Patient refusing Hospice
- 1Sep 12, '12 by jammycakesRNI have been a home care nurse for the past two years, prior to that I worked in the clinic setting. I am not, nor ever have been a hospice nurse. In my area, we come in and help the patient on a temporary basis until they are back on their feet. During the certification time for this patient he has steadily had a decline in health. I mentioned hospice to his wife several months ago and she was not receptive at all. He continues to get worse and now is pretty much bed bound. Last week his wife began asking me for details about end of life. I explained to her that this is not my area of expertise & asked again about hospice. She declined. This week she finally said she was ready because she had questions & needed help. When she mentioned it to him, he was adamant that he was NOT going on hospice.
What do I do? I don't have a clue how to help her with end of life situations. I feel bad for them, but I can't force him to accept hospice. I won't leave them stranded, but I honestly feel I am way out of my comfort zone here.
- 5Sep 13, '12 by akulahawkA hospice team may have some resources for them... even if the patient doesn't accept it. They're very good at providing for comfort care and other end of life issues. The patient may never accept being on hospice as he may view it as "giving up" on life and he probably doesn't want to do that. They may benefit from the info though, about how to get some of his affairs in order instead of just leaving it all to his wife to figure out after he's gone. It's pre-planning, not giving up.
- 2Sep 13, '12 by westieluvThis happens a lot. As long as the patient has his full faculties, he has the right to make all of his own healthcare decisions, including the decision of whether or not accept hospice care. I have seen quite a few people die without the benefit of hospice because they felt like it was signing their own death certificate, and in a lot of cases, there's not a lot that you can do, so don't beat yourself up, you have done what you can do at this point. I do agree with the PP that there may still be resources that they can benefit from without actually signing on to hospice, but a lot of times if the patient gets of whiff of "end of life", whether it be funeral planning, writing a living will, etc. they will refuse or force their spouse or family member to refuse. It goes along with people not fully understanding hospice and being fearful and in denial about their own mortality. I can remember getting a phone call from a patient's family member because their mother/father, etc. was just diagnosed with a terminal disease and the doctor recommended hospice but when a member of our staff would go out to do an informational visit, the patient would flat out refuse, regardless of their diagnosis. Then, within a short period of time, we would see their obituary in the local paper. It's sad, but it happens.
- 4Sep 13, '12 by Sun0408Can you get a hospice consult for the family and pt. He may not except but at least she will have the information needed. Many fear the word hospice alone, many don't understand what it really means and the benefits it brings to the pt and family.
- 0Sep 13, '12 by needshaldolPerhaps this person does not need Hospice? Perhaps some of us think that Hospice is the "only" way to go at the end? Not true for all. If the person is No Code and is comfortable at home with family or other help and cared for what is the point of Hospice? Hospice will give out meds in liquid form for example. One can get that liquid form as a Rx and take care of pain issues if needed or anxiety.
Not every patient needs Hospice at the end of life.
- 1Sep 13, '12 by NurseDirtyBirdQuote from needshaldolThat is an excellent point. Hospice is not the end-all be-all of end of life care. However, it sounds like they could benefit from education with someone with end of life expertise. I agree that a consult with at least their MD about the pt's decline and inevitable end is in order.Perhaps this person does not need Hospice? Perhaps some of us think that Hospice is the "only" way to go at the end? Not true for all. If the person is No Code and is comfortable at home with family or other help and cared for what is the point of Hospice? Hospice will give out meds in liquid form for example. One can get that liquid form as a Rx and take care of pain issues if needed or anxiety.
Not every patient needs Hospice at the end of life.
- 0Sep 13, '12 by edmiaI would make the hospice referral anyway. Often, people are unaware of what hospice is and have preconceived notions about it. Hospice nurses are able to counsel and educate in a way that those outside of the specialty can't. Let the family know that end of life care is outside of your expertise and you'd like them to have better information and hopefully, the right resources for their loved one can be found. As someone else mentioned, they don't need to accept hospice, but there are other resources that may be helpful.
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- 0Sep 13, '12 by jammycakesRNI don't think I'm trying to force him to be on hospice, it's just that I know his wife is struggling & I do not have the resources (or know what resources) she needs that are available. I know she needs more help than I can provide. I am only there for an hour every other day. That's a lot of hours she is there alone with him. She is doing a great job at caring for him, but she has admitted that she doesn't know what to do when he passes.
I told her she can call me, BUT he doesn't have a DNR order, so I have to consider him a full code & send him to the hospital and possibly even do chest compressions. He probably weighs less than 100 pounds now & the last time I tried to send him to the hospital, he refused. I'm just so out of my zone here, I have no idea what to do. I DID make a hospice referral, that's who he refused. His wife told me that he has already admitted to her that he doesn't have much time left, I just can't figure out why he doesnt want her to have some assistance.