End Of Life Issues---The Good, The Bad, and the Ugly - page 4

by VivaLasViejas Guide

11,770 Views | 42 Comments

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


  1. 0
    okay first of all DNR does not mean kill. when someone dies their soul leaves their body. honestly it is not up to you, me or the patient. is it up to God when they will be "set free". it is your job to help them as much as you can no matter how much pain they are in. until the patient passes out you do not have the option to do anything except DO YOUR JOB! when he blacksout then you can follow the DNR order until then DO YOUR JOB!! it is not your choice to do anything but that until then!!
  2. 5
    Quote from krissy_mack
    okay first of all DNR does not mean kill. when someone dies their soul leaves their body. honestly it is not up to you, me or the patient. is it up to God when they will be "set free". it is your job to help them as much as you can no matter how much pain they are in. until the patient passes out you do not have the option to do anything except DO YOUR JOB! when he blacksout then you can follow the DNR order until then DO YOUR JOB!! it is not your choice to do anything but that until then!!

    Where did this come from? No one here even came close to suggesting euthanasia.

    Viva's original post was talking about the ways in which DO YOUR JOB translates into abusing a dying person.

    She gets to kvetch about that and try to find ways to DO HER JOB without beating on defenseless elders. Her JOB, btw, includes relief of pain, preservation of dignity and education of family members. She and her facility can be sued for not doing so ... it's happened.
  3. 3
    Thank you! I was wondering where all that came from myself, as I thought I'd made it clear that I know what DNR means (and doesn't) mean. I also stated very plainly that I don't believe in euthanasia. Whew...........was beginning to wonder if I'd somehow posted the exact opposite of what I wanted to say.
    sharonp30, nitenite, and Spidey's mom like this.
  4. 1
    So sad to think of death, yet its true that this is the end of all journies, and as an advocate of life, we must never to neglect to make those people comfortable till the very list end
    No Stars In My Eyes likes this.
  5. 2
    One of the perks of spending years nursing, taking care of others' family members, is that when the end was coming for both my mother and father, my family and I allowed them to die at home. It was because of all my experience with other patients I fell in love with that I made certain my own mother and father (and me as well) had a living will with DNR written way before time in exact details and encouraged them as soon as they got sick (my father was almost 80 and my mother was 95) to tell all of us exactly what they wanted. Both wanted to die at home with those they loved around them. Both died peacefully without struggle and with great grace. And that was due to all of us, including the hospice nurses and the grandchildren who all came to help toward the end. It was a very good death for both of them, and even the doctor came to visit often. Afterward, I asked that same doctor how he would want to die, and he answered, "Just like your mother did." Maybe with health care reform, more people will be able to take care of their dying family members at home. A great gift of intimacy, and hopefully a place that we can all have the help of those caring hospice nurses and doctors who helped support the rest of us as our loved ones die. Thank you all.
    LTCangel and VivaLasViejas like this.
  6. 2
    Excellent article! I was a long term care nurse and am now a hospice nurse, and your comments about the desires of families, moves, upcoming weddings that people are being kept alive for are all about the family member, NOT the patient. As a caregiver, I can only recommend education, education, education. I have often told families when doing a hospice admission that we are programmed to live, not to die. There is real fear about having someone die in their own home, yet it can a natural, peaceful process. If you can get past some of the issues surrounding keeping the patient alive, you may have more luck with honoring the patient's wishes. Sometimes it takes an outside, objective opinion to make people see that what they are asking for, while they may see it as advocating for the patient, is really a need they have themselves. Moving a family member to be closer to a caregiving relative speaks to a certain guilt that they cannot be in attendance to take care of Mom or Dad. The patient being kept alive for an upcoming wedding....she will have no more knowledge of the fact that there is a celebration if there is pain, discomfort or shortness of breath. Yet, a patient on hospice who cannot be at the wedding may cast a negative light on the festivities, so let's just keep her alive to attend. The topic of dying is very uncomfortable in general, and the reality of someone you love who may be dying is something that has to be eased into. The hospice admissions I do, when the family and patient are both ready and understanding, are usually after a long and, at time, debilitating illness. The family and patient are both understanding there is no more quality of life, and the reasons for keeping them alive diminish. With a sudden change, decline or rapidly progressing terminal illness, I often see families tend to want to look for another avenue besides acceptance of death. It's really not a bad thing, I think more a human thing. As health care professionals, we need to educate about the body's way of shutting down and keeping the topic of death as a pleasant, almost humane thing for the patient. A wonderful group of examples about why hospice care is needed in our ever growing population of elderly and terminally ill patients.
  7. 2
    i currently work in a catholic hospital on a geriatric unit....when issues like this arises we call the sister and or the palliative care nurse. they would read and get an understanding of the patients advance directive, if there is one. they are very good in having family meetings and in helping the family understand the patients diagnosis and prognosis and all the available options for them...sometimes these families need someone to tell them like it is...so they can have better understanding.
    LTCangel and VivaLasViejas like this.
  8. 1
    Excellent article! I was a long term care nurse and am now a hospice nurse, and your comments about the desires of families, moves, upcoming weddings that people are being kept alive for are all about the family member, NOT the patient. As a caregiver, I can only recommend education, education, education. I have often told families when doing a hospice admission that we are programmed to live, not to die. As such facing something we donít know provokes anxiety and fear in everyone, especially the caregivers. There is fear about having someone die in their own home, yet it can be a natural, peaceful process. If you can get past some of the issues surrounding keeping the patient alive, you may have more luck with honoring the patient's wishes. Sometimes it takes an outside, objective opinion to make people see that what they are asking for, while they may see it as advocating for the patient, is really a need they have themselves. Moving a family member to be closer to a caregiving relative speaks to a certain guilt that they cannot be in attendance to take care of Mom or Dad. The patient being kept alive for an upcoming wedding....she will have no more knowledge of the fact that there is a celebration if there is pain, discomfort or shortness of breath. Yet, a patient on hospice who cannot be at the wedding may cast a negative light on the festivities, so let's just keep her alive to attend. The topic of dying is very uncomfortable in general, and the reality of someone you love who may be dying is something that has to be eased into. The hospice admissions I do, when the family and patient are both ready and understanding, are usually after a long and, at times, debilitating illness. The family and patient are both understanding there is no more quality of life, and the reasons for keeping them alive diminish. With a sudden change, decline or rapidly progressing terminal illness, I often see families tend to want to look for another avenue besides acceptance of death. It's really not a bad thing, I think more a human thing. As health care professionals, we need to educate about the body's way of shutting down and keeping the topic of death as a pleasant, almost humane thing for the patient. Your article provided a wonderful group of examples about why hospice care is needed in our ever growing population of elderly and terminally ill patients.
    VivaLasViejas likes this.
  9. 0
    I had have a question about end-of-life care that maybe someone can answer. I'm a Jr BSN student, and am currently watching my grandfather as he dies from stage 5 melanoma. The edema is seeping into his lungs, and I can hear the breath sounds change as his death draws nearer. He will soon drown in his own fluid...

    My family is asking many questions, but the one I do not know, nor can I find the answer to, is how long after his death can we expect his bowels to evacuate? He has a Foley cath, but is not wearing Depends or anything, and we want to prevent my grandma from witnessing him having a bowel movement if possible.

    Thanks guys.
  10. 1
    Quote from CT Pixie
    Amen!
    I work LTC and I, too, cringe at the things we are supposed to do to these poor souls who want nothing more than to be set free.

    I am of the thinking, that just because we CAN make people live longer and longer doesn't mean we SHOULD! I see no benefit of living to see 99 if my mind and body are just a shell that houses my being, with no quality of life, I'd rather be in the better place.

    I promise you, if my family EVER did to me what I see some families do to those they love, (tube feeds, full codes, treat at all costs, force feed meds/food etc) I will come back from the afterlife with a vengance and haunt them to the very end.

    The hospice nurses who come to my facility are always trying to get me to go work hospice for their company, I have the "knack" they say. Hospice has always been an area i'd love to try.
    Go for it! We always have room for one more good nurse.
    VivaLasViejas likes this.


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