- 0Apr 28, '13 by MomRN0913I was thinking back to a case I had and a debate I had with my director.
Elderly woman with end- stage dementia max 80lbs. Reddened sacrum. Daughter took ExCELLENT care of her. Changed her 4 times a day, turned her often, says its not a problem as she is so light. Our associate director did her admission and sent me in as the case manager on the second visit . Told me to go with a foley as she is having the daughter consider one. I go into the home, meet them, assess the patient and the daughter and I am finding no reason for a foley. None. Patient is clean and dry and a little fidgety and can't communicate much , especially unable to communicate discomfort. I speak about the foley anyways, thinking, well I've been hospice nursing for a year and she is the director and has been doing it for 16 years...... The daughter refuses, doesn't feel a need to introduce infection when she states she has no problem keeping her clan and dry.
I couldn't argue with her. I completely agreed and I told her that. When I get back to the office, I told the director she refused the foley and I wasn't quite grasping the need for one. She says she disagrees with me the daughter would benefit and it would make it easier on the daughter to have one. I felt the daughter was having no issues and it would cause discomfort to the patient and her skin is fine.
I'm getting long winded here, but am I right or wrong? Whydo something invasive to someone at end of life if unnecessary ?
- 1Apr 29, '13 by curiousauntieI also agree with you. For all the reasons you and 4_Sq give. Skin intact and daughter is obviously taking good care of Mom. Your director needs to tell you what makes her think it would make it "easier" on the daughter to insert a foley the patient doesn't need and the daughter doesn't want. I would think forcing something like this on the daughter would cause distress in the daughter, not to mention the patient.
- 0Apr 29, '13 by tewdlesI agree that this is the decision of the daughter.
However, it is important to support the assessments and recommendations of our teammates.
You will be the ongoing case manager, so your relationship will be the strongest, but always keep in mind the relationship of the patient to the "team"...there must be trust across the board.
This is not to suggest that you did not support the ADONs assessment or recommendation, rather it is intended to highlight another facet of the discussion.
- 0Apr 30, '13 by leslie :-Dthis is one of those cases where i am amenable to either/or.
catheterization is relatively non-invasive, considering the procedure is hopefully done one time only.
and even if it happens a couple more times, the benefit could outweigh its hindrance.
my only thought is that this pt's sacrum is reddened...
and depending on the reason why, a foley could prevent redness from macerating or spreading.
if it was me, i'd discuss the daughter's objections with your mgr and ask "what should we do"?
this keeps mgr in control and feeling respected.
as tewdles stated, you have an ongoing relationship with her.
inevitably, it's preferable to stay in an amicable relationship.
again, i say this only because i don't feel this is a battle worth fighting.
blessings to you and all involved.
- 1Apr 30, '13 by MomRN0913Thanks for all the input! She has since passed, without a catheter. The daughter was against it. For infection reasons and that the patient was very grabby and fidgety. Which makes complete sense. I would have supported it if she wanted it. But I supported her when she didn't but my director felt I should have pushed it more, but I saw no reason to.
The reddness was not do to incontinence, it was because she was failure to thrive, 80 lbs soaking wet. Bony and bed bound.
I hate to say it, but my now old boss was very " I am right, I've been doing hospice for so many years"
But as always, these are things that should be discussed in team, and was. And the medical director agreed.
I'm just greateful she died a peaceful death at home.
- 2May 2, '13 by RNandlovingitMomRN do we have the same boss? LOL. I have a director who has that whole I am right and you wrong and you will do everything my way attitude! Very frustrating some days! I have gone rounds with her on several occasions especially regarding admits that I did not feel were appropriate and been forced to admit anyway. Don't ever be afraid to stand your groundand advocate for your patients. I will never do anything that goes against a families wishes unless the patient is fully alert and still able to make their own decisions. A lot of what we do in hospice is about supporting the choices of family.