couple of things come in mind here:
1. primary nurse needs to find out patients wishes promptly while family not present in room.
2. physician needs to be updated re situation if not already done.
3. family meeting needs to be held involving physician, clinical manager, patient and nurse to advocate for patients desires.
areas i would address:
a. pain assessment:
.....the joint commission on accreditation of healthcare organizations (jcaho) announced in august 1999 that it would require hospitals, home care agencies, nursing homes, behavioral health facilities, outpatient clinics, and health plans to implement ways to assess and manage pain.
the new pain standards, which are being included in 2000-2001 jcaho standards manuals, require providers of healthcare services to
*recognize the rights of patients to appropriate assessment and management of pain,
*assess the existence and if positive, the intensity of pain in all patients, record the results of the assessment in a way that facilitates reassessment and follow-up,
*determine and ensure staff competency in pain assessment and management, and address pain assessment that supports the appropriate prescription or ordering of effective pain medications,
*educate patients and their families about effective pain management, and address patient needs for symptom management in the discharge process.
what pain management tools has your facility developed for patients and families?? use them!!!
b. pain management
need to educate patient and family what to expect re pain and effedtive management patient should not be snowed. poor pain management impedes healing process.
comfort care does not mean no care---just the opposite---maxaminizing patients life and comfort. can be provided in home health, pre hospice program if family will desiring treatment or hospice. many individuals can not face inevitable but once home change their mind.
good pain article:
challenges in pain management at the end of life
other pain resourses i've identified in previous post:
pain management-- see post 15.
if patient and family at odds, call in facilities ethics committee.
c. life expentency/discharge planning
physician needs to outline course of treatment for this illness and followup arrangements needed. what would happen if aggressive treatment not persued. discuss patients quality of life issues here what's important for hom needs to be stressed by patient's nurse with support from clinical manager. discharge planning--referral to home care, supplies needed etc to be reviewed.
some times these conferences need to be broken up over several days to give time for patient/family reflect over issues presented. some familys need concrete written info re pain management before they buge on an issue. some never change and you have to accept that you've presented options. if you keep the patient the focus, this sometimes helps.
good luck...let us know what happens.