Patient's family requesting pain medication

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A couple of times I have had comfort care patients(meaning that treatment is stopped and only measures to improve comfort are taken such as pain medications, and repositioning) where the patients themselves do not look like they are actively in pain and some even state that they do not have any pain yet family members INSIST they need morphine. It kind of made me have the impression that the family wants death to occur and they think pain medication is going to move that along?

Some nurse colleagues have told me to just give the medication because they are dying and it's not going to hurt them as well as it will help to appease the family. I kind of had an ethical issue with this but...

What do you think?

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Specializes in Clinical Research, Outpt Women's Health.

The family may see things that you don't knowing them so well. Also, I often think they are afraid they may be in pain and unable to report it.

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Like most things, to me it depends on the patient. A hospice or DNR comfort patient, if they are A&Ox3-4, then they are able to determine their own medication needs... if they tell me they are not in pain or do not want pain meds I am not going to give it to them. If we are talking about a patient where a family member is making medical decisions then I feel we still need to use pain scales to score the patient instead of just blindly following what family wants.

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Specializes in Acute Care, Rehab, Palliative.

Palliative patients will quite often not appear to be actively in pain. You have to pay attention to body language and respiration rates. As another poster mentioned, the family may recognize signs of discomfort you may not pick up on. Even patients that state no pain will display signs of discomfort. I wouldn't wait for the patient to be in obvious distress before medicating. The goal is to keep them pain free.

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Specializes in NICU, PICU, Transport, L&D, Hospice.

In my view your job is to advocate for the patient.

If the patient denies pain and does not want the pain medication I will not give it and I will explain to the family why I won't.

If the patient is not communicative I will assess the patient and share my POV with the family BUT if the family believes the patient is uncomfortable I will medicate the patient with a safe dose deferring to their intimate knowledge of the patient.

Keep in mind that most hospice patients are in an environent where their family is immediately connected to delivery of the medications included on the POC. The hospice staff administers the least amount of medication to the routine hospice patient typically, the family is in control as a general rule.

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Specializes in Critical Care.

I take into account the families input in my assessment of the patient's comfort and ask for their input, but it's not the only thing I base my assessment of the patient's medication needs on. I've had many families say "they need more morphine" despite no apparent signs of discomfort so I ask them why they think the patient needs more morphine, and the answer often is "because they're still alive".

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Keep in mind that most hospice patients are in an environent where their family is immediately connected to delivery of the medications included on the POC. The hospice staff administers the least amount of medication to the routine hospice patient typically, the family is in control as a general rule.

I have been in situations where I was keenly aware that the family member(s) was indeed controlling the administration of medications and I was forced to walk a thin line in providing appropriate patient-focused care while running the risk of being bounced from the case. The supervising personnel are quick to tell you to do what the family requests and "document". That does not always make it right for the patient.

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Specializes in LTC Rehab Med/Surg.

The OPs question is one I've struggled with my entire nursing career. I've always been opposed to being used as the instrument to hasten a patient's death. Let me clarify lest someone think I'm opposed to giving Morphine to a dying patient.

I'm talking about the patient whose only movement is their chest going up and down 8-12 times a minute.

The last dying pt/family I took care of, told me they had been promised as much Morphine as they wanted. Not needed. Wanted.

That was after I balked at giving Morphine to a patient who was most definitely not in any distress.

The dilemma never gets any easier for me. I don't suppose it ever will.

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Specializes in LTC,Hospice/palliative care,acute care.

The goal is preventing discomfort.When someone is actively dyingwith no intake it is appropriate to start administering comfort medications around the clock.Don't wait until the are symptomatic........Once they transition and are unable to verbalize you will be behind the 8 ball and need to play catch up.I believe irregular resps and mottling are uncomfortable,Have no problem titrating meds to comfort.,comfort of the resident AND the family..

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Specializes in Med/Surg, Academics.
The goal is preventing discomfort.When someone is actively dyingwith no intake it is appropriate to start administering comfort medications around the clock.Don't wait until the are symptomatic........Once they transition and are unable to verbalize you will be behind the 8 ball and need to play catch up.I believe irregular resps and mottling are uncomfortable,Have no problem titrating meds to comfort.,comfort of the resident AND the family..

This is true with a patient actively dying--unable to verbalized, eyes closed. You don't want to get behind on properly medicating for comfort. I received a hospice patient with supraclavicular retractions, and it took me four hours of Q1 hrs Roxanol and Q 2 hrs morphine to get him comfortable, then just Roxanol to keep him comfortable. You have to be very observant for the first signs of discomfort so that you don't lose control of it.

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Specializes in ICU.

In the ICU I work in we usually have orders to titrate the morphine drip to 16 respirations. We can adjust as needed within the parameters given. Sometimes the family does think it will speed things along, but it is our duty as nurses to educate them, and explain that is it only to make them comfortable and for them not to have air hunger. In truth it may speed things along, but when a human is dying in pain, gasping for air, and scared, giving them something to make them comfortable is important. In my experience the families are scared for their loved ones and fear they are in pain, they fear what is going to happen afterwards, and sometimes the journey for the patient and family has been a long tiring one, and they are ready for peace for their loved one. I once had a family member tell me that the patient was going to have a good death, and then be welcomed to heaven.

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I get more worked up when a family actively disapproves/convinces patient to NOT have pain medication due to an altered level of consciousness, the fear that they will become "addicted" and the like.

The family knows the patient well. Therefore, they do know the subtle changes that begin as pain level increases. There are instances where the patient has made their wishes well known to the family--and after unbelievably unrelieved pain, there's no desire to return to acute and unrelenting pain--therefore "keep me drugged up".

If the goal is comfort care and a peaceful death, then go with the flow and medicate accordingly. You do not want to play catch up with pain medications, especially when a patient is actively dying. Drugs like morphine can also ease breathing, which is a huge worry with end of life patients as well--that they can't breathe, "suffocating".

You do not want to get into a situation where you have an actively dying patient struggling. Whether that be to put on a brave front for family members, their own fears regarding the dying process, whatever the case may be.

The goal is peaceful and comfort. So to keep that as the plan of care--which includes medications to assist in that--is paramount.

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