by Crystal J. Smith
In my experience as a hospice nurse, I have taken care of many patients that are in pain. When you mention that their doctor wants to start them on morphine, more often than not the patient or family are hesitant at first due to the stigma associated with the drug. Most people think that when you are being ordered to take Morphine that you will either get addicted to the medication or that it is a death sentence. Neither is completely true. Usually when a disease process is in its end stages there is pain associated with the malfunctioning of the organ(s). After Morphine has brought comfort to a patient, it is usually continued, due to the fear of rebound discomfort. Since hospice patients are considered to be terminally ill, we are not concerned with them becoming addicted but more focused on keeping them comfortable.
The other cause for hesitation is that the use of Morphine causes a patient to pass away quicker than intended. When a terminally ill patient gets to a point there body systems are on over load they may become short of breath, have a fast heart rate, they may be agitated, and express signs of pain. The use of Morphine will relax the heart rate, breathing, agitation and pain. In turn, the body systems become relaxed and may continue to slow down. Morphine given safely as directed, with proper nursing assessment, will not hasten life any sooner than the disease itself will.
Morphine can be administered several different ways making it the “gold standard” of palliative care and hospice nursing. Oral morphine solution (liquid morphine) works quickly and is easy to administer. It can be concentrated to allow larger doses of morphine to be given in small amounts of liquid. There are long acting Morphine tablets as well as short acting. Morphine can be delivered as an injection into the muscle or as an infusion intravenously (IV) or subcutaneously (into fatty tissue) these forms of delivery aren’t usually the first choice in the palliative care and hospice setting because other delivery methods, like oral morphine solution, are usually quite effective, less painful, and carry less of a risk. Morphine can also be delivered as a suppository (inserted into the rectum) for patients who need longer-acting dosing but cannot swallow. Hospice patients with lung diseases can benefit from Morphine nebulizer treatments, by breathing in the medication directly to the source of the pain, deep in the lungs.
It is common knowledge that Morphine helps control pain, but it also controls symptoms of shortness of breath. There comes a time in many disease processes that the body slows down and is no longer able to circulate blood carrying oxygen to all of the organs and body tissues. Placing a patient on oxygen may not be enough to keep their saturation of oxygen sufficient and this leads to difficulty breathing. Increased respiratory rate is the minds way of over compensating to get much needed oxygen delivered to cells. Morphine is used to ease the mind into a more relaxed respiratory rate. Hospice philosophy is not to prolong nor hasten life but to improve comfort and bring quality into every day.
Crystal J. Smith is the Director of Patient Care Services at Delta Hospice. If you have any questions about Hospice, please contact Delta Hospice at (909) 438-4407.