Honoring the Moral Concerns of Caregivers Afraid of Giving Morphine

Joan’s breathing relaxes as the morphine starts working. Her son Travis, on the other hand, is clearly upset as we sit at her bedside where she is dying. Despite his mother’s intense respiratory distress before he gave her the morphine, he’s convinced that he’s just made a big mistake. “I’m sorry, mama,” he whispers.

He turns his head my way. “I wish you hospice folks had never brought that morphine out here,” he says. “Now she’s dead for sure and it’s my fault.”

A sometimes essential medication.

For caregivers with this level of fear about morphine, it’s a painful dilemma. If you don’t use the best, sometimes the only, medication we have for getting acute respiratory distress in terminally ill patients under control, both patient and caregiver suffer. But if giving morphine is freighted, as it is for Travis, with a belief that it causes death and/or signifies giving up on, even betraying, a loved one, it can intensify a caregiver’s distress.

The hospice nurse had already given the standard education, assuring Travis that in patients near the end of life morphine is safe and effective when used as prescribed. We had given him written information debunking some of the common myths about morphine—“it kills you”; “makes you crazy”; “it’s addictive”—when used appropriately with hospice patients who have active symptoms. We had promised […]

2018-01-22T10:19:38-05:00January 22nd, 2018|Ethics, family caregiving, Nursing, pain management|0 Comments
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A Dream of Horses: An Aging Veteran’s Healing Encounter

“Let’s go for a ride,” I said to Joe as he lay expressionless on his bed, covered in blankets and staring at the ceiling. The room was stuffy with hot, stale air. No bigger than a walk-in closet, the space held the lifetime possessions, many of them scattered on the bed, floor, and windowsill, of a 75-year-old veteran residing in an assisted living facility. Joe appeared frail and bored in the silence of the room.

Illustration by Janet Hamlin for AJN.

That’s the start of the Reflections column, “A Dream of Horses,” in the January issue of AJN. Written by a nurse at the Department of Veterans Affairs, the short, moving essay describes a series of healing encounters between a frail older man, who seems to have given up on life, and the horses at a therapeutic equestrian barn.

The here and now.

The story told here reminds us how much we humans can cocoon ourselves against the more elemental forces of the natural world, and how healing it can be to encounter a magnificent animal that asks only that we be present in the here and now. The senses awaken. We look beyond our own habitual ways of thinking […]

2018-01-16T10:00:35-05:00January 16th, 2018|Nursing, nursing stories, Patients|0 Comments
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Simple Intervention Decreases Oral Mucositis from Head and Neck Cancer Treatment

A painful effect of cancer treatment.

Nurse Cindy Dawson provides patient education on oral care kit used in a nurse-led intervention to reduce oral mucositis severity in adults treated for head and neck cancer. Photo courtesy of Kay Klein.

Years ago, when I worked with patients being treated for head and neck cancer who had been admitted for one reason or another, I felt helpless in the face of their extremely uncomfortable oral mucositis. None of our topical concoctions seemed to bring much relief to these patients, who had often endured disfiguring surgery as well.

While there is as yet no perfect solution to this uncomfortable side effect from the radiation or chemotherapy used to treat head and neck cancers, a group of oncology staff nurses and their colleagues have demonstrated that a consistent, standardized approach to oral care for these patients may significantly alleviate the pain of this almost universal treatment effect.

Consistent, standardized oral care.

After reviewing the literature on oral care, Cullen and colleagues enhanced their usual patient teaching with oncology […]

2018-01-12T09:13:13-05:00January 12th, 2018|Nursing, nursing research, patient experience|1 Comment
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Comforting Our Patients: The Importance of Well-Chosen Words

‘What I Said,’ ink and crayon on paper, Julianna Paradisi 2018

Nurses and writers understand the importance of well-chosen words. Precision of language is important for both. But nurses learn the emotional impact of words, wisely or poorly chosen, on the job, directly from our patients. There’s seldom an opportunity to edit or revise on the floor of a nursing unit. Words cannot be unsaid.

As an oncology nurse navigator, my nursing practice is almost entirely based on words. My stethoscope, which rarely left my body when I was a PICU nurse, now rests coiled like a snake in a basket, nestled among the art supplies I used to illustrate this post.

Since patients rate my nursing skills by my words, the ability to pass the ‘bs test’ is more important than ever before in my career. As a navigator, I have impressed a patient or two (and helped them get proper care) by recognizing over the phone that the symptoms they described were cardiac related and not the side effects of cancer treatment. But for the most part, words are the tool I rely on to prove my value.

It’s the nature of nurses to want to comfort our patients. […]

2018-01-09T10:09:34-05:00January 9th, 2018|Nursing, nursing roles, patient experience|1 Comment
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Emotional and Physical Health Consequences for Children of Jailed Parents

Michael Coghlan/Flickr

In the United States, more than half (54%) of all prison inmates are parents with minor children. As we discuss in the December AJN Reports, those children—an estimated 2.7 million, or one in 28—face physical and emotional health challenges that often go overlooked, including:

  • obesity, asthma, migraines, and hypertension
  • depression, anxiety, PTSD, and problems at school, including a higher likelihood of being expelled or suspended

Additionally, children with incarcerated parents are at an economic disadvantage due to lowered family income caused by the parent’s absence, and are more likely to experience racial discrimination, parental divorce or separation, a parent’s death, domestic abuse, neighborhood violence, and coresidence with a mentally ill or suicidal person or with a person who has a substance abuse problem. […]

2017-12-15T08:29:46-05:00December 15th, 2017|Patients|2 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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