Hospice and Families

  1. When I was in school, it was my intention to eventually work for Hospice. I have been working med/surg now for about 1 1/2 years. At times we get hospice patients and I always take them if I can. I recently had an experience with a family that has made me question my goals.

    I work 12 hour shifts and for the first 9 hours, all was fine. The pt's wife was there and we got on fine. I told her what I was doing and medicated her husband every time she asked. We seemed to get on well, although we weren't buddy buddy. There were no problems, though.

    In the evening, the daughter came in and all hell broke loose. I wasn't doing anything right, her father was not being medicated enough, I was changing the dressing wrong, etc. etc. When I performed care, the daughter was LITERALLY right at my elbow, telling me what I was doing wrong. This went on for 3 hours, not to mention the fact that I also had four other patients to care for. By the end of the night, I was a physical and mental wreck. I was questioning everything I had done that day, and feeling I was a terrible nurse. I was SO angry at the daughter, and then felt guilty for feeling that way, as I totally understood what was going on. Then during report, she interrupted us, wanting care for her father. I assured her we would be there very quickly. She immediately went back and got ANOTHER family member and brought them out to bring us back. The oncoming nurse went back and by the time she came out of there, SHE was sick. I felt guilty leaving her there with that family! When I got home, I just cried I was such a wreck.

    Now I am questioning my career path. I don't know about my ability to care for my patients with family members reacting that way. I LOVE end of life care, nothing makes me happier than to keep my patients comfortable and I am very good at it. Could it be that it was different because it was a hospital setting? Do family members often react this way? I have to say I never gave that much thought.

    All that being said, I think I am having an interview with hospice soon as I need to bring in a little more income and I thought this would be the perfect way to get an intro to hospice. Is this something I should talk with the nursing director about?
    AM I just a terrible nurse who should be nowhere NEAR hospice?

    Any feedback, positive and negative is welcome.

  2. Visit ParrotHeadRN profile page

    About ParrotHeadRN

    Joined: Nov '02; Posts: 153; Likes: 6
    Hospice Case Manager
    Specialty: 7 year(s) of experience in Med/Surg; Critical Care/ ED


  3. by   RN always
    First of all, don't let one patient or patient family ruin it for you. This is obviously your calling and I think you should pursue it. I too, am interested in Hospice. That is what got me into nursing to begin with. I work on a medical floor also and I have not come across this kind of situation before. Of all the patients that I have cared for that were dying, it was a pleasant peaceful experience. Leave it to one person to mess things up for you. But that could happen in anything. Dont let it bring you down. Keep thinking positive and another thing, the daughter is probably like that wherever she goes, and in whatever she does. I don't buy into that saying that they are under stress and pressure cuz of a family member dying. B/C just because you may be under pressure of stress or even grief is no excuse to treat people mean. I hope this helps. I'm sure lots of other friends here will give you positive feedback too. That's the beauty of posting threads! Keep smiling
  4. by   renerian
    Wow I know dealing with the dying makes people react very protectively towards their loved ones especially if they feel they have no control over the care and act of dying. I know I have dealt with this and found if I pulled the anxious person to the side and talked it helped. Most of the time the person would break down. I think if you care enough keep your dream. REalize that is a tough job but most of the people will love you for it.

  5. by   ParrotHeadRN
    Thank you both for your replies, I feel much better. :kiss I am going to pursue the per diem Hospice job and see what develops.
  6. by   renerian
    Good Parrot...............it is a very worthwhile job!

  7. by   ParrotHeadRN
    Now I am really excited. I have an interview next wednesday! I'll let you all know how it goes. And thanks to renerian and RN always for your support.
  8. by   Sleepyeyes
    It's not so hard to take care of the patients; it's getting the family members' emotional needs met that's tricky.

    One man hounded the staff so badly one Christmastime, trying to make everything perfect for his bedridden wife, I finally had it up to here with him and when he said, for the thousandth time, "You wanna know what's wrong here? You wanna know?"
    I replied smoothly, "Yes, I know exactly what's wrong here. Your wife is here in this facility instead of being home with you-- and it's Christmas."

    Took the wind right outta his sails....
  9. by   bzaslow

    Gosh Parrothead, I am so sorry that you had such a horrible experience. It doesn't sound like you did a thing wrong. What you decribed is NOT the typical hospice care experience. Most families are grateful for your care and expertise. That said, there will always be a few folks that you just can't please no matter what. I don't think that has a thing to do with Hospice care it is just their attitude toward life.

    I once had a family during home hospice request that I not be allowed to come back because I said the "d" word (death). Everyone else in the family had been talking about it but I wasn't allowed to. Go figure. Eventually the requested me again and we became close but I was VERY careful about what I said around them!

    Don't give up your dream. You will be (actually already are) a terrific Hospice nurse and the field needs you. Good luck and don't let this get you down!
  10. by   nurseT
    Poor parrot... I have a family like that right now. It's been a nightmare. Every time grandma(pt) farted or blinked the grnddtr calls everyone and tells them grandma has stroked and is actively passing, she will cry, call numerous Dr's office and say grandma is in pain, even though grandma denies pain. She makes such a stink that the Dr. doubled and tripled pain med at grnddtr request, has ok'd pureed diet even though no chewing or swallowing problems noted, pt started vomiting profusely due to med increase, has constant watery stool due to grnddtr insisting on doubling stool softeners when pt had regular BMs, now that pt really is having s/s, grnddtr never calls anyone, seems to be coping better. Isn't that something? This family member insisted on playing Dr. and nurse. I can't wait till it's over. I've been doing hospice a long time and that's the first and last munchhausen I ever want to meet.
  11. by   waves
    i have an interview for nursing school in a couple weeks. and i've been searching to remember why i wanted to go into nursing. the application process has been so drawn out. coming to the hospice section reminded me. my mom died in the hospital waiting for a hospice bed to open up. waiting for someone else to go with peace and dignity so she could too.

    because i have only first aid and short emergency medicine courses under my belt, i went to work as a caregiver for a local agency. i wanted to get a better feel for ongoing care vs. emergent care. i started with a couple in their 80s who had been best friends for over 55 years. one of the couple was hospice but fairly independent, the other though not bed-bound needed constant supervision and care. since i started 6 months ago (3-4, 24hr shifts per week) the non-hospice husband passed on (about 3 months ago).

    now the widow is slowing. all the little things are starting to add up. she is an at home hospice patient, but one daughter is not completely ready to accept all the basic ideas of hospice...dignity, respect, peace. the daughter lives 4-5 hours away. everyone who is involved in the mother's care can end up on the phone for hours with the daughter...her questioning everything from the doctor's oxygen prescription to how to dial 911. the daughter needs some therapy. the social worker is unavailable after this month...no one can talk to this woman. her siblings, her mother, her husband, etc. who wants the last month of their time with their mother to be correcting, nagging, badgering?

    it is the family politics of this whole thing that will make me chose some other area of nursing. it has definitely helped me discover boundaries for myself. the widow is a wonderful lady...i'll endure more for her...but i don't know how much more.
  12. by   cargal
    It is a tough job- from the recent husband who thought "hospice would come in and take over" to the obsessive and fighting sibling offspring that try to draw you in and get you to take sides, to the son who did internet research on alternative meds, herbs and vegan diet to reverse cellular death, althewhile eschewing the prescribed meds his mother was supposes to be taking. A sister actually called me and said to do something as "my brother is nuts." I stated that her mother was alert and oriented and of sound mind and it was her choice to follow her son's advice. He since has been banished and the pt is doing much better. I have had families where a meal could not be cooked in the kitchen due to gross messiness, garbage, stink etc and all the mom and dad did was sleep (drugs?) all day when the mom was not at her job as a privately employed cook. The patient, once again, was competent and denied any nutritional deficit. I doubt that she has adequate intake. A nutritionist would be lost on these folks. It is all very sad, and you do what you can. I agree with the comment about boundaries. Also, most patterns are set up from a lifetime and can't be changed, so I define my goal with my patients and usually they don't include feeling guilty over family dynamics that I can't control. Great luck to you all.
    Last edit by cargal on Jun 17, '03
  13. by   Hellllllo Nurse
    I worked inpt hospice for 4 years. You will see families at their best and at their worst.

    I've had quite a few like you've described. The families are often tough to deal with, the pts are the easy ones!

    I found one thing that helps w/ these kinds of people is to NOT get defensive. It seems to make them go that much more into attack/critisize mode.

    Smile, remain friendly. Don't speak to these family members when you don't have to, it tends to give them ammo.

    It's the feelings of guilt for not being their for their loved one, or feelings of helplessness, lack of control coming out.

    It's not you, it's them. Remembering that helps.
  14. by   waves
    i guess i really believe in the general mission of hospice; and that does keep me going back. i do know that in general it is not the worst possible situation. it could definitely be worse. i just don't know if my head is ready for 10 years of this. is hospice something that nurses rotate in and out of...for a break?