I took over care of a "comfort-measures only" 37 yo woman who was comatose and dying -- I was the night shift nurse. Her vital signs were being monitored via telemetry but were not being displayed in her room. Her vital signs were normal when I assumed care except for an 02 sat in the 80's. I was told that her family was all exhausted beyond belief but wanted to be called if she had any changes.
So, about an hour into my shift she is satting in the 60-70s and throwing lots of PVC's for over half an hour. So, I thought "This is it." I called her family and let them know. The entire night she lived, satting in the 60's and throwing occasional to frequent PVCs.
She was on 16mg morphine/hr, btw.
Her family all came in after I called. But after I realized that her status had really reached a plateau I was honest with them. I said that she had not gotten worse over the last few hours and I didn't know whether she had a few hour left in her or a couple days. I said that I would try to keep them updated via phone if they decided to go home and catch up on their rest. I said that whether they decided to go or stay -- neither decision was wrong -- just to say their goodbyes if they decided to take a break and that would be very understandable.
But no one wanted to miss her death, of course! So, then I left my shift feeling like she was probably going to die any moment after the family had an unneccessarily sleepless night. Probably, thanks to me, they'd miss her death AND be sleep deprived wrecks.
I would have done the same thing in your situation. I would rather call them and her not pass away than to hold out on calling and them to miss it. It was important to them to be there with her so I think you did the right thing. I remember when I had a patient who was dying and his wife was totally exhausted. He had been stable all day so I encouraged her to go home and get some rest. He passed about 1/2 hour after she left. I felt so horrible. She was not upset, but understanding that since he had been stable all day I thought it would be safe to go home for a while. I must have apologized to her a million times and tried to offer comfor the best I could, but I still felt horrible.
Specializes in ER, NICU, NSY and some other stuff.
You did fine. We can only guess based on s/s that death is imminent. I am sure that the family would have been WAY more upset if you hadn't called and she had passed.
They are exausted, to be sure, but they will rest after their loved one has passed on. I will just bet that this is the way that they feel about it.
You did the absolute correct thing. What if you HADN'T called them? What if she had died and they had been at home. Even if they were wiped out and too exhausted to hear the phone again and the patient did die - they got to see her one last time. Otherwise they may not have gotten to say any more final goodbyes at all.
When they reflect on the death, they will remember the effort you put into informing them of the change in condition. Which is lovely, they will forget the sleepless night, but remember your call which showed you cared that her family knew exactly how their loved one was.
If my facility allow nurses to call family members in a situation like this, I would not do anything different than what you did. Who knows when Mr death will come knocking on the door. However, in my facility, it is the doctors responsility to do that.
So if you are allowed, rest your mind, you did the right
Hi ... I agree with everyone else. You did exactly the right thing. I work in hospice. We often get a lot of questions from families about exactly when the pt will die. Deathbed vigils can be torture for them, especially when people have to travel long distances to be there and have only a limited time off their jobs, away from their own families, etc. It can be hard to tell them that we just can't predict, especially since, as a society, we just don't have a lot of experience watching people die ... very little research has been done on the process. Sometimes I'll tell them that this is just like waiting for a baby to be born. We know it's going to happen, we just don't know exactly when.
When my dad got the call a few months ago that his mother probably wouldn't make it until morning, he jumped in the car and drove 14 hours. His sister flew in from out east, and his brother and his family postponed (then cancelled) their family vacation. Grandma hung on for three more weeks, and everyone had to put their lives on hold and stay with her. There is just no way to predict when it will happen, and you definitely did the right thing.
Specializes in ER, Occupational Health, Cardiology.
I think you did a very compassionate thing,by contacting the family. Don't beat yourself up. I agree, good job.
there just isn't any way to know for sure when the pt is going to expire. You used your objective data and Nursing judgement very well, I'd say. I would've done the same thing, in your shoes. Better for the family to be there, if at all possible.
Specializes in LTC,Hospice/palliative care,acute care.
"Comfort measures only" doesn't include telemetry!! I also gave up on trying to "guess" when someone is going to die,..that's in waaayyy bigger hands than mine.
In my experince "Comfort measures" seem to include anything the family is comfortable with.I hate to see someone like that on tele-it's too morbid for me...I don't "guess "any more either-I was reported last year by a family because their loved one did not die when I called them in due to significant changes.Luckily the supervisor really backed me.It was ridiculous.We all have to do our part and offer these families and s/o's lots of support and education and hopefully they won't be surprised.Sadly we fall short even in LTC where you would think end of life issues would be the focus... You did good-always err on the side of caution.If I want to be with my loved one I won't care if I'm called in numerous times..
Specializes in Telemetry, Oncology, Progressive Care.
I agree you did a wonderful job. It is true you just never know. I am on a tele floor and I did have a hospice pt. He died on my shift. They were actually expecting him to die 5 days before he died. The only reason I had this hospice pt is because he had family that worked at the hospital and they wanted the pt kept on tele so that we would notice EKG changes and someone wouldn't just walk into the room and see that the patient had died and we didn't know exactly when that happened. They understood that if this room was needed for another patient the patient would have to go to med-surg.
Once there were EKG changes he still hung on for several hours. You just never know. The family was there in the am and left to go to the cemetery to get things finalized. While on the way there I noticed the first EKG changes and called them to come back to the hospital. I honestly didn't think he would hang on until they got back. I went into the room and held his hand to let him know his wife and daughter were on their way back to the hospital. During this time his heart rate had been in the 20's and 30's. His HR picked up to 90s once I told him that. I didn't get any reaction from him or so I thought. He did hang on until they got back and there was also other family and friends who were there. Now really I only had a gut feeling and went with it. If this patient was not on tele I never would have known when he was having EKG changes but I got to pretty much see many different rhythms until he finally flatlined.
So yeah tele is generally not used for hospice patients but in this case I never would have known and may not have had the family there until it was too late.
I took over care of a "comfort-measures only" 37 yo woman who was comatose and dying -- I was the night shift nurse. Her vital signs were being monitored via telemetry but were not being displayed in her room. Her vital signs were normal when I assumed care except for an 02 sat in the 80's. I was told that her family was all exhausted beyond belief but wanted to be called if she had any changes.
So, about an hour into my shift she is satting in the 60-70s and throwing lots of PVC's for over half an hour. So, I thought "This is it." I called her family and let them know. The entire night she lived, satting in the 60's and throwing occasional to frequent PVCs.
She was on 16mg morphine/hr, btw.
Her family all came in after I called. But after I realized that her status had really reached a plateau I was honest with them. I said that she had not gotten worse over the last few hours and I didn't know whether she had a few hour left in her or a couple days. I said that I would try to keep them updated via phone if they decided to go home and catch up on their rest. I said that whether they decided to go or stay -- neither decision was wrong -- just to say their goodbyes if they decided to take a break and that would be very understandable.
But no one wanted to miss her death, of course! So, then I left my shift feeling like she was probably going to die any moment after the family had an unneccessarily sleepless night. Probably, thanks to me, they'd miss her death AND be sleep deprived wrecks.
What should I have done?
You should have done just what you did. Appologize for nothing. My mother-in-law was a hospice pt at home dying. One day I went to her home. She was having long periods of apnea for several hours. I told them I didn't think she would last long. Everybody in town left work and came to the house. She lived a week. Don't know how that happened but several hours after everyone showed up the apnea stopped. I guess she knew what we thought and resisted. I don't know.
fultzymom
645 Posts
I would have done the same thing in your situation. I would rather call them and her not pass away than to hold out on calling and them to miss it. It was important to them to be there with her so I think you did the right thing. I remember when I had a patient who was dying and his wife was totally exhausted. He had been stable all day so I encouraged her to go home and get some rest. He passed about 1/2 hour after she left. I felt so horrible. She was not upset, but understanding that since he had been stable all day I thought it would be safe to go home for a while. I must have apologized to her a million times and tried to offer comfor the best I could, but I still felt horrible.