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.
I don't know if this is going to make sense or not, but my mom passed away this year on Mother's Day. She was a nurse for 45 years, and was diagnosed and died from cancer all within 4 weeks. She was 62.
She drover herself to the hospital, so she was fully functioning, and had actually just retired from work 2 months before. Within 1 week of her diagnosis, she was out of the hospital- moved in to my home, and under radiation treatment (brain) along with some meds that I don't recall. Immediately, she began to weaken. By the second week she couldn't walk without me holding her waist with a gate (sp?) belt. *which she taught me how to use. By the 3rd week, she could walk, but we used a wheelchair whenever one was available. I set up her room with a bed table, and we installed safety bars along the path to her bathroom. The day before she died, she said she was in pain and wanted morphine. In order to do this, we needed to call in hospice (which she had refused up to that time). Hospice came, she got her first dose of morphine and died within an hour of the second dose that I gave her. Me. I won't go into the painful details of her passing, but she died in my arms just after I finished helping her use a bed pan. Parts of me felt responsible for her death. I know, from researching, that radiation makes you weak. I know that morphine compromises respiration. These are things that I learned only AFTER her passing. Learning these things made me feel very guilty. It has taken me until this thread today to reconcile the events that led to her death. The wonderful people on this board have helped me understand something, that I think will help me in nursing school.
We have to act "as if" the patient will live! Had my mom, or the patient in the OP lived another day or two, would it have been ok for her to be left dirty for those days? No, of course not. I get it now, it's the dignity of life. Would it have been ok to deny pain medication so siphon a few extra days of life from her? No. I wanted my mom in comfort at that moment. I acted as if she would be alive for the next. Clean and pain free. Unfortunately, she was not, however I feel a great deal of peace right now. Thank you to the nurses who helped this poster, you have all helped me a great deal with something that has been heavy on my heart for the past 7 months.
My Grandmother's greatest fear was to lose her mental faculties and not be able to speak for herself. Thankfully she did not and made her decisions right to the end, just as your Mom did. Your Mom made the decision to take Morphine and she definitely needed it, I am sure. So just knowing how much you helped her in her time of greatest need can gladden your heart, knowing that her wishes were carried out and you were by her side. That is the best gift - not to die alone and to have respect and dignity!
My Grandmother made me promise that if she couldn't speak for herself I would not allow her to have testing or anything to prolong her life in pain.
. . . I won't go into the painful details of her passing, but she died in my arms just after I finished helping her use a bed pan. Parts of me felt responsible for her death. I know, from researching, that radiation makes you weak. I know that morphine compromises respiration. These are things that I learned only AFTER her passing. Learning these things made me feel very guilty. It has taken me until this thread today to reconcile the events that led to her death. The wonderful people on this board have helped me understand something, that I think will help me in nursing school.
We have to act "as if" the patient will live! Had my mom, or the patient in the OP lived another day or two, would it have been ok for her to be left dirty for those days? No, of course not. I get it now, it's the dignity of life. Would it have been ok to deny pain medication so siphon a few extra days of life from her? No. I wanted my mom in comfort at that moment. I acted as if she would be alive for the next. Clean and pain free. Unfortunately, she was not, however I feel a great deal of peace right now. Thank you to the nurses who helped this poster, you have all helped me a great deal with something that has been heavy on my heart for the past 7 months.
Thank you for taking such good care of your mother.
You will be a better, more compassionate (and more knowledgeable) nurse because of your experience with your mom. I'm so glad that the posts you read here have helped you to reconcile your feelings about her passing. And that you were able to put your thoughts into words that may help someone else make sense of such a situation.
Thanks for sharing what this thread has meant to you.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
Cookderosa--
I'm so glad these responses helped you to understand the process you and your mom went through. It all happened so fast! It sounds like you did everything right within a rapidly developing situation.
I will echo Miranda's thoughts on this-- and that is most of the time we don't really know in a concrete manner how our posts affect the lives of other people. Thanks for taking the time to post your very touching experience with your mom, and for letting everyone know how their posts helped you reconcile your feelings. :redpinkhe
No, you did not make the patient pass sooner. After nearly 30 years experience I can tell you that patients who are already dying seem to pass shortly after repositioning. I don't know of any physiological reason for this, but it seems to happen that way. The "explanation" the nurse gave you is not remotely logical or scientific. Further more, how does that nurse know what time the patient was "scheduled" to die? The nurse must have known this if she knew that repositioning the patient caused the patient to "die so soon." This isn't possible. Sounds to me like hte nurse is not comfortable with dealing with death--try not to let her attitude rub off on you.
I work in a LTC and see many deaths. It does seem to be that the shifting fluids when the body is turned does make them pass quicker. but YOU DID NOTHING WRONG!!!!!!!!!!! Death is a part of life and if its their time you wont stop it. Most people would rather just go then go on living with no quality of life. You did not cause the death and dont feel guilty. You just provide the best care you can and make the last hours the best you can :)
This post reminded me how thankful I am to have a place outside the hospital where we can ask these questions. I'm sure all of us at some point just accepted a pseudo-fact that was handed down by another nurse -who believed what she was saying, but was wrong. It also reminds me to check some of the knowledge I learn by word of mouth, even from the best intentions!
To the original op: I do hope you have been comforted by the more correct you have learned here. I share some of their thoughts: you should feel honored that you helped a person pass with the care, and dignity that we all deserve.
In our profession even with all the loving and supportive care we give, death is sooner or later inevitable. I apologize on behalf of the nurse that made you feel the way you did. I applaud your job as a CNA and I could not do the job y'all do.
As stated throughout these posts, by caring for her you helped your patient to die with dignity. Have a Merry Christmas!
As an oncology nurse for three years and ICU for three more, I agree with the statement that a patient who is dying dies "when he is ready." Turning a patient however can sort of cause this to happen, but remember it is the disease that is causing the patient's death, not anything we are doing. In my opinion, it is also completely unethical to withold pain meds or anxiety meds on a palliative care pt, even if giving them might "hasten" the death. I think that nurse was being a little mean to say that to you, especially as a CNA who was new. Sometimes staff who work in critical care or death and dying adopt the attitude that they have seen everything and get sort of crass about it, especially when teaching others. It is their way of coping, I guess...
There you have it - an example of a b____. That comment was inappropriate and said to make you feel bad and question your own judgment and ability. You should report what she said to you to your manager in just a FYI way. There is a lot wrong with nursing today, and that is one of the problems - these attitudes and way of treating others which really makes your day exhausting.
cookderosa
155 Posts
I don't know if this is going to make sense or not, but my mom passed away this year on Mother's Day. She was a nurse for 45 years, and was diagnosed and died from cancer all within 4 weeks. She was 62.
She drover herself to the hospital, so she was fully functioning, and had actually just retired from work 2 months before. Within 1 week of her diagnosis, she was out of the hospital- moved in to my home, and under radiation treatment (brain) along with some meds that I don't recall. Immediately, she began to weaken. By the second week she couldn't walk without me holding her waist with a gate (sp?) belt. *which she taught me how to use. By the 3rd week, she could walk, but we used a wheelchair whenever one was available. I set up her room with a bed table, and we installed safety bars along the path to her bathroom. The day before she died, she said she was in pain and wanted morphine. In order to do this, we needed to call in hospice (which she had refused up to that time). Hospice came, she got her first dose of morphine and died within an hour of the second dose that I gave her. Me. I won't go into the painful details of her passing, but she died in my arms just after I finished helping her use a bed pan. Parts of me felt responsible for her death. I know, from researching, that radiation makes you weak. I know that morphine compromises respiration. These are things that I learned only AFTER her passing. Learning these things made me feel very guilty. It has taken me until this thread today to reconcile the events that led to her death. The wonderful people on this board have helped me understand something, that I think will help me in nursing school.
We have to act "as if" the patient will live! Had my mom, or the patient in the OP lived another day or two, would it have been ok for her to be left dirty for those days? No, of course not. I get it now, it's the dignity of life. Would it have been ok to deny pain medication so siphon a few extra days of life from her? No. I wanted my mom in comfort at that moment. I acted as if she would be alive for the next. Clean and pain free. Unfortunately, she was not, however I feel a great deal of peace right now. Thank you to the nurses who helped this poster, you have all helped me a great deal with something that has been heavy on my heart for the past 7 months.