End Of Life Issues---The Good, The Bad, and the Ugly - page 2

If I ever become a hospice nurse (which is what I've decided I want to be when I grow up), the varied experiences I'm collecting in long-term care should stand me in good stead. Right now I have three different residents in... Read More

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    This is an issue I hold very near and dear to my heart. Although I have only been a nurse for 1 year now (on med-surg floor) I find myself relating closest to the patients who come to our 3 "hospice suites" on my floor to die. These patients and families evoke in me the kind of compassionate nurse I know I have always wanted to be, and know I have it in me to be, but sometimes am not able to be due to patient load, crazy pt. families, etc. I would love nothing more to get into hospice nursing somehow, but am unsure of how to go that route (most places want nurses with hospice experience...I wonder if my care of dying hospice pts. on my floor would suffice?). At any rate, I applaud all nurses, MDs, families, and pts. who have the understanding and knowledge to accept death as a normal part of life and who work tirelessly to make hospice / palliative care the standard of care for all end-of-life people! I hope we as a society can get this to be the standard as opposed to the exception, although I know we have a long way to go...
    rashana, rubig56, and heatherhammy like this.

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    I work in oncology and once had an 80-something yo man who came down with some type of cancer. (I can't remember which one.) He ended up in our hospital's ICU with a GI Bleed that turned into DIC. By the time he got to our floor he was hopeful that he could go home to his farm soon. He had been strong and healthy up to this point and had a POA who was not related to him. He stayed on our unit for a few weeks. His blood counts were never right and we kept having to give him blood and platelets. The POA kept insisting on the most aggressive cancer treatment because "My Godfather is precious to me." ALL the doctors adviced against it. They said it would make his life miserable and probably wouldn't even work. But he kept insisting.

    The patient, in the meantime, kept getting more and more depressed. He wanted to go home and sit on his porch and enjoy his farm. He didn't want to go through chemo and radiation. He was perfectly capable of making his own decisions, but the POA kept butting in, kept throwing his weight around, kept talking about money, and lawyers, etc.

    It was criminal. I really wonder what ever happened to that man.
    nitenite likes this.
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    Being a nurse yet having taken care of an Alzheimer parent I can see somewhat where people are coming from that I wouldn't have been able to see before. If not for the gentle encouragement of me and the other caretakers...my Mom would have never gotten washed, would have never eaten anything but ice cream (and I KNOW she would have refused any feeding tube), and would never have taken her Alzheimer medicine which totally prevented sundowner's and allowed more then five years with a good quality of life. If she was allowed the choice, my brother and I would have missed out on five wonderful years. I learned early not to call the "washing up" we did in the morning a "bath", to add sugar to foods that she would eat, to forget the typical breakfast/lunch/dinner and work on what she would and wouldn't eat, and to work on ONE pill at a time giving her some food after to make sure she swallowed it (as she hated to take any pills and wouldn't eat anything with them crushed). Refusing hospice for awhile because if agressive measures that wouldn't cause her pain or discomfort were needed we may want to do it...for instance she had kyphoplasty that helped her backpain tremendously. Hospice was finally called four days before she left us from her bed at home as she would have wanted...and even those short days was tremendously helpful with pain control alone.

    My point is no one actually can tell you what is going on with family dynamics...IMO the best we can do is show the family all that is being done and the quality of life their loved one is living right now. It is up to them to decide once they have all this information.

    I remember one group of nurses in ICU where I worked that despite hospital policy allowed the family to see the 10th code on a patient that the heart had given out a long time ago. Previously no amount of discussion from different professions helped in their decision process. After seeing the code the patient was quickly placed on hospice by the family.

    Our jobs as nurses is not to be judgemental but educate, inform and be a patient advocate and yes, this can extend to the family.
    StrwbryblndRN and nitenite like this.
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    That's just plain selfish of the families to keep these people from moving on to the next life. I'm currently a first semester student working in LTC now and I have had so many people tell me they just wish to die. We need to educate the families that sometimes the best miracle is "to let go and let GOD". It breaks my heart the way some of these people are kept alive for no one's good except the family that isn't willing to let go yet. And bless you hospice and LTC nurses for doing this day in and day out!!!!
    nitenite likes this.
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    Quote from VivaLasViejas
    Maybe so many of us are afraid to let go because that means we're next; maybe we cling to our forbears so fiercely simply because they are our last connection with the younger selves that we will never be again.
    Anyway, that's a lot of generalization, but it sort of makes my point.
    I agree, when our parents die there is no longer a generation between us and the grave. I do think being nurses helps us to get there more gracefully though
    nitenite and txredheadnurse like this.
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    I work in the ICU at a fairly large hospital. I totally understand about the inability for people to have a 'good death' because of family members that are clueless. Too bad everyone is afraid of trial lawyers or we could practice medicine in an ethical, sensible and financially responsible fashion. Until things change however I guess we are stuck letting lay persons run the show. What we see is appauling to say the least!! I totally hear ya!
    nitenite likes this.
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    This goes on at the other end of the spectrum too - with tiny preemies. But the core issue is still the same. Just because we can, should we? In whose best interest is it to keep people alive that are trying to tell us (verbally or otherwise) that they are dying? I think too many times we fight to keep bodies around when souls want to go gracefully.

    Great post.
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    Would it make you feel better if I told you there is one person who will not allow it to happen to their family member. My mom will be 86 shortly and her dementia is getting worse. She made it perfectly clear to me when she started to feel herself slip that she did not want what you are describing to happen to her. She always disliked medical treatment, the more invasive it was the more she disliked it. It would be obscene to subject her to treatments she would refuse if she were in her correct mind. I do worry how far we can go with this. Take for instance the fact that she has mild heart failure and her feet swell on some days. I know she would refuse treatment for the heart failure and accept whatever the consequences of that would be, but could it be misconstrued as neglect on my part if I follow that path? I worry about that. I do have her medical and durable power of attorney.
    Last edit by oramar on Apr 27, '10
    nitenite and txredheadnurse like this.
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    I think as nurses we have to be reminded every day that dying with dignity is important to everyone. I, too, don't understand why some family members don't understand this. But as patient advocates we must offer our understanding to both patients and family.
    rashana and nitenite like this.
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    It's not just the families that don't understand that death happens. So many in our profession and so many physicians see death as 'giving up' and 'losing' the battle. And so many are woefully ignorant about what hospice does and why we use the drugs we use. The medical profession needs WAY more education about hospice as well.
    sharonp30, rashana, UKRNinUSA, and 2 others like this.

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