Does her family know how sick she is? - page 2

by SuesquatchRN | 3,729 Views | 34 Comments

Asked the doctor this morning. I told him that they come in a lot and he mentioned comfort care, which can mean many things, but it always means end-of-life. They had come in to see their mom and I opened the discussion. ... Read More


  1. 11
    I would suggest that nurses are certainly supposed to have conversations with their patients about health care options and choices they have. If we are caring for the whole patient we help them to make informed choices...advocating for them along the way.

    We are not limited by physician orders in our practice of nursing in total. We nurse people in ways other than by simply completing an ordered procedure or administering a prescribed medication, etc. That stuff is an important part of what we do but there is more...

    It IS okay for us to identify knowledge deficits, acceptance or decision making issues, as problems that we can positively impact with our nursing process. How we intervene in these instances...the plan of care, if you will...is unique to each patient. Ideally we should be documenting most of this nursing care on the POC. Alas, too many times we have no nursing care plan or a nursing care plan which serves to meet a requirement but has minimal relevance to the nursing care provided.

    Nevertheless, we should address these issues...within our scope of practice and the policies and mission of employers.
  2. 7
    I think you did just fine!

    In LTC (this is the geriatric forum), the MD may only actually see the resident every month or two. There isn't the opportunity for them to speak to the family all the time like there is when a person is in the hospital. Therefore, it is often left to us LTC nurses to educate the family about their loved ones condition and the options available to them. It takes a strong and soft heart to do this effectively and with kindness. Sounds like you were able to pull that off beautifully.
    Moogie, teeniebert, IowaKaren, and 4 others like this.
  3. 8
    I agree, I don't see anything wrong with what the OP did here...no matter what the forum (LTC, acute care, home care, etc)...it is the nurse that spends the most time with the family, and after working in each of these areas and seeing the family/MD and family/nurse interaction, it has been my experience that the families are more often willing to open up and talk to the nurses vs. the MD during this trying time anyhow. The MD is most often not around, and it becomes an uneasy situation for all parties involved when they come in and introduce the end of life topic, it's much "easier" if you will for the nursing staff who has often developed a much more personal relationship with the family and/or patient at this time to discuss these options. And in homecare, the MD is never there to intro this topic...we as nurses always intro hospice, normally we have spoken with the MD ahead of time, so they know what is coming, but sometimes that isn't the case, the family will just ask about it during a visit...and what are we supposed to say about it? "I'm sorry, you'll have to call your family doctor about that..." No--you give them the information about it, and it's nothing different than what you would tell a patients family if you were in an acute or LTC setting...it's just that the MD is down the hall, rather than across town.
    teeniebert, canoehead, IowaKaren, and 5 others like this.
  4. 4
    It is not about YOU feeling good about what you did....if I start picking it apart one comment by one comment I can find many things wrong...I see your responses as presumptuous...."I guess nobody likes to talk about IT so it falls on the nurses"....that is burdening the family with info they do not need....that is a conversation to have with the team...also by the doctor saying "comfort care" you are clarifying this to mean end of life but then you tell the family the different courses of care they might take including extensive care (whatever that means)....how do you know that is one of the options???? Then you tell them she will recover from this bout of pneumonia but will get it again soon.......how do you know that....do you have a crystal ball.......I am not sure what the point of your post is....just remember when you take actions to make yourself feel good often times you are not actually being a patient advocate or caring for the caregiver you are doing it for yourself....IMHO
  5. 13
    Nobody likes to talk about it.

    We do not have staff to call family meetings for every dying person in LTC nor is it usual.

    I know what the options are because I am familiar with and refer to the MOLST when determining how to respond to an illness/crisis in a patient.

    I know that the family wants information because I know the family. I see them frequently. And they asked me today.

    I do have a crystal ball about residents I know and who are being repeatedly hospitalized for bout after bout of pneumonia, have advanced dementia, severe heart failure, are O2 dependent, and have lost the will or ability to feed themselves.

    Your comments are presumptuous. If you think that this was an easy conversation, if you think that when I tried to assuage their fears that their mother would die alone I didn't cry as I thought of my own father, who did, if you think that I had this conversation to make me feel good rather than address their fear and uncertainty about their mother, who they love, you have gained astonishingly little insight or empathy in your 24 years in nursing.
    Wise Woman RN, rachelita, teeniebert, and 10 others like this.
  6. 3
    Quote from elizabeth321
    Then you tell them she will recover from this bout of pneumonia but will get it again soon.......how do you know that....do you have a crystal ball.......

    Does anyone have a crystal ball?? Nurses, Doctors, Therapists, Human Beings in general make assumptions like this everyday about medical and non-medical things alike--you are using prudent judgment based on clinical experience, the same thing that a doctor would do. I find it very difficult to believe that as a nurse, you've never answered a patients questions based on "what you've seen in the past".
  7. 3
    I think that you did the right thing by talking to them. It sounded like family needed to hear this information. At least now the family can make an informed decision about care for their family member.
  8. 5
    Quote from elizabeth321
    It is not about YOU feeling good about what you did....if I start picking it apart one comment by one comment I can find many things wrong...I see your responses as presumptuous...."I guess nobody likes to talk about IT so it falls on the nurses"....that is burdening the family with info they do not need....that is a conversation to have with the team...also by the doctor saying "comfort care" you are clarifying this to mean end of life but then you tell the family the different courses of care they might take including extensive care (whatever that means)....how do you know that is one of the options???? Then you tell them she will recover from this bout of pneumonia but will get it again soon.......how do you know that....do you have a crystal ball.......I am not sure what the point of your post is....just remember when you take actions to make yourself feel good often times you are not actually being a patient advocate or caring for the caregiver you are doing it for yourself....IMHO

    With all due respect, I can't help but be curious as to how you would have handled the situation. Waited a couple weeks for the Dr. to come in? Ignore it?

    There is absolutely nothing wrong with walking away from a situation and feeling good about what you did. The nurses that scare me the most are the ones that seem to take NO pride in their work or the way they handle situations.

    I'm not sure what the point of your post is except to be critical. Let's support one another or at least offer suggestions as to how to handle an issue.
  9. 2
    Quote from elizabeth321
    I am not sure I understand your post...but based on what I can determine from the content I think you were out of line.
    Liz

    I disagree. I don't see any way that the OP was out of line. I have noticed that many oncologists have a hard time giving patients their prognosis and always extend the amount of time they believe the patient has left. Why do they do this, to give them hope? This is false hope and doesn't give the family sufficient time to make whatever arrangement they need to make to be there when the time comes.
  10. 3
    Quote from elizabeth321
    It is not about YOU feeling good about what you did....if I start picking it apart one comment by one comment I can find many things wrong...I see your responses as presumptuous...."I guess nobody likes to talk about IT so it falls on the nurses"....that is burdening the family with info they do not need....that is a conversation to have with the team...also by the doctor saying "comfort care" you are clarifying this to mean end of life but then you tell the family the different courses of care they might take including extensive care (whatever that means)....how do you know that is one of the options???? Then you tell them she will recover from this bout of pneumonia but will get it again soon.......how do you know that....do you have a crystal ball.......I am not sure what the point of your post is....just remember when you take actions to make yourself feel good often times you are not actually being a patient advocate or caring for the caregiver you are doing it for yourself....IMHO
    Hmmm...not quite sure I understand what you are suggesting here. I've seen this scenario occur many times: physician walks into a room, explains the situation, and walks out. Only the patient and/or family are left feeling confused because of medical jargon that gets thrown about, or the real crux of the situation is not actually teased out with the patient & family. As nurses, it is up to us to help clarify whatever needs clarifying, and making sure people have a real understanding of their options.

    The alternative is to step back and let things play out without getting involved. Let the patient and/or family be confused. Don't get involved and let things happen in a downward spiral.

    And yes, I have seen many physicians who are uncomfortable with talking about IT.


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