Need to Put Together a Quickie Inservice for Hospital Staff

[hospicenurse]

I have a 37 yo cervical cancer patient in our hospital on hospice who will be there until she dies, due to the acuity of her care. she has been there for 4 weeks now, and may last for weeks yet. She is on 660 mg IV MSO4, and has been on high doses of IV Ativan, Versed, Valium, and now phenobarb. The physician is trying, at pt's request, to keep her terminally sedated. It hasn't been easy. Family can't manage this at home (husband also doesn't want her at home with the kids), SNF won't take her with IV pushes, no inpatient hospices in the area. I have been asked by the DON to provide an inservice to staff on hospice, pain mgt (they have never seen these doses of drugs before) and emotional support for the staff. And please don't take more than about 20 minutes. And can I do it within 48 hrs? So, can any of you help me with some online reference materials? I need to pull this together quickly and make it concise - not sure how to fit in the emotional support part in 20 minutes. Any ideas appreciated.

I have been spending up to 3 hours a day on the floor supporting and assisting staff with her care. It takes 4 people about an hour daily to do her wound/personal care. MSW also visits daily, as does hospital chaplain and HHA. And the hospital staff is doing a wonderful job. It's a challenging case. And heartwrenching. Not many patients these days cause me to lose sleep, but this one does.

Hope you all can give me a little help.

[hospicenurse]

Well, the inservices are done. They went well, I think - and I had some staff tell me they were helpful. The first two were done with day shift. The first was all staff and we discussed pain mgt/terminal sedation as related to this patient. The second was all nursing students so I spent more time on basics of pain mgt in terminal patients. Then that evening the patient died. I came in to be with the family and staff, that went as well as could be expected. The next day's inservices were very different, but were what was needed: debriefing for both day and night shift. I gave them the handout on pain/t.s. and then we spent the time talking about how the 35 days went. Most of the staff had also experienced previous admissions with this patient. They were very connected to her, and were able to express their grief. Me too. It was a good thing, and very good timing.

Thanks everyone, for your input - it really helped me focus.

Gail

[renerian, BSN, RN]

Glad your inservice went well!

renerian :)