Does her family know how sick she is?

Specialties Geriatric

Published

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. "Why didn't the doctor tell us this?""Have you talked to him?" "Yes, this morning." "I guess because no one likes to talk about it so it falls to the nurses."

Anyway, I explained that there are various ways to handle their mom, including extensive measures and also including not even using antibiotics. I told them that she would recover from this bout of pneumonia but that her heart is failing and she will get penumonia again and soon. And that this will continue. I also assured them that should they decide to continue hospitalizing her that we would support that as well. And to take their time in figuring it out.

I got thanked for my honesty. They're going to call a family meeting and hash it out.

I love my job when I feel competent. But it's a bittersweet love.

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.

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Specializes in ER/Geriatrics.

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

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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.

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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".

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Specializes in LTC.

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.

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Specializes in LTC, Hospice, Case Management.
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.

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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.

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Specializes in Critical Care, Patient Safety.
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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Specializes in Gerontological Nursing, Acute Rehab.

I have to agree that I don't understand what some of the fuss is about here. In my years working in geriatrics, I was the one who ALWAYS (and I mean always) initiated the end-of-life care talk with the family. Then, I let the doctor know what the family and resident wishes were.

The one thing to remember is that the doctors not only make rounds on all the residents in a facility, but they also have their own private practices to manage as well, so they depend on us to manage these types of issues. That's why I love LTC and gerontology....once you gain the trust and respect of the doctors, you're a bit more independent to handle these issues and then get orders.

To the OP, I think the gist of your post got lost in translation, but I feel that you did the right thing. It is a good feeling to help families and residents through difficult times. I'll never forget one family that I worked with. After their father died, they said, "We didn't know anything about death or the process. You made it a very spiritual experience for us. Thank you."

It's a great feeling! :redpinkhe

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Specializes in Hem/Onc, LTC, AL, Homecare, Mgmt, Psych.

In LTC when you see a patient going in and out of the hospital every week you have to look at the quality of life. The hospital doesn't want her, we can't fix her, family doesn't know what their options are. In the OP's case, the MD suggested comfort cares and the nurse brought it up and explained to the family. I work in LTC too, and oftentimes after speaking to the MD and reading off the list of interventions we have attempted for a declining patient, the MD will say, well maybe its time to discuss comfort cares with the pt and family. Nursing & maybe social work then goes in to ask how aggressive they wish to be treated and go from there. It's true, not many people want to talk about this. Good job AlmostABubbieRN for helping the family to make an informed decision.

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. "Why didn't the doctor tell us this?""Have you talked to him?" "Yes, this morning." "I guess because no one likes to talk about it so it falls to the nurses."

Anyway, I explained that there are various ways to handle their mom, including extensive measures and also including not even using antibiotics. I told them that she would recover from this bout of pneumonia but that her heart is failing and she will get penumonia again and soon. And that this will continue. I also assured them that should they decide to continue hospitalizing her that we would support that as well. And to take their time in figuring it out.

I got thanked for my honesty. They're going to call a family meeting and hash it out.

I love my job when I feel competent. But it's a bittersweet love.

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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

Ok....gonna have to chime in on this one.

1. I don't think the OP actually SAID to the family "I guess nobody like to talk about IT so it falls on the nurses" THAT would have been wrong. I think OP was just stating that is how many nurses feel when they work with critically, chronically ill patients. Some MDs will talk about death in plain English, but many will not.

2. We can ALWAYS treat aggressively until a person's appendages start to turn black and fall off in the ICU bed (seen it, by the way). Or we can stop all of those aggressive measures and make sure the person is comfortable. The only thing I don't agree with is the part about stopping antibiotics. In hospice we usually do treat pneumonias, etc. with antibiotics because that provides comfort to the patients.

3. As to recurrent pneumonia. Ummm.....do you know the pathophysiology of CHF? It doesn't require a 'crystal ball' to know that the patient most certainly WILL get recurring pneumonias, fluid overloads, etc. We don't know when, but it does happen.

Talking about death and dying IS being an advocate for the patient. They need to know what they're up against and what their alternatives are. And people do not live forever. Just because we can prolong 'life' (if you can call it that when you're hooked up to a ventilator and 20 different meds to stabilize your vital signs) doesn't mean we should, unless a patient has specifically said "I want it ALL" after knowing the consequences. That is a different story.

Be curious to know what area you've worked in, Liz.

And to OP: Her family knows....denial ain't a river in Egypt.....sigh. People hear what they want to hear, and only hear it when they're ready. You did the right thing.

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Just throwing my support behind the OP. Everyone else who supported you said everything I could have said.

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