Did I cause my patient to die faster?

[lou_tango]

I am a CNA on a medical/surgical floor and am in dire need of clarification (from a nurse please) of what just happened at work last night. I work nights, came on the floor and got to work right away. I got a walking report from the 2nd shift CNA. One pt was an unresponsive very elderly woman who had suffered an acute MI several days earlier and wasn't expected to make it through the night. I was told in report by the CNA that the pt was being turned side to side every 2 hours (with oral care, checking for incontinence, etc.) and she was due again at 11:30, so I had him help me change her and turn her before he left. She passed less than an hour later. Here's where I need some help...

One of the nurses told me (not even the patient's nurse) that it was our fault the patient passed when she did. She didn't do it in an accusatory or mean way...just in a very matter-of-fact (and a little condescending) way. Like: "by the way, you shouldn't have turned her, that's why she passed so soon." I've been at this hospital for 9 months and somehow I have managed to skate by without any patient deaths...so this was my first. Needless to say I was speechless and felt terrible, as if I had taken her away from her family sooner than she was supposed to go.

She then gave me some explanation that I didn't understand. Something about when turning the patient, the blood floods the heart and the patient will pass soon after. First of all, we had to turn her to get her cleaned up. Second, I was told she was being turned every 2 hours all through 2nd shift. So did I really do something wrong? Is there truth to what she said? And if so, can someone give me a better explanation of what happened?

Thanks in advance...feeling confused and guilty here.

[BluegrassRN]

You didn't do anything wrong.

We often *joke* about being fearful of turning end-of-life patients. Anecdotally, it does seem to be a Murphy's Law sort of thing. If you are turning patients for comfort, though, it's not a reason to stop turning them. We do often stop repositioning patients when death appears imminent, but usually because the repositioning appears distressing.

The explanation the nurse gave? I'd challenge her to find ANY sort of reference to back up her "theory". Why do people seem to like to die with or immediately after turning? I just always assumed it had to do with the added oxygen requirement that the activity cause, combined with lowering the head of the bed. Also, if you turn someone on their side, I mean WAY on their side, like you would to clean them up, you are physically diminishing their lung capacity. On most people-it's not significant. On someone who is already compromised, it might be the tipping point. Just my own crack-pot theories, to throw into the pot.

[canoehead, BSN, RN]

Ok, in ICU patients they sometimes don't turn people as much because their cardiac function is so fragile. They plan for it though...try to have pads underneath so you can just slip them out to keep the patient clean, Foleys, rectal tubes, specialty beds, and DOCTORS ORDERS to not turn.

You had a woman where the entire goal was to keep her clean, comfortable and dignified as she made her transition. Part of her plan of care was a peaceful death, not recovery, not to even keep her alive as long as possible- to have a peaceful death. Part of dignity is care and hygiene, you absolutely need to provide that based on this particular patient's needs. And she died an HOUR later...that had nothing to do with your turning or hygiene. That nurse was talking out of her butt.

[bill4745, RN]

You did nothing wrong. Sooner or later the pt would have to be turned. As the other posters indicated, turning could possibly put enough extra workload on the heart to cause death, but if the heart is that weak, death is inevitable .

[GilaRRT]

The nurse is an idiot. I do not often directly call people such names, but picking on an aide in such a way deserves straight up language defining the emotional and cognitive deficits that someone must possess to say such things.

The patient was very old, had an MI, and was not expected to live through the night. Then, shockingly, the patient died.

[Straydandelion]

Please! If I am on my last leg, don't let me die dirty because someone was afraid to turn and clean me up!

Honestly, it is possible that ANY movement at that low ebb could have contributed to her demise a few minutes earlier then if you didn't touch her...due to the increased, even slight speed of the heart. It could also have been just her time to go. I wouldn't second guess. :-)

[Batman25]

You did nothing wrong so please don't feel badly. The nurse was wrong to make you feel you did anything to hasten this woman's death. She was dying. You helped her to die with the dignity and respect she deserved.

[Emergency RN]

when the nurse said that, you should have replied, "can i turn you too?"

seriously, you did nothing wrong. that nurse is just passing flatus (ie. she's talking out her... )

[RhiaRN75, RN]

There is a pretty prevelent belief in all the places I've worked that turning a pt can be the final straw. That said, I think the general concensus is that if it's going to happen, it happens during the turn, not almost an hour later. So it's a myth I mostly believe, BUT......

It's a good thing to keep in mind only in regards to timing and length of care. If I have a terminal pt, I still turn them, who wants to die in a dirty bed or with the pain of a pressure ulcer developing? Unresponsive doesn't mean brain dead*. Now, I try to keep the whole intervention as short as possible but the pt still deserves the basics. I may keep family at bedside if it's appropriate, just in case.

I also have had the occasion where comfort measures such as morphine or ativan may have hastened the inevitable. Again, I may time things so that family can be present if that was the pts wishes, but that's about all. If a terminal pt is in the hospital w/ a terminal prognosis- usually the whole purpose is to provide comfort care. To be blunt, if I wanted to die at home in pain and in a dirty bed, I wouldn't be in the hospital.

It was mean-spirited and rather distasteful for your co-worker to tell you it was your fault. Were I in your pt's situation, I would definitely want to have you taking care of me- you did a good job! Were your co-worker my nurse, I think I might want to haunt her for a while. You don't have a single thing to feel guilty about.

*The pt may not be braindead, but the devil on my shoulder makes me ponder the sate of your co-worker's neural activity!

[rn/writer, RN]

You had a frail, elderly, post-MI patient who was not expected to make it through the night. She died approximately an hour after she was turned. I see nothing to indicate any wrong-doing on your part. At least she was clean and comfortable when she passed.

It saddens me to think that someone would lay a guilt trip on you for doing your job. The patient was knocking hard on death's door. You did your best to care for her. The nurse should have comforted you rather than try to make you feel bad for doing what was expected. Even if it was deemed better not to turn the patient at the end, that requires a change in orders, and the patient's nurse would have been the one to initiate that.

Thank you for caring for your patient to the best of your ability. It was simply her time to go.

[Otessa, BSN, RN]

Turning the patient every 2-3 hours to prevent bedsores and increase comfort is important.

If incontinence occurs then the patient needs to be cleaned and unless you can do that without turning the patient........you are better than I am.

Patients pass when it is their time-you and your co-worker were doing what was expected in that situation.

[Supernrse01, BSN]

First of all, you did nothing wrong. If that had been my family member, I would have wanted you to turn them to keep them clean and comfortable. While turning, as everyone else has also pointed out, can sometimes overload the heart, you did not make her die faster by turning her. God had already chosen her time to go and she would have gone with or without the turn. You did the right thing by caring for your patient. :redpinkhe