse after she cannot tell you anything. They are never going to believe the nonverbal signs of pain. If I was you I would get the ethics comittee involved. Don't give up. Don't let that woman be in pain. Good luck to you. :smokin:

Altra, BSN, RN · Jan 30, 2007

To my way of thinking, an alert patient who is expressing pain in any mode (verbal or nonverbal) has the right to medication for that pain and you have the duty to provide it. This family needs to be honest about why they want to interfere with mere comfort measures. They want "everything done" except pain med? She's dying faster because of being in pain. You need to take this to a higher level because my concern is they will turn on the nursing staff -- "You didn't do anything for her and she was in agony!" Family can be so irrational at times of crises. They sound so totally oblivious to the real situation. Get Risk Management, Ethics, the physician, Spiritual Care, Hospice, whomever can help involved.

ITA. Your responsibility is to the patient. If this case were reviewed/litigated, could you defend the decision not to medicate this patient? Have family members actually interfered with administration of ordered meds?

A DNR order ... but family wants "everything done" ... but no pain meds??

A meaningful discussion with this family is in order, pronto. They will be well-served by gaining a clearer understanding of advance directives and appropriate, ethical end-of-life care.

txspadequeenRN, BSN, RN · Jan 30, 2007

This is a situation that just burns me up..... I would involve anyone I could to get some sense into them. I also would consider looking into a pain patch and placing it on her back (out of sight) then doing some supplemental pain med work until that kicks in..It is my thought that if the patient has indicated she is in pain, then that's all I need. She gets what she needs to be pain free.