[SharonK]

I am a current RN student and hospice volunteer. I would like any information concerning advice for combating Hospice work burnout and also how you all deal with the ethical and theological ideals concerning TS? Thanks for your help. Your input is so helpful.

[caroladybelle]

What is TS????????

[renerian]

Just let us know what you mean by TS as the letters might mean more than one thing. I can think of 5 things but none seem appropriate.

renerian

[SharonK]

Oops, sorry about that.

[earle58]

there have been patients that we have sedated to a level of unconsciousness when physical pain could not be managed and such pain was that excruciating that it was tortorous.
it is an intervention that is used as a very last resort and if it finally relieves the suffering, then ethically i have no problem with it whatsoever.

as for burnout, i've had periods where i needed a break. but typically it is after repeatedly 'bad deaths'. these burnout feelings usually don't last longer than a week. if this happened to me on a consistent basis, i would consider changing specialties.

wishing you peace,

leslie

[renerian]

I worked hem/onc/bmt over 6 years and have been a hospice volunteer for over 10. I have no problem with sedating someone into comfort as watching your loved ones suffer needlessly is horrible to watch/done it several times so I know how it feels. I don't think you really know how hard it is to watch your loved ones live in agony unless YOU WEAR the shoes so to speak. I can only hope I have a nurse if I get terminally ill that will help me be comfortable no matter the outcome.

I took periodic breaks/time off but rarely could afford to go anywhere. I agree some deaths are peaceful and others are terrible.

renerian

[compassionate care]

Your question on TS is the main reason I started looking for hospice support sites. I am an lvn with 23 yrs nursing experience, 12 in geriatric nursing and now 7 months in hospice. While I absolutely love working in hospice and believe in what we do, TS has caused the most conflict within me, especially in patients who have prolonged, lingering deaths. Or in situations where family members requests for continuous or increased pain meds have been a large factor in med management. This has forced me to do alot more studying of the dying process/pain management at end of life. Hospice philosophy and mine, holds that if a patient says they have pain, they do and should be medicated accordingly. I agree completely. But when the patient can no longer speak for him/herself and we are required to medicate them entirely on objective data and hospice protocol, it can at times feel as if we are "playing God". We just want to feel we are doing the right thing for the patient. There seems to be a sort of taboo or negative judgement about a hospice nurse admitting thatshe/he struggles with this sort of issue but I believe it is the deep caring for our patients dying process and the integrity of the hospice nurse that makes us raise the difficult questions.

[doodlemom]

Originally Posted by compassionate care

Your question on TS is the main reason I started looking for hospice support sites. I am an lvn with 23 yrs nursing experience, 12 in geriatric nursing and now 7 months in hospice. While I absolutely love working in hospice and believe in what we do, TS has caused the most conflict within me, especially in patients who have prolonged, lingering deaths. Or in situations where family members requests for continuous or increased pain meds have been a large factor in med management. This has forced me to do alot more studying of the dying process/pain management at end of life. Hospice philosophy and mine, holds that if a patient says they have pain, they do and should be medicated accordingly. I agree completely. But when the patient can no longer speak for him/herself and we are required to medicate them entirely on objective data and hospice protocol, it can at times feel as if we are "playing God". We just want to feel we are doing the right thing for the patient. There seems to be a sort of taboo or negative judgement about a hospice nurse admitting thatshe/he struggles with this sort of issue but I believe it is the deep caring for our patients dying process and the integrity of the hospice nurse that makes us raise the difficult questions.

I've been a hospice nurse for 8 years and haven't ever felt uncomfortable with the few times that we've used "terminal sedation." We used an ativan drip mixed with dilaudid on a patient recently that had intractible nausea and vomiting and excruciating pain. She was given this option and she took it. We kept her asleep until she passed about 5 days later. Terminal sedation is different than giving meds to a patient that is actively dying and exhibiting non verbal signs of pain and agitation, or dyspnea - of which I also have no ethical problem with this and don't feel like I am playing "God." I think about what I would want done for me if I were that person on that bed. I have had families asking me to give more meds when the patient appears very comfortable and peaceful. That has been hard for me to deal with when they insist, no matter what you tell them.

[compassionate care]

Thank you for your response. I would not have a problem with the situations you described, either. I work primarily with end stage dementia patients, some with co-morbities, some without. I hope this is a place where one can safely and honestly explore one's ideas,etc. Hospice is a nursing specialty that will probably continue to make me look at my beliefs with each new experience in order to better serve the patients I have the priviledge of caring for. God bless the work we do and may I always keep an open mind and heart. If anyone out there has it all figured out, more power to you.

[saribeth]

Just one thing to remember...we can only follow the Drs orders, we are not doing it on our own...the 1st pt I "TS'd" haunted me and I had to really do some real live soul searching...but I came to a good place! Think about what your goal is...you are trying to make the pt as comfortable as possible and I am sure you are doing that really well...hang in there...it's always good to be able to reflect on what we are doing and why! I think that is called growing which by the way I am tired of always having to "grow"