Combating Hospice Burnout and ethical dilemmas concerning TS

caroladybelle, BSN, RN · Jan 10, 2005

What is TS????????

renerian, BSN, RN · Jan 11, 2005

Just let us know what you mean by TS as the letters might mean more than one thing. I can think of 5 things but none seem appropriate.

renerian

SharonK · Jan 11, 2005

Oops, sorry about that. :imbar

leslie :-D · Jan 11, 2005

there have been patients that we have sedated to a level of unconsciousness when physical pain could not be managed and such pain was that excruciating that it was tortorous.

it is an intervention that is used as a very last resort and if it finally relieves the suffering, then ethically i have no problem with it whatsoever.

as for burnout, i've had periods where i needed a break. but typically it is after repeatedly 'bad deaths'. these burnout feelings usually don't last longer than a week. if this happened to me on a consistent basis, i would consider changing specialties.

wishing you peace,

leslie

renerian, BSN, RN · Jan 11, 2005

I worked hem/onc/bmt over 6 years and have been a hospice volunteer for over 10. I have no problem with sedating someone into comfort as watching your loved ones suffer needlessly is horrible to watch/done it several times so I know how it feels. I don't think you really know how hard it is to watch your loved ones live in agony unless YOU WEAR the shoes so to speak. I can only hope I have a nurse if I get terminally ill that will help me be comfortable no matter the outcome.

I took periodic breaks/time off but rarely could afford to go anywhere. I agree some deaths are peaceful and others are terrible.

renerian

compassionate care · Oct 15, 2005

Your question on TS is the main reason I started looking for hospice support sites. I am an lvn with 23 yrs nursing experience, 12 in geriatric nursing and now 7 months in hospice. While I absolutely love working in hospice and believe in what we do, TS has caused the most conflict within me, especially in patients who have prolonged, lingering deaths. Or in situations where family members requests for continuous or increased pain meds have been a large factor in med management. This has forced me to do alot more studying of the dying process/pain management at end of life. Hospice philosophy and mine, holds that if a patient says they have pain, they do and should be medicated accordingly. I agree completely. But when the patient can no longer speak for him/herself and we are required to medicate them entirely on objective data and hospice protocol, it can at times feel as if we are "playing God". We just want to feel we are doing the right thing for the patient. There seems to be a sort of taboo or negative judgement about a hospice nurse admitting thatshe/he struggles with this sort of issue but I believe it is the deep caring for our patients dying process and the integrity of the hospice nurse that makes us raise the difficult questions.

doodlemom · Oct 16, 2005

Your question on TS is the main reason I started looking for hospice support sites. I am an lvn with 23 yrs nursing experience, 12 in geriatric nursing and now 7 months in hospice. While I absolutely love working in hospice and believe in what we do, TS has caused the most conflict within me, especially in patients who have prolonged, lingering deaths. Or in situations where family members requests for continuous or increased pain meds have been a large factor in med management. This has forced me to do alot more studying of the dying process/pain management at end of life. Hospice philosophy and mine, holds that if a patient says they have pain, they do and should be medicated accordingly. I agree completely. But when the patient can no longer speak for him/herself and we are required to medicate them entirely on objective data and hospice protocol, it can at times feel as if we are "playing God". We just want to feel we are doing the right thing for the patient. There seems to be a sort of taboo or negative judgement about a hospice nurse admitting thatshe/he struggles with this sort of issue but I believe it is the deep caring for our patients dying process and the integrity of the hospice nurse that makes us raise the difficult questions.

I've been a hospice nurse for 8 years and haven't ever felt uncomfortable with the few times that we've used "terminal sedation." We used an ativan drip mixed with dilaudid on a patient recently that had intractible nausea and vomiting and excruciating pain. She was given this option and she took it. We kept her asleep until she passed about 5 days later. Terminal sedation is different than giving meds to a patient that is actively dying and exhibiting non verbal signs of pain and agitation, or dyspnea - of which I also have no ethical problem with this and don't feel like I am playing "God." I think about what I would want done for me if I were that person on that bed. I have had families asking me to give more meds when the patient appears very comfortable and peaceful. That has been hard for me to deal with when they insist, no matter what you tell them.

compassionate care · Oct 17, 2005

Thank you for your response. I would not have a problem with the situations you described, either. I work primarily with end stage dementia patients, some with co-morbities, some without. I hope this is a place where one can safely and honestly explore one's ideas,etc. Hospice is a nursing specialty that will probably continue to make me look at my beliefs with each new experience in order to better serve the patients I have the priviledge of caring for. God bless the work we do and may I always keep an open mind and heart. If anyone out there has it all figured out, more power to you.

saribeth · Oct 21, 2005

Just one thing to remember...we can only follow the Drs orders, we are not doing it on our own...the 1st pt I "TS'd" haunted me and I had to really do some real live soul searching...but I came to a good place! Think about what your goal is...you are trying to make the pt as comfortable as possible and I am sure you are doing that really well...hang in there...it's always good to be able to reflect on what we are doing and why! I think that is called growing which by the way I am tired of always having to "grow":)

compassionate care · Oct 23, 2005

Hi Saribeth! You have a beautiful name. Thank you for your understanding reply. I love my job. My combined experience, in work and in life ie; 12 years as a psych nurse and 12 years in geriatrics, and providing end-of life care for my beloved step-father prepared me for this work. I was literally "called" into hospice. They recruited me from my resume with the unemployment office. Even 5 years ago I would not have been ready for this job. But going through the process of caring for and grieving for the loss of my Dad made me do alot of soul searching about my views on death and dying. I learned that the dying person must be allowed to make his/her own choices about all aspects of care. My dad wanted to die at home and we were in the process of making all of the arrangements for in-home support when he suddenly had a crisis. He decided to go to the hospital. I believe he didn't want my mother to have to deal with anymore. But things didn't go well. The hospital at one point felt he was "stable", moved him out of ICU, and was planning to send him to a nursing home to continue his recovery(he had multyiple life-threatening aneurisms). We went home so mom could get some rest. Apparently, the hospital didn't realize that one of his aneurisms had ruptured. He died that night,alone, no one at his side. My mom never got to say good-bye. The guilt she's felt has made the grieving process more prolonged and painful. I never want anyone elses family to go through that. So, when I was called to do this work, even though I had a lot to learn about hospice protocols, etc. and I was initially unsure of myself, I have just trusted my heart and now feel very comfortable and competent most of the time. In this job, the learning never ends. Well, that's enough about me. It's fun talking to other nurses around the country, isn't it? Stay in touch. I don't read my e-mail every day but, as our Governor said ,when he was doing someting he actually knew how to do, "I'll be bock".