What would you do?

[sharann]

If you had a terminally ill patient who was in agonizing pain whose son or daughter had power of attny for healthcare and wouldn't allow you to give narcotics because"I want mom aware so she can pray for healing". Seriously, would the hospital petition the court for guardianship? Would this be an ethics committee thing? All the while she is suffering and SHE(daughter) is the legal decision maker. Mom is coherent but refuses to go against kids wishes.

Thanks.

[JHUBRAIN]

I agree - If a patient is suffering (in pain) I am not doing my job very well. Back to the original question. While working in Onco I came across this a lot (family wants mom awake to talk with - Forget the fact she is in so much pain all she does is scream) anyway I would always give the pain med in that situation (I would ask the Patient if they wanted it - They always said yes!!)If the med knocked them, we would add a little ritulin to it and that would usually perk them up a bit so they could talk with their loved ones - Thanks to all & God Bless - Gary

Um, yeah, I agree to that (I'm Catholic), and that's great for those of us who choose to use their suffering as a way to salvation. But the patient involved may not make that choice, and if they don't intend to use their suffering in such a manner, it doesn't do them much good, and we as their caregivers are failing our job for letting them be in pain without any relief. Of course, if they (or their loved ones if they aren't able to decide for themselves) don't want painkillers, you can't do much about it.

Sorry if this doesn't make much sense, but I'm in a hurry b/c I need to flee the computer to go somewhere.

[CoffeeRTC, BSN, RN]

Hmm...never heard of the ritilan and pain meds. Well What happened?

If you have and ethics committee I would go to them. Seen this in ltc. Even if pts is confused...I will still give the med. I'd love to speak with the family and ask how they view pain and suffering. I'd be curious to see if this is their religious belief or just something else. (I know its none of my business) Then I would try to educate the family that pain relief doesn't always mean sedation.

Whole other thread, but can't stand family not wanting pain meds because old confused mom (demetia) doesn't really know they are in pain. :angryfire

[purplemania, BSN, RN]

You can involve your Ethics Committee and the Chaplain. Perhaps if the Mother had a scheduled time for prayer, then was given pain med, all the stipulations would be met. The daughter has no rights at this point.

[JHUBRAIN]

We would add the ritalin on and it would wake them up quite a bit - it only would work for 2 weeks or so, and then it is not quite as effective.

Hmm...never heard of the ritilan and pain meds. Well What happened?

If you have and ethics committee I would go to them. Seen this in ltc. Even if pts is confused...I will still give the med. I'd love to speak with the family and ask how they view pain and suffering. I'd be curious to see if this is their religious belief or just something else. (I know its none of my business) Then I would try to educate the family that pain relief doesn't always mean sedation.

Whole other thread, but can't stand family not wanting pain meds because old confused mom (demetia) doesn't really know they are in pain. :angryfire

[dragon5282001]

You are supposed to be the patients advocate. If you agree or not with the decisions they make.

[DelightRN]

Except it doesn't sound like its the patient who has made this decision. Being the patient's advocate in this situation would involve advocating for adequate pain control, IMO.

I can't help but thinking maybe a little open communication would help. Maybe if they could get a pain management specialist involved who could identify some options that wouldn't leave this woman so gorked, her family would be more likely to agree to a pain relief regimen.

After all, it is part of the patient's bill of rights to be free from pain. Pain interferes with every body function. The woman isn't truly there and mindful for prayers or other spiritual activities if she's in excruciating pain.

I hate to hear that pain is undertreated, or not treated at all.

[NurseFirst]

We would add the ritalin on and it would wake them up quite a bit - it only would work for 2 weeks or so, and then it is not quite as effective.

When my Dad was dying, I asked if it made sense for him to be on the pain meds and the modafinil (sp?) (aka provigil) that one of his docs had prescribed for him d/t the tiredness from cancer. His PCP said no. Once we put him on pain meds, he became rapidly unavailable to us--and when people are about to leave this earth, there may just be some useful conversations to have. Even if the patient, themselves, thinks they have prepared everything well in advance.

NurseFirst