question for the oncology nurses

Patience911 · Apr 5, 2002

All terminal patients, whether they have cancer, copd,renal failure, liver failure, etc can be demanding and require alot of care. Usually they are very weak and need assisstance with everything. Psychologically, they can be very angry and try very much to "control" whatever they can in their environment. ( I think this has something to do with feeling a loss of control over their lives...they are after all dying and most do not want to). They also have many fears....fear of pain, loss of dignity and further control.

As to whether they are appropriate for your floor...I guess that depends on what their medical and surgical needs are. Unfortunately...patients die in every area of the hospital, even labour and delivery. It may not happen as often as on a medical floor, but it does happen. I find it interesting that you used the phrase "dumped" and I am not sure why. Does this have anything to do with your level of comfort in caring for a palliative patient. Do you feel uncomfortable around terminal patients? Or is your ward too understaffed for you to feel like you can provide the care required for terminal patients?

Also, I am not sure what you mean by demeanor...is it their anger, lack of coping skills, depression?

ADUCHA · Apr 5, 2002

Yes terminal patients can be more demanding but they require more tlc. It means a lot for them to have some control over their life as they have no control over what is going on with their disease. Sometimes it is the little things like having their door closed or administering their own meds make them feel like they have some control. And ususally a smile goes a long way with them.

thisnurse · Apr 6, 2002

i use the term dumped because thats what they are.

the main objective is to empty the er, regardless of what is right for the patient. i dont think its right to put a cancer patient on our unit because we just dont have the experience with chemo and radiation.

i have no problems caring for the dying..and yes some of them require a lot of assistance but im talking about the ones that constantly call you in the room.

the family members who call you in to tell you dad needs a kleenex...thats what im talking about. ive been on this unit for a year. we have never had so many cancer patients. usually when the oncology floor is full they will admit to our floor and transfer the next day.

and yes we always get patients sent to our unit to die, its always been like that.

im asking this question only to get a better understanding of these patients so that i can better care for them.

Patience911 · Apr 23, 2002

Hello again:)

It sounds as if the patients you are getting definitely have some issues with control, hense the frequent calls for things they could probably do for themselves.

Another thing that may be occuring is what I call "displacement anxiety". Most oncology patients are in hospital on and off over a period of years. They usually spend time on the oncology ward and become familiar with the staff(so do their families). In our hospital, if they end up somewhere else until a bed is available, they can on occasion give the nurses a hard time. Some patients think that only the oncology nurses can look after them and distrust the nurses on a different ward. You may find it helpful to reassure them that your floor will do their best to look after them until a bed is available on the oncology ward. This sometimes stops the behavior you described. And it may not hurt to remind them that they are in a hospital bed receiving care. It may not be the place they want to be in hospital, but the alternative is a few days spent in a hallway in the ER.

Then again, it may not. Some patients and their families, irregardless of thier diagnosis, can be, if you pardon the term...a pain inthe a$$. These patients usually require some firm boundaries that are enforced by all the staff. This can be time consuming to set up but it does work. If you are finding that you are receiving alot of these off-service patients, it may not hurt to bring it up at a staff meeting to set up a protocol or strategy for your floor that deals with the more demanding patients. It does work if all the staff are consistent.

Good luck

:) :)