ANA code question... please help

[Proverbs 16:3]

I'm doing the questions for the ANA code of ethics and i'm having problems with some of them. I'm hoping some of you can help me.

A patient who is receiving palliatve care for palliative cancer begins asking for increasing dosages of morphine for his pain, beyond what the physicaian ordr says. The pt has a history of drug abuse and the nurse is wary of over medication for fear of hastening the pat death. She is not sure if the patient is in as much pain as he reports. The nurse shold

A) Accept the pt report of pain and give the dosages up to the maximum allowed by the order. The code allows for nurses to give medication for pain, even if it hastens death.

(from what i've read from t he code, it allows nurses to give palliative meds though they may hasten death)

B)Try to convince th pt to hold back on morphine in ordr to preseve his decision making skills and hence, his autonomy. ( i know this is the wrong answer)

C) Give the maximum amount of morphine ordered and call the physician to increase the dose in ordr to minimize the pt's pain and help hasten his death. (the only thing that makes me disagree with this option is "help hasten is death)"

D) Give the maiximum amount of morphine ordered and call the phyician to increase the dose in order to achieve the patient's comfort.

I'm torn between option A and D. what do y'all think?

my ethics instructor said some of the questions have more than one answer but she wasn't going to tell me which questions. that part sux but i need help.

[Daytonite, BSN, RN]

Hey, guys! Would you keep in mind that this is a student forum and the OP was asking about the answer to a question on ANA ethics. You might notice that the students originally responding to this thread aren't even participating in it anymore. Go over to the General Nursing Discussion if you want to square off on this. I'm answering you knowing that students are reading this. They need to know the basics. I am fully aware that being a nurse practitioner puts an RN in a different role and capacity. But, students also need to understand what the responsibilities are of the various jobs of personnel within the healthcare system and that includes the doctors. Getting off on a discussion about our attitudes toward other healthcare roles isn't helping the students, is it? I hear, understand and respect your passion for the work you do, but I think this thread has gotten way off base. And, I'm just as guilty for helping it get there. My apologies to the students.

[NRSKarenRN, BSN, RN]

...listening to a nurses' suggestions of a patient's needs is purely polite courtesy on the doctor's part. doctors have no obligation to take the suggestions of any of us. it's pretty conceited to believe that the data provided by the bedside nurse might be the deciding factor that results in the doctor changing a patient's dose of pain medication.

thirty years ago i might have been making this same statement but not today, especially after my early 90's hospice education and 20 years in homecare.

medicine and nursing have developed into a collaborative relationship each dependent on the other to meet a patients needs, especially in the inpatient and homecare setting.

i've educated many a physician on why 10mg /hr morphine not enough medicine to control patients pain based on patient's pain description, physical assessment and medication regimen....allay their fears that bom will not yank their license from prescribing too much medication with appropriate documentation...and tell them that a duragesic 50mg patch is inappropriate for opiate naieve patient, that's why gentlemen is woozy and bp 70/50 and feels so out of it.

physicians do have final say in prescribing care and medications; however

nurses have ethical duty to ensure patient needs are meet nor harmed by physicians orders.

sent one patient back to hospital 8hrs after arriving home as in excruciating pain----was on morphine drip in hospital and oral dosage not correctly calculated nor breakthrough dose provided; pulmonologist didn't believe patient needed higher dose and declined to prescribe so back to the hospital pt went and admitted by hospice director who also educated pcp. fast forward one year later, pulmonologist thanking me for educating him: had a subsequent patient on morphine 100mg hr ---feds didn't pull his license, no respiratory depression and patient died comfortably.

in opioid naive patient who'd only been taking tylenol, i immediately removed patch and washed skin area, called pcp and informed him of medication dosage--doctor ordered percocet instead. visited daily and by 2nd day patient back to usual state and pain free.

physicians once viewed as "captain of the ship" have changed in many settings to be co-captains with np's that co-manage patients as physician partner; cns/np's managing nursing units using standing protocols jointly developed and homecare nurses assessments solely relieved on for medication and wound care adjustments. nursing's influence and responsibility for patient care is key in today's complex health care world.

by choosing only answer a and medicating patient with current meds, nurse is not informing the physician that the patient still is experiencing pain despite maximum dosage prescribed, therfore patient nursing goal of effective pain managment is unmet......what action do you need to take to achieve this goal:

call the physician, inform him of patients reported pain level, nursing assesment and current medication regimen = answer d.

[ginger58, ASN, RN]

Daytonite, I agree that this discussion has gone on beyond the OP question but I do have to say that us nurses of the other stance of " I trust my doctor and feel that he knows me and my needs far better than any of the nurses. The doctor is the one who is in charge of the patient's case, not the nurse. I'm a nurse and I never forget my place in the healthcare hierarchy". New nurses need to know the nurse is in a very important position in medicating pain patients, and beyond an insulting statement that the doc is in charge of the patient's case, NOT THE NURSE. Yes, he's in charge as orders fall back on him but I feel like you're undermining the nurses very important role.

So, to all you new nurses, please understand what an advocate you will be for your patients and you indeed will not generally play second fiddle to a doc. Times have changed, thank goodness. Nurses are very well educated these days and pain education is finally being addressed.

[Daytonite, BSN, RN]

So, based on what you just said, when the nurse has just informed the doctor of her pain assessment need of the patient and the doctor respectfully responds with, "no, I'm not increasing the dosage on his pain medication", are you implying that the nurse has now became a second fiddle because the doctor didn't respond in the way the nurse wanted? If that's what you are meaning, then that's more manipulative than being an advocate.

[Becca608]

Whoa!!!!

I choose D because A is included under D. Give the maximum dose because the patient is the ultimate authority on how much pain he is truly in. That it may hasten death is besides the point. If the max dose is not providing the necessary comfort (which we as nurses are in the position to evaluate with our closer contact/relationships with our patients) then the MD should be contacted about increasing the dose.

:smiley_ab

[ginger58, ASN, RN]

Nope. That's not my use of "second fiddle". And although I love the sword fighting little people in #17 I'm done with this discussion.

[Becca608]

Oops...sorry for the faux pas Daytonite and Ginger. I put the little sword-fighters at the end of my posts because they are cute. Nothing was intended by it!!!! :uhoh21:

[CRNI-ICU20]

I think it is doing a new nurse, or a student nurse a disservice to imply that all doctors are like your relatives, ie "and where did you get your medical degree types?".....that is terribly undermining of advocacy for a patient, because it right away implies that there are doctors who are just too "godly" for a "lowly" nurse to even suggest, collaborate, or critically think on behalf of her patient....

I think you should re-read your own statement, Daytonite....because while you are reminding us all that this was a thread started by a new nurse, or student, I have to wonder just exactly what were you trying to teach that new nurse by saying what you said about your relative doctors...

the intimidation flags were flying everywhere...and that's the last thing a new nurse needs to feel, from ANYBODY.