Does her family know how sick she is?

[SuesquatchRN, BSN, RN]

Asked the doctor this morning. I told him that they come in a lot and he mentioned comfort care, which can mean many things, but it always means end-of-life.

They had come in to see their mom and I opened the discussion. "Why didn't the doctor tell us this?""Have you talked to him?" "Yes, this morning." "I guess because no one likes to talk about it so it falls to the nurses."

Anyway, I explained that there are various ways to handle their mom, including extensive measures and also including not even using antibiotics. I told them that she would recover from this bout of pneumonia but that her heart is failing and she will get penumonia again and soon. And that this will continue. I also assured them that should they decide to continue hospitalizing her that we would support that as well. And to take their time in figuring it out.

I got thanked for my honesty. They're going to call a family meeting and hash it out.

I love my job when I feel competent. But it's a bittersweet love.

[elizabeth321]

I am not sure I understand your post...but based on what I can determine from the content I think you were out of line.

Liz

[SuesquatchRN, BSN, RN]

Really? Then who is supposed to open discussions about death?

[mamamerlee, LPN]

In this case, the doctor. Unless he specifically asked you to talk to them, this was his place.

[SuesquatchRN, BSN, RN]

He did. Implied.

[SuesquatchRN, BSN, RN]

And where does this come from that only the doctor can talk to families? I have heard this time and again and it is simply not accurate.

[bosnanurse]

Reading this I almost can see myself sometimes from both perspective : WHO will say it and SHOULD I say it? This topic is always so sensitive that it is almost hard to ever honestly open it up. I think that docs are those who should say it but they DO NOT. So, we are often left with the person who is suffering in the bed, with the family that suffers around the bed and us who suffer with them all, because feeling of failure that you can not save it from death or from sometimes prolonged suffering.

Gosh, it is always hard to even question how much do they really understand? When they need to see whole picture and do they see it or they are fed with a few sentences of docs saying " oh we started a new antibiotic and it works fabulous" Depends also where you work and what relationship you have with docs , what is his vision on death and dying...I know that some of them would put me on the wall if I mention DNR to the patient and patients need to know their options. So, question is who really should do it?Who is the one who opens that box ?

I usually question family about how they see situation , what is their expectation , what are wishes of their loved one to put it from their perspective and at the same time to try to open their eyes so they can question docs plan of care.

I give them our plan of care: "So, Mrs. N at this moment we are monitoring your husband, turning him and positioning q2 hr, looking his skin,a feeding tube, breathing through ventilator,and checking his vital signs as often as prescribed by doctors. We also take care that your loved one does not have any pain but we are not sure what are his wishes? Does he wants this kind of care where we are doing everything possible to keep him alive or he would like something different?what is your view on all this care that we are providing and doctors are prescribing , are you satisfied with it or you are scared from this or would like something else? " I know it is almost going around hot milk but it gives them time to think about it. So , I do not think that we are out of line mentioning other options , and I would like if someone would "protect me" from love of my kids or husband, or stubbornness of my doc if I have to go. God bless .

[Forever Sunshine, ASN, RN]

It's important to ensure that the patient(if alert and oriented) and family are aware of whats going on with their care.

I don't think you were out of line, maybe the doctor did tell them but they didn't understand what the doctor was saying.

[SuesquatchRN, BSN, RN]

Well, I have discussed this with my usual doc in the past and she is adamant that I SHOULD open the discussion and that it is not only the doctor who can or should. S. made it very plain without directly asking me to do it that he wanted it done -- and asking me if the family knew how sick she was after he had already spoken to them made that pretty clear.

Anyway. I felt good about it, and am confident that I did the right thing. Thanks for the support.

:)

[Hospice Nurse LPN, BSN, RN]

I am not sure I understand your post...but based on what I can determine from the content I think you were out of line.

Liz

Why was this out of line? When we get a referral to hospice, we'll call and set up a time to meet with the family. I wish I could remember how many times I have asked, "What do you know about hospice" and the family is surprised because the doctor didn't tell them he was going to refer the pt to hospice. He told them, "I'm going to have some people call and set up a meeting to discuss your family member".

I don't see anything wrong with what the OP said.

[tewdles, RN]

I would suggest that nurses are certainly supposed to have conversations with their patients about health care options and choices they have. If we are caring for the whole patient we help them to make informed choices...advocating for them along the way.

We are not limited by physician orders in our practice of nursing in total. We nurse people in ways other than by simply completing an ordered procedure or administering a prescribed medication, etc. That stuff is an important part of what we do but there is more...

It IS okay for us to identify knowledge deficits, acceptance or decision making issues, as problems that we can positively impact with our nursing process. How we intervene in these instances...the plan of care, if you will...is unique to each patient. Ideally we should be documenting most of this nursing care on the POC. Alas, too many times we have no nursing care plan or a nursing care plan which serves to meet a requirement but has minimal relevance to the nursing care provided.

Nevertheless, we should address these issues...within our scope of practice and the policies and mission of employers.

[Nascar nurse, ASN, RN]

I think you did just fine!

In LTC (this is the geriatric forum), the MD may only actually see the resident every month or two. There isn't the opportunity for them to speak to the family all the time like there is when a person is in the hospital. Therefore, it is often left to us LTC nurses to educate the family about their loved ones condition and the options available to them. It takes a strong and soft heart to do this effectively and with kindness. Sounds like you were able to pull that off beautifully.