I need help processing my first hospice patient experience. - page 3

by pkateRN

Hi Guys, I'm a new grad RN who was hired into a palliative care/hospice unit at a VA hospital. I have no prior experience with hospice (or nursing in general) and was given very limited training in this area- only 4 days before... Read More


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    My second death was Wednesday, but I wasn't there for it...and for that I am thankful. I had been taking care of a man with leukemia for 2 weeks who was transfusion dependent before coming to me, and they decided to stop the transfusions. when I went into work yesterday I asked about his passing. they were reluctant to give me details, but eventually they told me the truth- that he bled out from every orifice very quickly, and even worse, his family was there. I cried and cried and cried that this is how he passed. when I last spoke with him he was not ready to die, he still had alot of things he wanted to do, and was fighting until the end. when I got off work I sat in the shower and cried some more. I wanted him to have a peaceful death, and some acceptance. does this ever get easier? I feel like I'm not cut out for hospice when I have this type of reaction.
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    Quote from pkateRN
    My second death was Wednesday, but I wasn't there for it...and for that I am thankful. I had been taking care of a man with leukemia for 2 weeks who was transfusion dependent before coming to me, and they decided to stop the transfusions. when I went into work yesterday I asked about his passing. they were reluctant to give me details, but eventually they told me the truth- that he bled out from every orifice very quickly, and even worse, his family was there. I cried and cried and cried that this is how he passed. when I last spoke with him he was not ready to die, he still had alot of things he wanted to do, and was fighting until the end. when I got off work I sat in the shower and cried some more. I wanted him to have a peaceful death, and some acceptance. does this ever get easier? I feel like I'm not cut out for hospice when I have this type of reaction.
    Don't assume that his bleeding out was a source of suffering for him, it may have been very quick and peaceful dependent upon his LOC.
    It is ALWAYS traumatic for the family when a patient bleeds at EOL.
    I hope they had dark linens, etc to help with the bloody visuals.
    Not everyone accepts their mortality and it IS hard for us when they go to their grave, seemingly, in denial.
    It DOES get better over time. It is not abnormal that you are emotionally affected by your patient's death. As you gain experience over time you will develop your own professional coping skills that will allow you to provide this care without owning the pain of the family or patient, focusing on the fact that the death is not YOUR loss personally but rather your loss PROFESSIONALLY.
    It really is all about boundaries and good self care.
    Good luck.
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    Hi I just had a couple of questions about some of the things on here. I work on a med-surg Oncology floor and we do all the comfort care and hospice patients in the hospital. A few of you have mentioned using scopalamine, I was wondering what it helps with (I have never seen it used on our floor)? Also I was wondering what a subq port was. And one last question, why do you not give IV medications? Thanks!
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    We use anticholinergics for pulmonary congestion/secretions at EOL...we like to prevent the "death rattle" when we can as it is very upsetting for the family and potentially uncomfortable for the patient.

    We do use IVs in hospice sometimes, but since most of our care is provided in the home, maintenance of IVs is not easy and these folks often do not have good peripheral vascular access. If they have an implanted port or a PICC line we will use those.

    Most of the time we will use a subcutaneous infusion approach as they are easy to initiate, easy to maintain in the field, and represent little risk for bleeding if they are dislodged. SubQ infusions are typically less painful to start and maintain for patients. We use them both for intermittent and for continuous infusions. We can easily teach family to administer meds safely using this approach.

    Of course, there are limitations to which meds can be delivered by that route.
    Last edit by tewdles on Jan 9, '13 : Reason: content
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    tewdles, I wanted to say thank you for giving the advice of "it is your loss professionally, not personally." that mantra is one i repeat over and over and as a result, the deaths have become easier to deal with. thank you for the perspective!
    tewdles likes this.
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    I, simply too much as there is a personal component to it, but the primary loss is certainly professional.

    My weakness is reviewing the case repeatedly in my head, as the difficult cases are the ones we mourn most...many hours have typically been spent with those patients and families. I have to be diligent in giving myself permission to move on, let go...give it to God...

    Funny, how we often have to give patients permission to let go of this world...and then, as nurses, we have to give ourselves permission to let go of them.
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    last night a patient died right in my arms as I was holding him. that is one I need to give myself permission to move on from.
    nitenite and tewdles like this.


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