Family members at bedside

[sissiesmama]

Hey - this is an issue I encountered a few years ago while working on a busy medical unit. I didn't think about it again, until I re-encountered the same type of episode and was wondering if anyone else had. I was caring for a woman who had lung cancer and developed a PE. The patient was on a heparin drip and BR, as well as IV pain mgmt. I walked in the patient's room one afternoon and the daughter, who was an RN, was trying to get mom out of bed, which she would not be able to tolerate. The daughter did tell me at that time she did not want to see her suffering any more, so she was going to get her OOB to make her "throw the clot". This situation was handled, and I didn't think about it again until recently.

Again, different hospital, medical unit. I had a patient with lung cancer admitted for pain control. I had been caring for this patient and her family for a little more than a week. The daughter called out for the patient's Morphine and was waiting outside the room. She asked me what dosage I had and when I told her, she requested a higher dose be ordered by the MD, and 'the morphine be given "really fast"'. She said she didn't want the med diluted, and she wanted the MD to write an order for "20 or 30mg" ivp Morphine to be given rapid push.

I have had family members in the hospital, and I have had them pass away while they were there, and did not want them to suffer, but had never even thought to cross my mind. In the latter situation, when I went to my unit manager, she just laughed and called me "Nurse Kevorkian". (Of course, I did not do what the daughter requested and earn the nickname, but I thought the manager would have not have made that comment either.

Have any of you experienced this? Thanks!

Anne, RNC :paw::paw::paw::saint: Shadow, Sissie, Bea, Sam, and Cookie

[canoehead, BSN, RN]

I'm in the minority, but I hope euthanasia is legal for people when my time comes. Just give me the meds and let me go- I don't want to be a museum piece for a week while my body breaks down.

[sjt9721, BSN, RN]

...I don't want to be a museum piece ...

:sofahider (I am laughing behind this couch!)

[Jolie, BSN]

Sounds like time for a Social Services referral for the family members, and hospice for the patient.

[sjt9721, BSN, RN]

nursbee04 said: I am one hundred percent for pain control and palliative care...Too many times I have seen patients and families hit in the face with EOL issues because no one addressed any of it until it was too late...but my goal is to keep the patient comfortable and pain free. Not to facilitate death, but to make the dying process EASIER on the patient.

Thank you!! My thoughts exactly! I would NEVER want my pts or family members to suffer, especially in the terminal stages of an illness, but just the thought of requesting a lethal dose of meds, OMG! And, the thought of a family member comparing taking care of one of their family members pain like a vet would at their office, just made me sick.

My comments may not apply to the OP's situation, but here's food for thought:

Sometimes I think family members want the process to be easier on them as well. And not necessarily because of malicious or selfish reasons, but because it's hard watching/waiting their loved one to die. The night before my grandpa died, we (Grandma, Mom, 3 aunts) were all in his room. His breathing was irregular and he barely had a blood pressure. I declined the tech's offer for repositioning because we all know what happens when you turn someone in that condition! The doctor had talked to us and explained that we were near the end and how we could keep him comfortable. My aunts kept asking me "how long will this take", "when is he going to die", and "doesn't it hurt to watch him".

I think once families get to the point of acceptance...and then the patient is actively dying...they just want it to be over. They've fought alongside during the illness, never giving up, but then once dying is imminent, all their 'fight' & strength is gone.

As far as the comparison to a vet putting down an animal...many have made those same comparisons. Nurses complain about families that want everything possible done for the demented 97 year old with contractures, bedsores, and terminal cancer. I've heard nurses make the comment, "They wouldn't put their family dog through that torture."

With all that being said.....I'm not making excuses for the families described in previous posts. I wasn't there and don't know the entire context of the conversations. If someone says the family was downright creepy about asking those questions, then I believe them! But...I just wanted to bring up the fact that some families might be coming from a different place when those situations arise.

[RN1982]

very true.

[Blove86]

Agreed

[RN1204]

"I hate family members, which is why I purposely choose to work the night shift."

Sad but it's true. The family members from Hell I like to call them. Sounds like those two you mentioned should be on the Jerry Springer show with their mentality. Seriously, I have had encounters when the family didn't make it blatantly obvious, but you could tell if all they had to do was flip a switch, it would be lights out. I can sympathize with "I hate to see mother suffer" but you have to draw a line and not go around like putting dogs to sleep. Peace.

[NurseyBaby'05, BSN, RN]

It is hard on the families once they have accepted the person dying. Many of them want vitals/sats so they can see "how much longer". I explain to them that it's not an exact science or formula. Someone could have borderline ok vitals and take his last breath in the next minute.

I have also had families beg me to end it for their loved one, threaten to hold a pillow over the loved one's face, etc. I tell these people in no uncertain terms "We don't euthanize." This usually sends them backpedaling a bit when they realize that that is what they were really asking. As for the ones that want to actively "assist" a family member, we keep a close eye on the person. As a last resort, we'll ask that person to leave. (With or without security is left up to the visitor )

[ktwlpn, LPN]

I can attest that when you are watching a loved one die you don't have full control of your faculties.The filter between your brain and your mouth goes out and you are liable to say anything. It's normal to want the suffering to end and it is true that we do that for animals -why should our loved ones have to suffer? The minutes seem like hours at that bedside......

[leslie :-D]

i don't know...

i see this all the time.

ALL THE TIME...

that family members want me to just get it over with.

and i understand completely.

i see an awful lot of uncontainable suffering, and short of palliative sedation, there are (too) many who die an anguished death.

morphine/dilaudid/benzos do not always work, for sure...no matter how high the dosage.

i think it's a perfectly reasonable response to watching a loved one in such distress.

leslie

[sissiesmama, ASN, RN]

Thank you all for providing me with such great insight so far. In both cases, I could not even attempt to put myself in their shoes. Being a patient dealing with a terminal illness is hellish enough, to be a family member that sees what suffering the patient must endure makes worse, and then on top of all that, throw in all the nursing knowledge, and it just adds to it.

My dh is also a nurse, and was the nursing supervisor that shift when the second incident occurred. We did talk about it when that happened, and that did help in dealing with my reaction to it. He and I have also both related quite a bit personally, r/t to the fact that unfortunately, it could be me or him lying there in the hospital, not only dying, but miserable, and terrified. The fact that I will be 38 on Saturday and in the last 2 yrs. I have been diagnosed with labile HTN, bigeminy, runs of vach, and the list goes on does give me a little educated guess that it would probably be me, but I digress.

I could not even attempt to put myself in their position. I guess, since the first incident seemed isolated, until the 2nd one of course, I kind of just put in on the "back bumper". And watching these patients suffering, crying out, moaning, not sleeping, mouth breathing and providing oral care, knowing that it would only be a temp. fix for one symptom, when their status progresses to pds of apnea, Ch. stokng, color and temperature changes just seems so minute, so to speak, does stir up emotions and felings that we as nurses try to rationalize, or try to deal with it in other ways.

I guess, you tell yourself you can just stuff it, but sooner or later, your gut will only hold so much and then it comes right back up, and bringing more issues with it Hope this makes a little sense.

And, leslie, you are always able to state your feelings so well, while taking other points into consideration. I always feel so much better when I see your name in the pages of my thread.\! Thank you SO much!

Anne, RNC

[10MG-IV]

Preach it, Sister.

I am not good at dealing with long, drawn out conversations with families. I actually had to tell a visitor to shh! the other day. I wanted to give the patient (her sister) some pain meds and was trying to assess her pain, nausea, etc. She kept answering the questions for the patient. I politely told her that I needed to hear it from the patient, and she answered ANOTHER one of my questions. I just said SHH! and held up my hand finally....lol.

That worked! I would have been so mad if the nurse shh'd me! lol....but she actually smiled about it, and apologized for being in the way a little while later. I told her that my big sister would have done the same thing. :)

As for the 'Nurse Kevorkian' angle, I was asked by a family member during my first 'terminal wean' if I could make her dad die faster. "Maybe with some more medicine?"

I told her that I gave the amount prescribed by the doctor, and that giving more would be illegal and just plain wrong. I noted that he was resting quietly, and that if at some point we felt that he needed more meds to keep him comfortable, I would call the doc.. He died like an hour later.

SS you did wonderful nursing in that situation. I was giving a terminal patient morphine, when the family came in and asked " how do you know you aren't going to kill him"? I explained by having long conversations with Jack, when he was lucid alert oriented I promised him I would do everything I could to keep him out of pain, and I did not give life and I did not take it away. I assessed Jack and gave the meds. the next day I had a letter, card and flower from the family. Jack died next shift, without pain. I found out later the family was appreciative of the bond and care given by all the staff on our oncology unit. As a nurse, caregiver, if you can help someone thru the worse time of their life, relieve pain, anxiety, suffering and worry, you have done the best nursing on the planet. Some time you have to tell the patient and family "You have to give me your worry. hand it to me and let me hold your worry and you get some sleep."