I am happy that she passed with her family there, and quietly...and yet even though I don't know your patient, I still feel the loss and feel the sadness at the loss of someone you care for. I can picture so many that I have cared for when I read this posting...and how this issue was brought up in different degrees...and the emotions come back as if it were today...I don't think I will ever forget, they taught me so much.
I too am a big stickler for the 'diet as tolerated' because I too have gone rounds on this issue with other Nurses/Doctors/Family. In my facility (assisted living) the deal is we have CNA's and unlicensed care givers that do patients medications, and all direct care...so many hospice nurses do not want a CNA determining what a patient can or can't swollow so they automatically put NPO. What they forget is that we do have a Licensed Nurse 24/7 and we can be called upon to either do feedings, or evaluate and give the okay. Word is getting out that we do have this...so it is getting better
Yes, I prefer the "diet as tolerated", and I have them also put 'fluids as tolerated (parameters on thickness if needed' as well because of the many feelings about hydration on end of life issues (boy that one can be a hot button topic in our field huh!?!?!? So I like specific parameters to follow). That puts the power back into the hands of the nurses on location that deal with these patients day to day...and that really should be considered
I love my hospice RN's..they really are very flexiable and really listen to us at my facility..and whenever there is a probelm like this..they are so open and friendly to work with (and get this..call back in 5-10 minutes every time!!! YEAH!!!!!!). I guess I am very blessed with three great hospice organizations in my area..they really make the difference
They are sympathetic towards the need for 'diet as tolerated' being comfort for patients in their last moments on this earth...