coping with end of life care and a full LTC caseload

[adrienurse, LPN]

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[fultzymom]

I can relate to how stressful that can be. When I worked night shift on a 50 bed unit at 11pm I was the only nurse and it never seemed to fail that was when someone would be dying and no one would be sleeping and no one ever was patient to the fact that I had a patient who was dying. That always blows my mind that no one has any compassion. They (meaning the other patients or their families) do not care. You are supposed to be right there helping them and drop whatever you are doing for the person that actually needs your attention the most at the moment.

Leslie

[CapeCodMermaid, RN]

First of all, Hospice is a benefit that almost anyone can take part in. If you have no hospice services who come to your building, I suggest you have a meeting with the DNS and ED and get some hospice in there today! I have a great relationship with several of the local hospices and they provide services not only to the residents, but the family and the staff.

Secondly I don't think it's at all reasonable to expect the other residents to not bother you because someone else is at life's end.

[adrienurse, LPN]

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[CapeCodMermaid, RN]

Hey don't jump on me.

I'm a human and am subject to emotions. I'm also not a machine. TLC care is fine and well when everyone is healthy but it doesn't take much at all to derail the whole thing, much less someone in acute distress.

Firstly in regards to hospice services, they may be available in your city but not here when it comes to inpatient facilities that are not designated "actual hospices or palliative care units". This is the reason for my complaint. Hospice services are neither a given or a right. I wish they were but they're not. I wasn't even able to get ahold of a chaplain the last time.

Secondly, I'm not faulting my other residents for asking for help -- that's why I'm there. My complaint is that it becomes more difficult to meet there needs when another of my patients is dying. I'm not calling them unreasonable.

YIKES...I wasn't jumping on you...I was trying to make suggestions to help you out. Sorry if you took it the wrong way. I've had to fight for hospice in one or two buildings I worked in and luckily I won and what really matters is the patients won.

[ktwlpn, LPN]

I understand your frustration-it's difficult to juggle everyone's needs.We do not contract with a hospice in our LTC either-we have a "comfort care" protocol now in place and it's better then nothing.I often arrive for my shift to find a dying resident with signs of discomfort that have not been treated during the previous shift through ignorance and it's sad.If I can get everything we need in place right away and get the resident comfortable then the rest of the shift is usually fine.There really is nothing more to do for the resident-if family is present I spend as much time with them as possible and I will call the social worker for support (not always available) Other residents/families really are self-centered and often just don't care what is going on.Their focus is their needs-be it dad's missing stuffed animal or mom's beauty shop appointment.I keep telling myself that nothing more can be done for the dying-the living do need me more.-I have had to firmly tell another resident/visiting family member that their needs would have to wait-never have been reported (yet) If staff has done their work with the dying resident and family then the last days/hours should go smoothly.Sadly in my facility (again-through ignorance) We seldom get a "no further hospitilization" order until the very end so we are dealing with families with issues and many of my co-workers are not comfortable with end of life issues...It can really get to you sometimes.The hardest aspect of end of life care for me is when families insist on every intervention-the docs throw their hands up in disgust and we are left at the bedside trying to make the loved one accept that the are watching their mom or dad actually DIE and nothing more can be done.It is exhausting.I've just been dealing with 2 situations (roommates,in fact) and I think I am going to suggest some type of team to meet with families/residents when they are recommended "comfort care" by their docs.Maybe one nurse,the social worker and doc if available.People need to HEAR the WORDS early in the process.We do not help them at all if we continue to gloss it aover and drag dying mom out of bed and prop her up at the hair dressers and say "your mom is continuing to decline" I HATE euphemisms-nothing wrong with saying someone is actually DYING.We all will someday..

[catlynLPN]

The LTC I work part time in is notorious for not addressing the Full code/No code status.

I mean I'm just a part time nurse and I've seen a couple of residents lately whom I could tell that death was fast approaching, within just days, and were still on Full Code status.

I am not trying to be uncompassionate about this, but I think they need to address this more often.

I know life can be good for some residents at 90.................

My mother is almost 82 and still doing great...........lives alone, still drives, still has a good mind, able to do for herself.

But some residents that I've seen who are slowly dying......unable to get out of bed anymore, not eating, not taking their medication or fluids, already having periods of apnea....death is fast approaching for that person and to be on full code status is just unrealistic.

If staff would just address this and prepare the family, and get that resident off full code....at that stage death is imminent and IMHO, coding someone in that condition is cruel.

We do have hospice services here, but seems sometimes it isn't taken advantage of for some residents when it could have been of such a help to them to make passing from this life to the next one a whole lot easier.

[Hospice Nurse LPN, BSN, RN]

Hospice is a medicare/medicaid benefit. Anyone who is eligable to participate in one or both of these programs (and meet certain hospice guidelines) may participate in the program. I know some docs and/or administrators want to have only certain hospices (or none) at certain facilities, but it is ultimately up to the patient.

[marjoriemac, LPN]

We have regular training courses with local hospices to promote palliative care in our care homes. The nurses in the hospice even recognise that palliative care is about more than cancer, and for example they have limited knowledge of people dying with dementia. One nurse even stated that on the rare occasion they got someone in the hospice with dementia, they were challenged. Unfortunately, although they show us how to use various tools, they need further training and death is sporadic, there is no regular death each week where you can gain necessary skills to deliver hospice type care. All we can do is our best and ask for help if needed. As for families, well you are never gonna convince them that Mrs X having a peaceful death is more important than dads lost denture until dad dies!