It shouldn't have happened this way.... - page 3

Okay, so I work part time with hospice. I like it. It's a nice break from feeling like I'm torturing souls their last days on earth up in ICU because their family of freeloaders are all living off... Read More

  1. by   Soozul
    In response to Needshaldol, I also do these things- part of being a conscientious nurse.I always call family c a turn of status or events (not hospice pts,) but in this situation, the nurse probably thought the family didn't want to be there or they'd been, c her being hospice.I don't know that I would have called family under those circumstances. We call the hospice nurse who is off-site when the pt. passes. Where I work, family overflow in a situation like this.They usually do most of the care which is basically being c the pt. Some don't even like the nurse coming in.
  2. by   Penelope_Pitstop
    Quote from nerdtonurse?
    When I was in telemetry, and had someone who was close to passing, I'd put telemetry on them just so I'd know when they started getting ready to go...I never wanted to walk in and find my patient had been dead for the time it took me to bathe and do wound care on someone else.
    At my hospital we are actually not allowed to do this. Once a patient's DNR order (we have a 3-tiered system) has indicated that no meds to correct dysrhythmias will be given, the telemetry is removed.

    I agree with you, and I wish this was an option for me. When patients are hospice in the ICU (it happens occasionally if death is expected soon after withdrawal of care), I'm not sure if the monitors stay on the patient. But for MedSurg and stepdown, those patients can NOT be monitored.

    As the others have said, I'm very sorry to hear this. I applaud you for your work - I do not like having hospice patients. I prefer the rush of emergent interventions! I hope that your discussions with your boss end in something positive.
  3. by   Soozul
    Hospice pts. NEVER have tele- comfort care only. I have never heard of hospice care in the unit either.
  4. by   needshaldol
    I have yet to hear of an acute care hospital accept "hospice" in the hospital. When a patient goes on hospice, the hospice team takes over. How does this work in an acute hospital? We have a palliative care team, but they do not give orders. What we do is "comfort care" which to me is exactly like hospice, or rather hospice in an acute care facility. I truly do not understand how hospice works in hospitals, perhaps; these are "for profit" hospitals?
  5. by   leslie :-D
    in nsg school, there was a dying pt across the hall from the pts i was assigned to.
    not once during the shift, did anyone enter his room, as was confirmed by a few of the students.
    when they say ekg changes, they gathered some of the staff and students and formed a circle around his bed.
    never said a word to pt, just the staff holding hands encircling the pt.

    truly, i found it offensive and disingenuous.
    that is not my idea of comfort.
    had they told me he was dying, i would have been honored to take him as my pt.
    i'll guarantee you, he would have received 1:1 attn all day long, to extent possible.
    note: hey people - it's ok to actually touch and comfort someone when they're dying.

    for the most part, 'hospice' in a hospital is fruitless.
    there are some families that stay with pt until the end.
    and when hosp nurse enters, they are usually not welcomed.
    but then again, there are far more pts who die unattended and alone.

  6. by   SuesquatchRN
    Quote from Soozul
    In light of what I've seen in my years of nursing, hospice should have never become an option in hospitals. Hospice was created for pts. to get nursing care AT HOME around familiar surroundings & FAMILY. That whole concept is missed these days.I know it started in hospitals due to more days of insurance coverage that way but the pt. gets cheated. In a hospital, if pt. becomes "hospice" that means a step-down in care given & time spent in the room by staff, not more as some here seem to think. Hospice is comfort care only so interventions are few.It is probably much better in the home setting as it originated because there the pt. & family get the staffs undivided attention as they should. That won't happen on a busy hospital floor. And forget familiar surroundings which are a comfort to a dying pt. & more conveniant for family.The post Oct 4th says family were called- where were they?? Seems they failed the pt. also. It is all very sad, but again, hospice should be @ home- none of this would have happened.
    This is simply incorrect. We often have people in the hospital simply because there is not enough family to provide loving care at home. That said, I have this week watched two different hospitalists panic the poor wife of one of those who can't be cared for at home.

    I'm sorry the poor woman died so frightened and alone.

    ETA: And comfort care only applies to the terminal diagnosis. Comorbidities may be and often are treated.
  7. by   needshaldol
    Having a dying patient at home can be impossible for some. We cannot judge. Families are not educated early enough to know what is best.
  8. by   mc3
    This makes me so angry, and sad. How horrible. I fear, though, that your managers may not want to "ruffle the feathers" of the hospitals' managers. I worked in hospice for 7 years, and many times I saw things that shouldn't have happened in a facility. When I brought it to the attention of our management, they said "you have to remember, you're a guest in their facility" and take it no further. Never mind what was best for the patient. They were afraid they wouldn't get any more referrals. It made me sick - it was one of many reasons I left there. I hope I'm wrong.....
  9. by   needshaldol
    Don't get me going on hospice. I find that hospice is useful in few cases. Most people at end of life do not need hospice unless they need a free use of a bed that is easy for the family to control. Hospice takes over the primary doctors duties and the doctor is probably very happy. But hospice is a paid position. There are a lot of staff at hospice, a lot of $ that goes out to staff. Sorry folks, I have seen it with my own two eyes with both parents. I fired hospice twice.
  10. by   eagle78
    I am so sorry your patient had to die like that. It brought tears to my eyes.

    I have to say that the one inpatient hospice exposure I had was not like that at all. My cousin died of cancer of the liver a couple of years ago. When she got beyond the care oncology could supply she was moved to the hospice floor in the hospital. Those nurses did regularly check in on the patients from what I saw. My cousin was clean and turned regularly. She was pretty doped up, really floating on a cloud you know. But I really appreciated the way the nurses still checked on her.

    When she was passing they did call my mother and another aunt who had been primarily the contacts for her. Both of my cousins parents were already deceased. The other aunt had health issues of her own that prevented her from going to the hospital. My mother went, and because the staff called my mother was able to get there before she passed.

    Now there were other patients on the floor, at least four or five if I remember correctly. The floor had two wings and I was only familiar with one side. From what I could see they did seem to keep tabs on the patients. Just wanted to say that I have seen good inpatient hospice care. Hopefully your situation will get the attention it needs so that another patient will not have to go through this. Peace...
  11. by   nerdtonurse?
    The patient was not in ICU, they were on the tele floor, MD's call on that one.

    And I've had hospice patients in the ICU at this hospital, just to have the 1:2 ratio (those folks usually have money, pull, or politics). I've done my share of terminal extubations, etc., usually with the lung ca folks, the "shortness of breath" in the ER that turns out to be mets'd cancer, or the MI that's so catastrophic that the person's on 8 different drips; when the family decides to stop treatment, they often don't live long enough to get upstairs, much less home, unfortunately. I'd love it if all my hospice folks could pass at home, that's the goal.

    Most of the time, the inpatient hospice is for the folks who live alone, since we don't do 24 hour home staffing -- if you have a sudden event (like this person), you either pass in the hospital or are sent to a local nursing home if you live more than a few days.

    The hospital I used to work in wouldn't even keep a DNR in the ICU, much less a hospice pt -- you were made a DNR, you were immediately sent to the stepdown, even if it meant you died in the hallway or elevator.

    In this case, the patient had been looking after her husband (Alzheimer's, lots of different comorbidities, we've had them both as patients); the children had to come in from out of state, and by the time they arrived, it was obvious the pt wasn't going to live but a few days. The husband was in no state to look after anyone, the adult kids were dealing with suddenly finding out how bad off their dad was and the fact that their mom was dying.

    We're a small rural county, about 30,000 folks, if you count the livestock. Most of the kids grow up and move away, and we get a lot of elderly who are in this situation (nobody realizing how bad things were getting until something happens to the caregiver in the situation). Most of the time, we do a good job, and most of the nurses are good with the DNRs and hospice patients. In this case, they didn't, and I'm worried (like others have said) that this will be swept under the rug, explained away, and nothing done (until it happens to a patient that the powers that be actually care about...).

    What our county really needs is an actual standalone hospice, so that the folks like this who either can't go home because there's no one there to be the caregiver can have a place of beauty and peace to spend their last hours. With the aging baby boomers and the fact that we don't have the multigenerational families under 1 roof like we used to, I'm afraid I'm going to see this situation more and more....
  12. by   kty1
    Quote from westieluv
    i can't believe that a professional nurse or cna, or whoever it was who took that 4 am bp didn't take action when they saw how it had plummeted. This is total negligence, as far as i can tell by what you have told us here. None of this had to happen the way it did. It is sad beyond words. One of our jobs in hospice is to let people die the way that they want to inasmuch as that is possible. Someone took that opportunity away from your hospice and, much more importantly, from that poor woman.

    shame on all who were involved in turning a blind eye to this situation!!!
  13. by   kty1
    Quote from nerdtonurse?
    my hospice boss is out of town, but we will be discussing it the minute she gets back. While our hospice is affiliated with the hospital, when i'm working as a hospice nurse, i'm not supposed to put on my hospital employee hat -- i can access the write up area because i work in icu, not because i work in hospice. Believe me, i will be discussing this with my boss, and she's not gonna be happy with these folks...

    It just breaks my heart. I called the family, and it was expected, but i just feel horrible for the patient. The family doesn't know the circumstances of the death.

    Note to self: Never, ever let mom or dad be a patient at my hospital...

    no one should ever die alone!