Bending and Breaking the Rules in Nursing - page 4

by TheCommuter 28,035 Views | 57 Comments Senior Moderator

I believe rules can be bent at times. Heck, I feel that some rules can even be outright broken as long as doing so has brightened someone’s day. Billie is a pseudonym for the septuagenarian nursing home resident whom I first... Read More


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    This reminds me of a lady I once took care of who was perfectly sane. Her friends and family smuggled some forbidden snacks into the facility and made her promise not to tell. She went all out to keep the secret. She stayed in her room, refused to speak, eat, or do anything until all her snacks where gone. Because the nurses had no idea what was going on with her, they documented in her chart that she was showing signs of dementia...lol When she found out, she was furious. Apparently, it's hard to live down documention that says you may have dementia.
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    Good on you for giving her some joy. She was in hospice care and so deserves to be able to have what ever she would have wanted. It is nurses like you that make me want to carry on and get my nursing degree.
    LTCNS likes this.
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    Just a student question here. Why does LTC have a rule about food items for patients whose care is being managed by hospice? I don't get it? What's the rationale?
    LTCNS and Spidey's mom like this.
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    God bless you, Commuter. You can be my nurse anytime. When I was a visiting nurse, I made daily dressing change visits to a diabetic octogenarian. He also missed his hamburgers. Every 2 weeks, I would stop @ a nearby fast food takeout & bring him a burger w/extra pickles, & small fries. In addition, I had a neighbor, 87 years old, in renal failure, on dialysis @ a low protein & low sodium diet. I used to stay w/him when his wife needed a break. He would tell me that he hated dialysis because of the diet & would rather be dead. I made a pot roast for my family one day & saved a plate for him. 2 days later, I went to spend some time w/him & brought the meal w/me. He loved it & cried over my "kindness". I was petrified that he wouldn't make thru the night. He did make it & the next day was dialysis. So I was glad that I had done it.
    kogafietsen likes this.
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    I don't know about the rules where you worked, but when I worked with hospice patients, we were told that whatever the patient wanted we should try to provide it. The orders were only there to cover all the bases, but the patients should be given the autonomy to choose what they wanted in the final days, weeks, or months of their life. Thanks for the great story. JoyKay
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    Quote from TheCommuter
    I believe rules can be bent at times. Heck, I feel that some rules can even be outright broken as long as doing so has brightened someone’s day.

    Billie is a pseudonym for the septuagenarian nursing home resident whom I first met seven years ago when I was a brand new nurse in long term care. She was a strikingly pretty model during her youth, and even as an elderly woman with a terminal prognosis, she still maintained a whimsical cuteness and a stylish flair through tasteful choices in makeup, haircuts, clothing and jewelry.

    Billie received hospice services because her physician did not expect for her to live another six months due to advanced congestive heart failure. Although she barely stood five feet tall and weighed no more than 100 pounds, her lower extremities were chronically wet, weepy, heavy, discolored, swollen, and resembled crude elephant legs. Diuretic medications did not help to pull the extra fluid off. Neither did pressure wraps, sodium restrictions, or keeping the legs elevated. Keeping her comfortable was an uphill battle.

    She suffered from mild cognitive impairment, but was very well-versed regarding her dietary restrictions. One day she asked me, with the impression of defeatism stamped on her face and a sense of sorrow prominent in her tone, “Will I ever be able to eat a hamburger again?”

    My dark brown eyes made contact with her pale blue eyes. I realized some of the things that I, a young and reasonably healthy adult, take for granted are small pleasures that many elderly nursing home residents will never enjoy again. Most, if not all, of these people will never take another vacation to a faraway city, state or country. Some will forever lose the ability to walk. Others will be robbed of their ability to talk after having a stroke. Still, others will never be able to enjoy a tasty meal due to dysphagia, feeding tubes, pureed textures, restrictive diets, or the notoriously bland foodstuffs commonly served to institutionalized elders.

    I did something I should not have done. I broke a rule. During my lunch break I visited a local fast food joint and ordered a hamburger with extra tomatoes. Since Billie spent the vast majority of her time in her room due to depression, smuggling the burger to her was an easier feat than I had expected. Her eyes lit up with joy and anticipation.

    “Thank you, thank you, thank you!” she exclaimed. She kept her door closed and picked at the burger for several hours, eating the fixings individually before finally polishing the sandwich off. This was the first hamburger she had eaten in several years.

    Billie died a couple of months later. She passed quietly, serenely, on her bed in the nursing home surrounded by the hospice nurse, a nursing student, and myself. She had two attentive adult children who visited frequently, but they did not want to be present during her final hour.

    I broke a rule by supplying an elderly resident under my care with an unhealthy food item. But if it alleviated some of the bleakness of her existence during her final days on earth, I feel no shame for doing what I did. To every rule there’s an exception.
    After doing my hospice rotation, you learn that people on Hospice kind of go by a different set of nursing rules. Unless this patient was NPO or had dysphagia to where the hamburger would put her at risk for aspiration, I do not see ANY problem with granting her wish. You were managing her symptoms (anxiety and depression) which is what hospice nursing is.

    I applaud you for it
  7. 0
    you may as well make another being as happy as possible for the time they have left. Well done! =)
  8. 0
    What a sweet story.

    That is rather strange though, that a hospice patient would have such a dietary restriction. But it's such a good example of breaching some (at times silly) rules that sometimes can be broken. Thanks for sharing.
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    We are in the middle of getting rid of diet restrictions at my facility. Read the studies....restrictive diets do little to nothing for an elder except upsetting them and diminishing their appetites. Really does a 90 year old need a low cholesterol diet? Of course not. The medical director is all for it so pretty soon the residents will be able to eat what they want.
    LTCNS, amoLucia, seanynjboy, and 4 others like this.
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    Quote from CapeCodMermaid
    We are in the middle of getting rid of diet restrictions at my facility. Read the studies....restrictive diets do little to nothing for an elder except upsetting them and diminishing their appetites. Really does a 90 year old need a low cholesterol diet? Of course not. The medical director is all for it so pretty soon the residents will be able to eat what they want.
    That is great! I wish all nursing homes would go for this model of care for 99 percent of elderly LTC patients. There really isn't any rationale for keeping them on these restrictive diets. At least where I work the food is bad enough, the more restrictions that get added to the diet the worse it gets.
    LTCNS, seanynjboy, and VivaLasViejas like this.


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