am I wrong to say this to a family?

[Ms.RN]

i had a hospice patient yesterday and when i saw her, she looked like she is about to expire. this patient said she wanted to see her husband and her daughters and that she is feeling afraid. so i called her daughter, told her that she is not doing good and if she can come to see her because i dont know if shes gonna make it until tomorrow. so her daughter came, was very upset that i told her that shes not gonna make it until tomorrow and i immediately regretted saying it to her. i called hospice for her and she told hospice lady that she doesnt know whats going on because she saw her sister yesterday and she was just fine. she think shes very lethargic because we gave her too much pain medicine. am i wrong to say this? what should i have done in this situation?

[SuesquatchRN, BSN, RN]

Well, I certainly wouldn't give someone a date. I would mention that her sister is frightened, and asking for her.

:)

[MIcrunchyRN]

I think yes in some way you wanted to communicate the seriousness of the situation to the family but hard to say they aren't going to make it until tomorrow. I have had that happen multiple times with my grandmother lol and she lived like 10 more years. Sooooo besides looking like crap was there anything else that pointed you in the direction?

[tencat]

Hospice patients have this really ANNOYING habit of appearing to be ringing the doorbell at death's door, then bouncing back for days or weeks. (Please don't take that wrong...it does sound pretty bad, I know!)

I myself have given up predicting when a patient is going to pass. I can give educated guesses, and I try to be very liberal "weeks to months" or "days to weeks" is usually fairly accurate for the situation.

It probably would have been better if you had called family and said "She wants to see you, and as you know she is very ill, and we don't know how much time she has left." or something like that. I think you had very good intentions, and you did the right thing by calling family members.

[HappyPediRN]

I have found that families often tend to be unrealistic. They sometimes expect a miracle and have not had time to cycle through their own stages of grief. Putting a timeframe on death forces the family to come to terms that their loved one is actually going to die. You didn't do anything wrong but through experience you'll learn to word things in a way that family can understand. It's often better to say things without saying them. Telling a family member that a patient may not make it til tomorrow invokes fear in them. Unless the patient has begun apneic episodes, Cheyne-Stokes respirations, lost peripheral pulses, is mottled, centrally cyanotic, and/or unresponsive (and all of these things are new onset), there's no way of knowing they won't make it until tomorrow...and even with all of these indicators, some patients can hang on for days to weeks. End of life is a tricky thing because loved ones are all over the map with their level of understanding...I find for every one patient in hospice you actually have approximately ten since hospice is every bit as much support for family and friends as it is for the patient.

[CHATSDALE]

i agree that telling them a specific is probably not a good idea

some bodies just choose to hang on

when a patient asks for someone then call them and if they ask how the patient is doing say something vague like 'not as well as we would hope' or not as well as yesterday'

i know it is hard to see a patient that is apprehensive and not try to reach out in any way you can

[pagandeva2000, LPN]

Ditto what everyone else said; I never estimate a date or time, because we can be fooled often. But, I support your effort to contact the family. I would have said "Your loved one is strongly requesting that you come; she said she is afraid" and maybe a few other comments similar to what others have posted. We really don't know what it is like to be almost at death's door; maybe we get premonitions, but rebound, however, I do believe that this is the body's and God's way of saying to prepare to say goodbyes while you are alert x3. We live and learn. I know you didn't say this to be cruel.

[queenjean]

I work on a medical floor, where we occasionally have the hospice or dying pt. What is so frustrating is that families often want you to be able to make this prediction. They will be upset that they missed the actual death, but they will be upset if you call them to the bedside and then the pt does NOT die.

You did the right thing by calling the family--after all, the pt wanted you to.

I usually say something like " The pt is requesting you; the pt is (describe symptoms)."

When the family asks "Do you think it is serious? Do I need to come up?" or some other question where what they are really asking is "is the pt going to die now?" I always answer "As you know, no one can predict that. In my experience, some pts who are in your sister's situation are in the process of actively dying; other pts will have ups and downs like this for days or weeks. I can't predict what will happen with your sister in the next 24 hours or 24 days. But I am telling you that there is the possibility that she will pass within the next several hours, and if it is important to you to be here at her passing, then you should come soon. I am not saying that she will pass tonight; but as you know her time is limited, and I would rather call you and give you the opportunity to come be with her if you wish, than wait too long and have her pass without giving you this opportunity."

I want the families to understand that I can't predict anything, and I don't expect them to come up if they've said their goodbyes and are at peace. If it is important for them to be there at the death, then I'm giving them that opportunity.

Hospice is very difficult, and very rewarding. This was a great learning experience for you. I am still, many years later, learning new and better ways to help these families and patients.

[leslie :-D]

i learned many yrs ago, to never give an estimation of death.

despite the imminent signs, i've had too many pts that suddenly 'perk up' and last sev'l more weeks.

dang, i've had pts who didn't show any signs, and just died there on the spot.

and i'd catch hell from the families about those situations as well.

it's usually safe to refer to a change in condition or pt is asking for you.

but it's clear, your heart was in the right place.

leslie

[nightmare, RN]

I'm with Leslie on this one! I've had relatives stay there for days and as soon as they leave their loved one passes! I've had others seemingly at death's door ,recover.We had one who did it so often she was nicknamed the 'comeback kid'! When she did eventually pass she took everybody by surprise! I usually say to the relatives that I can't tell them when.

[Smokey9283]

Once I had a resident that actually died in her wheel chair, pulsless, bp-less and breathless. We transferred her into her bed and she came back. She is still alive 3 years later.

[joyflnoyz, LPN]

I really try and gently educate the families- talk to them about signs of death, etc. When being pinned down as to "When will she die?", I usually answer something such as "A death is like a birth, it happens in its own time"

I often have trouble coming up with the right words.... I hate being the one to break bad news. I've gotten a bit better at bringing up hospice with my residents' families when I'm seeing a decline, but it's still hard.

You did well--