End of life care

jmgrn65, RN · Sep 1, 2005

If they are alone no family or friends I try to spend as much time as they want, if they are in a coma I still spend time with them talking to them letting them know it is ok to let go. If family is present, I let them stay with patient, let them know I am available for them if they want, offer chaplain. Explain to the family what to expect. The patient comfort is very important to the patient and family. Even if the patient is in a coma the family can and will become very upset if they think the patient is experiencing pain or discomfort.

hospicemom · Sep 2, 2005

I am a hospice nurse and would be more than happy to help you answer any questions you have. death and dying has many aspects of care associated with it, so I would need some more direct questions. But i am sure I could answer them. I LOVE to talk about hospice!!!!!! :)

allnurses Guide · Sep 2, 2005

How people are approached with end of life issues is important. When my DH was diagnosed with a rare, very advanced cancer, some person in my hospital that was walking through my department just off handly said, "oh, well, we'll just have to get him straight into hospice". No "gee I'm sorry" or even "what is the prognosis", or "what are you planning to do"........

The dx was less than 48 hours old, I was still in shock, he was still in hospital, I had just come down to my dept. to talk to my friends: and this person whom I hardly knew and certainly didn't work with comes up with that. :angryfire I about took her head off. We tried the chemo, and radiation, the tumor was actually responding a bit, but he died in 4 months, likely from micro emboli as his gut died and developed gangrene. Yeah, I signed the DNR when it was time, but not before. I took care of him at home for the most part, TPN, gastric suctioning via Gtube, feedings through a Jtube, you name it.

I guess I just felt she was saying there was no hope, while there still was. It made me very angry.

Hospice nurses are wonderful, they help you let go when you need to: but approach is very important.

(Yes, you may use this in your paper if it fits in :) )

Cute_CNA, CNA · Sep 2, 2005

This woman spent the better part of her life researching this topic: http://www.elisabethkublerross.com/

stidget99 · Sep 2, 2005

In addition to the OPs, special consideration also must be given for cultural and or traditional practices. For example, the Hmong elderly have something like a "death gown". Their head has to be on the collar at all times. They also tend to be more insistent on "going somewhere" when they die. I had a 97 yr old Hmong pt. She was DNR. At the beginning of my shift, she was totally unresponsive, extremities were flaccid. I was summoned to the room by a nurse and RT. They told me that she had tried getting OOB (legs under the side rails) and the she passed (no resp, no pulse). I went in to assess ~10mins later (I was busy in another room). She was having agonal respirations and a pulse of 13/min. By the time I completed my assessment, her resp went up to 16/min, regular and her pulse was a very steady 56bpm. I honestly thought that my co-workers were playing a really bad joke. However, they both charted their assessments on the permanent record so it had to be true. The RN had also paged the doc and hospice to inform them of her passing. I had to tell them both she "un-died" :rotfl: and explained exactly what happened. I kept a close eye on this pt for the next 1 1/2 hours. Resp and pulse remained steady. Then, I went back to check on her. She had both legs pinned under the side rails. I called the aid for help. We somehow managed to get her legs unstuck. In the process, she smacked the aide and myself upside the head. Now mind you, this pt was TOTALLY UNRESPONSIVE!!!! We wrangled her back to bed and she died again, within 1 minute. Needless to say, I didn't call the doc or hospice until she was pulseless and breathless for over 15mins. I honestly believe that she HAD to go somewhere in order to do her dying.

Although the whole experience is very difficult for family members, being a part of the death and dying process is an incredible experience for the health care workers. I went from a "non-believer" in the afterlife to a true believer. In addition to the above, I have witnessed several other pt experiences that brought me around to be a "believer".

Phenomenon · Sep 2, 2005

I would love to hear some of these experiences from anybody! I am very interested in the topic!!

DeeSki · Sep 2, 2005

I am a new nursing student so my involvement with death as a nurse is nonexistent, that said, unfortunately I do have quite a bit of experience with death as a person. Last month my 54 yo Aunt died of lung cancer. I believe she had a very positive experience with hospice care in florida. I was with her for her first (possibly only) visit to the oncologist. After this visit the futility of treatment was recognized and she immediately signed on with hospice. During our long distance phone calls she would tell me about her hospice nurse. My aunt didn't want the nurse to become too friendly with her because she didn't want her to be sad in the end. She thought providing the care for a younger dying patient was more difficult for the nurse. This from the patient's point of view, not the nurse. She was diagnosed at the end of November, oncology visit in January, hospice care began in February. She entered a hospice house for help due to not being able to stop vomiting, etc in June. Believe it or not-she left hospice and went home. I called to speak with her and the nurse on the phone told me "they are taking her out now." I thought she meant that my aunt had died. Turns out, they were taking her home. She died on 7/24. Her nurse had been sweet to her by not coming more than once a week. My aunt was terrified of the visits being more than once per week because that meant she would have to be dying. The same reason she didn't want to stay at the hospice house. I'm sorry that I couldn't be with her in the end (we were very close) but it seems like I was because she often thought I was in the next room or I had just left. sorry to go on and on. I've had a month to deal with the death but it seems that now that I have to concentrate on classes my mind is dwelling more and more on the sadness.