Re: Care at the Time of Death
Allow_Mystery…
That is an intriguing name by the way. I suspect Native American or Metaphysical influence.
My disappointment with the author of said article is its low intellectual level. If you go to the trouble of getting a Ph.D. why teach third grade? Why not teach grad school… or perhaps even do some meaningful research?
For example, in a previous thread I brought up the following point (but for whatever reason it got lost in the shuffle.) It has been my experience and observation that people can move on (die) sooner (and easier) if they get their work done. In other words, when you have finished, you may leave.
By “finish” I mean: Dying process is largely resolutional in nature; i.e. the task is to resolve one’s unresolved issues. When that work is finished we say things like- “He seems at peace now.” Therefore, to get at the real core of assisting the dying, to truly be helpful to them, we must focus on helping them to resolve their unresolved life-issues.
Instead, what I see happening in hospice more and more is focus on “comfort.” DON’T get me wrong… focusing on comfort is a good thing. Hear me say that. BUT (and this is the BIG BUT) if the focus is on comfort to the exclusion of assisting with resolution, then the net result will be to extend… as in- lengthen… the dying process.
In other words, the current trend in hospice appears to be heading in the direction of keeping patients alive longer so as to increase revenues (keeping them comfortable, chemically sedated but NOT assisting them in the core task of dying process; i.e. the resolutional work.) Because hospice is paid a per diem, the final result is: hospice makes more money by NOT doing its job… by dragging death out… by encouraging patients to linger instead of helping them get their work done.
This is the kind of thing… it seems to me… that would be worthy of a Ph.D.’s time & attention (as opposed to rattling off minutiae to impress rookies.) If hospice is beginning to veer off track in the direction of victimizing dying people for profit, I think that should be nipped in the bud… pronto! And it is hard to reach any other conclusion when one considers that assisting people in the resolution of their unresolved life-issues takes time and intimate interaction between nurse-patient-family… then looks at some of the threads in this forum which address the loads that are being dumped on nurses. I have to tell you that when I read through some of those threads it is truly disheartening.
Unfortunately, the majority of hospice reimbursement is set up on the capitation system, which basically comes down to: The less the hospice agency does for the patient, the more money they make… literally. I am not kidding… the less service the hospice provides, the more money they make. Let me restate that in yet another way so as to be absolutely clear: Hospice agencies are rewarded (financially) for doing less. So increasingly we see nurses quitting because they cannot even meet minimum requirements, much less have the time to sit with a patient… for HOURS PEOPLE!!!!! Not just a minute or two to adjust a med regime. You don’t resolve unresolved life-issues in a minute and a Haldol… it just doesn’t work that way. And if you are not helping patients resolve their unresolved issues you are dragging out (extending) their dying process for profit.
This, it seems to me, is urgent. Certainly it is more urgent than impressing rookies with minutiae.
And by the way Leslie…
You are so well thought of around here that any time you speak everyone stops to listen. Some others can rattle away and no one pays much attention, but when you speak everyone falls silent and listens. And I love your sense of humor… it is about as goofy as my own.
I did chuckle at your comment about my having too much time on my hands. There is more to that than you realize.
Thinking actually does take time. It’s funny, but I often hear nurses say things like: “I have next week off. Thank God! I really need to unwind.”
Let me tell you something, when I got out of the rat race, do you know how long it took to unwind? About a year. You really do not have any idea what the rat race is doing to you… until you have been out of it for some appreciable length of time. Until then you really don’t have time to think.
So I read (in this forum) what y’all are going through and it makes me heartsick… it makes me want to cry. Some of you are so incredibly good at what you do! But because you are still in the midst of the fray… still in the trees where you cannot see the whole forest… there are times when I am in despair for your well being. Then when some self-serving school marm of a Ph.D. starts wagging her finger in your faces, something snaps and I go a little crazy. I want to get in her face and yell, “You don’t have the right to talk to these people in that tone of voice! DO NOT talk down to them. For crying out loud, Leslie has more knowledge about dying process than you and all the people who granted you your Ph.D. ever imagined!”
Michael
Nursing News