Comfortable dealing with end of life

Ruby Vee, BSN · Feb 18, 2018

I started my career in Medical/Tele -- not much end of life care there; at least not in those days. When our patients died, they tended to do it in style, with the dramatic Code Blue and lack of anything peaceful or dignified. But then I moved on to Heme/Onc. I learned to be comfortable giving enough morphine to ease the pain even if that meant hastening their demise. So much of what we do as nurses in ICU, and I'm sure on the floors as well is prolonging the dying process rather than returning the individual to health. If the individual cannot be returned to health, then good end of life care should be a given. Unfortunately, that starts with a discussion with the patient (if possible) and their family about end of life care, and many patients, families and physicians aren't comfortable having that discussion. Death is a part of life; hopefully one day we'll be able to deal with it as such.

Grobyc82 · Feb 18, 2018

Back when I worked on cardio/respiratory floor we received overflow from the stroke/oncology floors. We had plenty experience with end-of-life. I will say that generally speaking, death and dying is seen as failure in the medical system and that palliative care is often overlooked to this day. I know certain physicians that always avoid these discussions with family and patients and as a result, the nurses take the role in education and initiating goals of care with patients and family.

Elfriede · Feb 18, 2018

Hhhhmmm....

I think, that "palliative care" is underrepresented in "general nursing education".

In every speciality we have to "deal with the death".

The death is a natural part of life and not a "failure".

So ... being better prepared, ... some colleagues would be more "culturally sensitive" than a sledgehammer. :banghead:

Grobyc82 · Feb 18, 2018

Right, it seems though that many health care professionals including doctors treat end of life as a failure in the system. I think your right on the money when you say that palliative care is underrespresented in nursing education. I cannot remember anything about my formal education training that really touched upon end-of-life and if it did, it was just a blip. We should have more training and curricula that deals with this stuff. Most nurses are uncomfortable when out of school dealing with this stuff on top of being a fresh new nurse as it is.

Here.I.Stand, BSN, RN · Feb 18, 2018

As an ICU nurse, providing palliative care makes for some of my most rewarding shifts. I die a little inside when I come to work and find that someone who had, say, had such bad brain swelling that despite having a BILATERAL craniectomy and every medical intervention possible, STILL had ICPs in the 30s-40s. Or who had been internally decapitated....... now has a trach and PEG and referrals to one of our area LTACHs.

When I can make the inevitable more comfortable, and when my care is a comfort to the family, I feel like I have actually done something good.

cardiacfreak, ADN · Feb 18, 2018

As an ICU nurse, providing palliative care makes for some of my most rewarding shifts. I die a little inside when I come to work and find that someone who had, say, had such bad brain swelling that despite having a BILATERAL craniectomy and every medical intervention possible, STILL had ICPs in the 30s-40s. Or who had been internally decapitated....... now has a trach and PEG and referrals to one of our area LTACHs.
When I can make the inevitable more comfortable, and when my care is a comfort to the family, I feel like I have actually done something good.

And this is why I now work hospice. I recently had a client who said there are worse things in life than dying.

I understand hospice and palliative care is not for everyone, but I truly believe that at the end of each person's life they should be able to die with dignity and comfort. Everyone talks about how beautiful a birth of a child is, I have witnessed beautiful deaths in which the family are surrounding their loved one holding their hand and singing their favorite song or hymn as their loved one takes that last breath. I always feel honored to be able to share in such an intimate event.

Grobyc82 · Feb 18, 2018

Yes, I think we all had our fair share of cases where palliative care was never a consideration and every heroic measure was instituted in a futile situation. Then you have the good cases where the family and patients are more accepting and properly educated.

Palliative Care, DNP · Feb 18, 2018

We have to provide daily education to physicians where I work. Many equate us with hospice. We are not the God Squad going room to room celestially discharging patients. Palliative Care provides symptom management and support to patients with life-limiting or chronic illnesses. We also assist with Advanced Care planning, Goals of Care discussions, and terminal extubations. We are able to assist with the coordination of hospice for patients who choose to go in that directions prior to discharge. In my area Palliative Care only exists inpatient and hospice would be the closest thing to us outpatient.

In my experience, oncologists are the worst with being truthful on prognosis with patients. We are often the first people who advise them that their disease is terminal. Oncologists like to use the words "palliative chemo or treatment" without explaining to the patient that means we can not cure this but may be able to prolong your life some. There are also those patients and families who are advised but believe in miracles. So far, I have yet to come across one miraculous recovery in a terminal cancer patient.

Been there,done that, ASN, RN · Feb 18, 2018

If palliative care is ordered, you must follow the orders. I had a hard time, supporting the family emotionally. It is not easy to change your demeanor between attending a rapid response.. and providing hospice care to your next patient

It was however, a highlight of my career.. when the family said to me.."you have such a comforting presence.. thanks for being here."

Use your resources.. a palliative care team, the attending, and the hospital chaplain.

vintage_RN, BSN, RN · Feb 18, 2018

When I worked with adults I remember loving those shifts where I got to provide palliative care, making someone comfortable and comforting their family in the last moments. They were some of my most rewarding experiences.

In the NICU we're generally pretty bad at this...as no matter how severe the babies' case is and even if nothing can be done - parents want everything and anything done (and I don't blame them). Even a 23 weeker, or an infant with a syndrome or genetic abnormality that means they will likely be severely disabled or a vegetable for the rest of their life - they almost always want to do everything. Lots of ethics in the NICU.

Palliative Care, DNP · Feb 18, 2018

When I worked with adults I remember loving those shifts where I got to provide palliative care, making someone comfortable and comforting their family in the last moments. They were some of my most rewarding experiences.
In the NICU we're generally pretty bad at this...as no matter how severe the babies' case is and even if nothing can be done - parents want everything and anything done (and I don't blame them). Even a 23 weeker, or an infant with a syndrome or genetic abnormality that means they will likely be severely disabled or a vegetable for the rest of their life - they almost always want to do everything. Lots of ethics in the NICU.

Sadly, it is not only in the NICU that people want "everything." Our culture is simply not comfortable with death. It is amazing how many people simply do not discuss the topic at all. I had one woman recently tell me that she would rather decide when to pull her father off of a vent than to discuss a DNR or hospice with him. It is really amazing the things we hear and see.