Horrible Death - What could I have done better?

Melinurse · Apr 17, 2009

Hi Everyone,
I'm new to this group. I had a horrible experience with one of my patients. The male pt. had panc ca w/mets to liver/lung. Lived with spouse and adult sons stayed with them. It all started when he became dyphasic. The family were, like most, insistent on feeding him. I've never had a family not respond to teaching re: aspiration, etc. The family fed him anyway, i.e. chewing food for him and putting it in his mouth!! I finally taught til blue in the face and they stopped. Then When he started transitioning, they kept shaking him awake, begging him not to die! Of course, I did teaching re: peaceful environment, etc. to no avail. This is the worst death I've ever witnessed in all my years in hospice. I called the SW quite early in the process and bereavement and the family refused visits. Declined Chaplain. He had a horrible death and I felt like I was witnessing torture. Is there anything else I could have done for this patient? He did sign a DNR for me about a month prior andreinforced I constantly ..." Nothing workedthat "his wish is !! For the first time, I feel like I failed a patient and family. Any suggestions or comments welcome. This has been haunting me.
Hugs,
HM

Sounds to me like you did the right things. It was the family who was in denial. How long was he on service? Perhaps there were other family dynamics that you did not have the time to explore. But that is not your fault. I feel bad for you though {{{ HUGS }}} because you tried to do the right thing and the family did not let you. You did not fail your patient. Let it go and use it as a learning experience for the next time you run into a family in denial. Talk to your chaplain and social worker regarding how to help families like this deal with the immenent death of a loved one. Maybe they'll have some teaching literature or have encountered this before. I can see why this is haunting you though and I wish you the best as you come to terms with it. You'll be in my thoughts and prayers.

heron, ASN, RN · Apr 17, 2009

Please cut yourself some slack and accept the fact that you are not all-powerful. We are not always going to see the textbook "good death" ... whatever that means!

Short of physically restraining the family, there's little you can do to control their behavior. They come to us with their attitudes and family dynamics already in place ... these things are not going to change in the short time we have to work with them.

Sometimes, the best you can do is all you can do.

texastaz · Apr 17, 2009

You did everything you could so there is no reason for you to feel guilty. Some families are just like that so just leave it at that.:heartbeat

nightshiftnut · Apr 18, 2009

:icon_hug:this is for you. you did all you could possibly.nothing more could be expected. sometimes you have no control over the family, no matter how much you educate. denial is obvious in this family situation. i've seen this in my own experience. it seems to be a rarity..but it does happen with families.

Valerie Salva, BSN, RN · Apr 18, 2009

Sorry you had to go through this- it's not your fault.

I've dealt with a couple of family members of pts who would not allow the pt to have pain meds. In both cases, the family member was the DPOA. No amount of education- even the medical director talking to the family had no effect and they just refused to be educated. There was another pt whose wife force fed him, and he aspirated repeatedly. No amount of education could get through to her.

In all cases, the pts died horrible deaths and I felt awful about it. the difference was that this was in an inpt unit, so all the other staff experienced it with me and I was not alone.

If you are doing in-home hospice care, it's really different as you are alone with the family and you can feel really alone in a bad experience. Can you talk to your mgr about it or does your employer have an EAP?

rngolfer53 · Apr 18, 2009

I have only been in hospice 7 months, but I've had two cases where family members were simply unteachable.

In one case it was, at least in part, because of financial issues, along with misinformation the person had read on the internet, and therefor it was gospel.

The second because all the family members have a functional emotional age of about 3. They are entirely centered on their own needs, compete for attention, fight over who the biggest martyr is, etc. Our social workers haven't had much more luck than me, so I don't feel so bad.

Sometimes, other than a two-by-four to the head, which will get you arrested, there is nothing you can do.

Take care of yourself, use the resources your agency provides, and live to fight another day.

Ginapixi, BSN, RN · Apr 20, 2009

unfortunately there are families out there who are "unteachable"! Thank God they are not all like that. I tell mylself that the dying family member lived with these people all his/her life and I cannot change the choices they make. Yes, it pains me, but I am not God; we all know the saying: you can lead a horse to water.... we can only do so much! You have not failed your patient! you did all you could (short of the 2x4 over the head)

shrinky · Apr 21, 2009

Please take all of this advice and don't blame yourself. I have seen this repeatedly in my years in Hospice. We are obsessed with food in the U.S.A and it is an important part of social and family functions. I can't tell you how many times that I have heard that Hospice starves patients to death. We know the truth and try as we may to teach, people believe what they believe. I had a 50 year old patient who aspirated and died while her father was feeding her. We had told him many times about feeding her, had presented articles even, but he did what he felt was right and he felt very guilty afterward. You did all that you could have done for her and thank you for caring so much for your patients. Hugs to you.:redpinkhe

HospiceMama · Apr 22, 2009

I'm sorry, I thought I already posted a reply, but it didn't show up! Thank you for your replies. I guess, no matter how long we've been in hospice we all have those kind of experiences. Hugs Everyone:yawn:

Ginapixi, BSN, RN · Apr 22, 2009

I'm sorry, I thought I already posted a reply, but it didn't show up! Thank you for your replies. I guess, no matter how long we've been in hospice we all have those kind of experiences. Hugs Everyone:yawn:

and we will keep having them! But the day I do not care abut those things any more I think will be hen it is time to quit my "job" with hospice; Just take it is a lesson learned and don't think you have failed!:redbeathe

nursebboop1, BSN, RN · Apr 28, 2009

I was a hospice nurse for ten years. You truly did all you could have done. I cannot think of one thing I would have done that you didn't try. You did your best.