Does her family know how sick she is? - page 4
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... Read More
Jun 22, '10Quote from CapeCodMermaidI mentioned the "do not hospitalize" yesterday for that very reason - let her die at home, with the people who care about and know her. I also stressed that whatever their decision, which they should not rush, we will continue to care for her with tenderness and dignity.Where do you start with this one? Most docs see the resident for maybe 10 minutes every other month. We, on the other hand, see the resident and their families every day. Who do you think the family is going to go to for straight talk? US..the nurses who have been caring for their family member for weeks or months or years. Many a time a family member has asked me "What would YOU do." We can't decide for the families, but we can be there to tell them the truth as uncomfortable as it may be. We can remind them that when they agreed to be the HCP, they agreed to speak for what the resident would want. We can remind them that sometimes doing nothing but comfort care is the best thing to do....that WE know their family member...we know what they like, what makes them afraid, what makes them laugh and at the end of their time it would be nicer for them to be with people who know them and care for and about them than to send them to the hospital with a bunch of strangers.
We should advocate for our residents and support their families whether we agree with their decisions or not. We can tell them what we've seen in our careers, what we think might happen. Like it or not, most of the time it IS the nurse who has this discussion with the family NOT the doc.
People just want a straight answer. SOmetimes they refuse to hear it but it's a process. I had a care planning meeting today with a daughter who has a plethora of problems and called State on us (and is my documentation good!) to no avail. She came in with guns blazing and by the end of the meeting I had explained dementia and its prograssion, disinhibition, the inability to make memories - and was thanked, again, for explaining things that they did not understand and that no one had taken the time to help them with. I was told afterwards that everyone from work was impressed with how I handled it. They were expecting a blood bath and were astonished at how I defused the situation. So was I.
I love my job. And I feel clinically competent again. I've had a good week so far.
Jun 22, '10Quote from elizabeth321It 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
You are WAY off base here-remember this is the LTC forum. As others have said we at the bedside have a rapport with the residents and their famiilies and this discussion is almost always initiated by us.We are the resident's advocate and every time one experiences a change in condition we review the advance directives and discuss plan of care with the family and the physician.Only occassionally have I had a family member call the physician directly themselves-I know most of them well,have gained their trust over the years and they have confidence in me.
At my facility we have comfort care and end of life care.Comfort care means we are not d/cing meds,tx,labs etc.Only when the resident enters into the active phase of dying do we start to do that.Comfort care means just that-we have the rescue meds at hand and use them if needed-no hospitilization. Some families do want extensive care-hospitilization with IV fluids,etc. I always lay everything out on the table-comfort or hospice care does NOT mean we don't treat their loved one. We can send a resident to the ED for a faster eval then we can perform in the LTC.Sometimes the family opts for that but then refuses admission for their loved one and they come back to the LTC to die. I ALWAYS explain to the family in layman's terms exactly what they can expect to see as things progress.
When you have worked in LTC for a few years and seen the progression of these diseases (CHF,end stage Alzheimer's,etc) you pretty much DO have a crystal ball.... Whoses duty is it to advocate for these residents? You say it's up to the "team" Crisis situations NEVER occur on team meeting days,in my experince and who do you think is at these team meetings? Here's a little secret-It aint the doc....
Jun 22, '10Hard to touch this post as every situation is so different and must be analyzed individually. Of course there are legal issues, and none of us play G-d or can foresee the future. I am sure the OP read the situation and responded appropriately as an experienced nurse who has the best interest of her patient at heart. I thank her for sharing and opening a very sensitive subject.
I see too many children of end stage patients who are kept in the dark ( due to the patients request that we not discuss his or her condition with their children) , and inevitably are in shock at the funerals. They often have a hard time dealing with the death, and have residual issues.
I believe in a multidisciplinary approach to this kind of situation and would get the SW (if available) on board. If appropriate, I would also invite the families religious or spiritual adviser to provide whatever assistance necessary. I would chart my conversations and care plan the problem.
Bottom line, - I, too, would have approached the topic with the family gently and with assistance of my team. I admit that this is not always available.
Jun 23, '10Quote from michelle126We are all real actual nurses. Having a relationship with your patients is a part of your specialty but doesn't make you anymore a nurse than any other nurse in another specialty. I may have a shorter contact/relationship with my patients but I can still have a big impact on their lives. I know you didn't mean it the way it sounded, or I hope not, but I felt the need to clarify.We LTC nurses are real actual nurses.
Jun 23, '10Quote from TwilightRNurseYou misread it, Twilight. The poster was referring to the fact that we in LTC are looked down on by many as being less than "real" nurses.We are all real actual nurses. Having a relationship with your patients is a part of your specialty but doesn't make you anymore a nurse than any other nurse in another specialty. I may have a shorter contact/relationship with my patients but I can still have a big impact on their lives. I know you didn't mean it the way it sounded, or I hope not, but I felt the need to clarify.
Jun 26, '10In my state, at least, "end of life" care DOES mean dc-ing labs, most meds, etc. And it has been drilled into my head that I am not allowed to give recommendations on what I think they should do. I'm only allowed to give the facts. You know, end of life means this, if you go to the hospital they will probably do this, if we don't treat this this is what happens, the natural progression of the disease is this. I'm not allowed to recommend end of life; I'm only allowed to state it as an option and educate the family about what it is and what it entails. It is considered up to the dr to make recommendations. I only educate. Does that make sense? IDK if it's different by state or by facility or what. Maybe the poster who thought the OP was in the wrong has the same regulations as I do? Because I thought the same thing when I read the OP. Believe me, I've WISHED I could tell the family what I think they should do, but, again, in school and in my facility is has been drilled in my head that I'm not allowed to.
Jun 27, '10Quote from DizzyLizzyNurseSo basically your employer is limiting your ability to apply the nursing process to those clinical cases and situations...?In my state, at least, "end of life" care DOES mean dc-ing labs, most meds, etc. And it has been drilled into my head that I am not allowed to give recommendations on what I think they should do. I'm only allowed to give the facts. You know, end of life means this, if you go to the hospital they will probably do this, if we don't treat this this is what happens, the natural progression of the disease is this. I'm not allowed to recommend end of life; I'm only allowed to state it as an option and educate the family about what it is and what it entails. It is considered up to the dr to make recommendations. I only educate. Does that make sense? IDK if it's different by state or by facility or what. Maybe the poster who thought the OP was in the wrong has the same regulations as I do? Because I thought the same thing when I read the OP. Believe me, I've WISHED I could tell the family what I think they should do, but, again, in school and in my facility is has been drilled in my head that I'm not allowed to.
What do you do with a nursing diagnosis of knowledge deficit or impaired decision making, etc? Your employer wants you to notify the doctor and then wait until he/she responds and tells you what to teach them??? In many EOL cases the patient would literally DIE before a medical POC would be developed. The sad but honest truth...nurses in this setting are too often limited in their ability to carry out the duties of their profession within the scope of their practice by employers ignorant in the field of nursing. Just my
Jun 27, '10I too have opened the conversation with family members on this subject. It has always been well received. In all cases the MD discussed palliative care and hospice first but the family wasn't ready or didn't understand. The patient and the family sees the doctor for minutes at a time. Sometimes I have gone in later and they didn't even realize the person they had seen was their dr. But they see me there 40+ hrs a week, sometimes for weeks or months on end. I know them and their family dynamics, and the family knows me well. I have gently opened the discussion and then answered questions. I see nothing wrong with that. I would answer other questions about their care, why should death be any different?
I think you did the right thing, and I think the family is and will be grateful for allowing their family member and them a positive end of life experience. Good for you!
Jun 27, '10A ot of the nurses where I am have told me that I can't discuss this. The DON and admin and physicians have all asked me to bring it up. I will continue to go with my heart and head and advocate that families let demented, sick old people go in peace when the time is obviously near.