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...
When I worked at this level of care, some family members could, and would request pain meds. If they were uncomfortable with this, I would ask the physician to have a standing order of give. He or she would be the next person I would approach. They may have been caring for the family, and patient for years. If a patient or family had no long term hx with a physician, I would ask the immediate disciplines such as the provider, social worker, hospice, supervisor, for their expertise in controlling pain levels for a comfortable passing for the family. Keep in mind that whatever you do, this part of nursing is never easy to get through, especially if you, yourself have had a long term relationship with client.
Specializes in NICU, PICU, Transport, L&D, Hospice.
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.
Exactly.
The family may administer according to their assessments and understanding and we educate to improve their ability to safely provide medication according to a POC which has been written so that it has goals achievable in the patient home.
The family has no power to require an RN to administer anything which seems inappropriate, unsafe, or outside of scope of practice. It is true that if the family is desiring something which the RN believes would be harmful or detrimental to the goals or safety of the patient, then that family may seek to have the RN removed from the case. An agency which allows families to dictate unsafe nursing practice to professional staff is not a safe agency to work for. IMHO
I don't care what "supervising personnel" might be quick to tell me. I am not medicating according to family preference if I believe that the request is unwarranted, unsafe, or illegal. There will be no completion of requested task with explanatory note in the documenation. There will, instead, be documentation of their request, explanation of why request was not fulfilled, and documentation of notification of MD, agency, and any additional individuals or groups that should be made aware of the family's requests if there is concern for the safety of the patient in their care.
When I worked at this level of care, some family members could, and would request pain meds. If they were uncomfortable with this, I would ask the physician to have a standing order of give. He or she would be the next person I would approach. They may have been caring for the family, and patient for years. If a patient or family had no long term hx with a physician, I would ask the immediate disciplines such as the provider, social worker, hospice, supervisor, for their expertise in controlling pain levels for a comfortable passing for the family. Keep in mind that whatever you do, this part of nursing is never easy to get through, especially if you, yourself have had a long term relationship with client.
Why would you ask a social worker how to control pain?
If the patient is actively dying and the request is well within the MD orders, where is the safety, legal or even ethical issue?
My dad was not coming back, his fluids were depleted, his skin was taut, he was already far gone to us, but his breathing was rhythmic and he was not exhibiting outwardly signs of pain. Taut skin pulling across his face just looked uncomfortable. He was inpatient unfortunately, on palliative care. After a long night I asked the nurse to up his Dilaudid drip or give him a bolus (I can't remember) and he was gone in less than 30 minutes. After seeing him go soon after I deeply regretted not asking sooner and potentially shorting this last phase.
I would have come undone and lit that place up if the nurse had declined, but fortunately there was no hesitation and my dad's struggle was over.
If the patient is actively dying and the request is well within the MD orders, where is the safety, legal or even ethical issue?
The issue with the OP is that the pt was A&O enough to deny pain and state he didn't want any morphine at that time. Of course if he were unable to express himself, the family's assessment should be taken into consideration; they know him best, and can pick up on nonverbal s/o pain quicker. But in this case, the pt was able to express his lack of pain and able to decline morphine. He still has his right to autonomy. He has the right to expect no morphine if he says "I'm not having pain, and I don't need morphine."
The issue with the OP is that the pt was A&O enough to deny pain and state he didn't want any morphine at that time. Of course if he were unable to express himself, the family's assessment should be taken into consideration; they know him best, and can pick up on nonverbal s/o pain quicker. But in this case, the pt was able to express his lack of pain and able to decline morphine. He still has his right to autonomy. He has the right to expect no morphine if he says "I'm not having pain, and I don't need morphine."
I didn't get that op was talking about a specific case, I understood it as a few diiferent patients some A&O. Maybe she clarified on a later post that I missed?
If someone is A&O then yes completely different situation than mine.
RamTaur
35 Posts
When I worked at this level of care, some family members could, and would request pain meds. If they were uncomfortable with this, I would ask the physician to have a standing order of give. He or she would be the next person I would approach. They may have been caring for the family, and patient for years. If a patient or family had no long term hx with a physician, I would ask the immediate disciplines such as the provider, social worker, hospice, supervisor, for their expertise in controlling pain levels for a comfortable passing for the family. Keep in mind that whatever you do, this part of nursing is never easy to get through, especially if you, yourself have had a long term relationship with client.