Is turning dying patients comfort care or not?

[C0252786]

I work on an acute medical floor and I had a patient who was on comfort care, pretty close to death, and a two week old hip surgical site from a recent fall. There was a debate whether or not to turn the patient on the basis of pain vs risk of skin break down. Would you still turn the patient knowing this would cause more pain or leave the patient be?

[westieluv]

I would give her whatever she had ordered for pain, wait a sufficient amount of time for it to become optimally effective, and then turn her with plenty of assistance and as gently as possible, making sure that the position that she was placed in was comfortable. It does cause brief, acute pain to turn a post-op patient, but skin breakdown itself can be quite painful, and chronically so. Skin care is a big part of comfort care.

[SHGR, MSN, RN, CNS]

Turning doesn't have to mean a big whopping turn. You can reposition gently for instance if the person is on her side, pull part of the pillow out- she would still be on that side but less so- and the pressure points are different. Sort of like the hour hand on a clock. Also consider the discomfort of being in the same position for a really long time. That makes me very uncomfortable, anyone with underlying arthritis would have problems.

Just a couple things to consider. Each person is different. We had a guy on hospice in our unit that refused turns for weeks on end. He was alert and decisional, and turns were very painful for him.

[Esme12, ASN, BSN, RN]

I am slightly annoyed that someone would argue that turning a patient on comfort care should not be done. What are they thinking?

If you have ever had to lie in one position for an extended period of time, not moving or being moved, your question would be answered. You give them something for pain, if you think they are uncomfortable, you reposition them, perform a skin check, give a gentle back rub, freshen sheets/pillow case if necessary (nothing feels better than fresh clean cool after lying on them for hours) and reposition for comfort. Since comfort care patients often have frequent IV pain meds or drips, medicate again as soon as possible if you think they are uncomfortable.

Tell whomever was arguing with you that Comfort care does not mean lack of care.

[Sun0408, ASN, RN]

I could not agree with Esme more. Turning all pts is very important, it is very unnatural to lay in the same spot for hours on end to days. A comfort care only pt requires just as much care as the critical ill... Pre-medicate if you are worried and if the PCP has not ordered pain meds and something for anxiety, please advocate for your pts and get it.

[DroogieRN]

Is it true that sometimes turning hastens death? Heard an old story about a nurse who used to turn pt's onto their left side to help them go faster... 8-0. I understand the physiology of that and so it unnerves me a little bit.

[VivaLasViejas, ASN, RN]

I've seen it happen a number of times. This phenomenon tends to freak out the family and some of the 'greener' staff members, but in a way it's a blessing because the pt. is usually on their side when it happens, and thus any emissions are somewhat better controlled.

[Esme12, ASN, BSN, RN]

Is it true that sometimes turning hastens death? Heard an old story about a nurse who used to turn Pt's onto their left side to help them go faster... 8-0. I understand the physiology of that and so it unnerves me a little bit.

The answer is yes......if they are that close to passing. I have seen this many times. Their heart just can't tolerate the physical activity and pressure on that side items. But it is usually a blessing as they have been near death for days and the family are heartbroken with the long process it sometimes can be. And yes....the "emissions" are better controlled.

[nurseprnRN, BSN, RN]

what part of "comfort" in "comfort care" do they not understand? if the patient is the least bit sentient, ask her what she would like. if she isn't alert enough to answer you, you premedicate the heck out of her anyway, move her gently, and give her some lotion massage, but if she so much as winces i'd apologize, stop, and hold her hand instead.

[twinkletoes53]

Tell whomever was arguing with you that Comfort care does not mean lack of care.

Thank you for that response. Many years ago we had an infant in our NICU who was on comfort care, due to birth defects that were incompatible with life. She was dressed warmly, swaddled, and in a bassinette. Her parents came in to visit, and were very upset b/c she was so cold to touch. Her temp. was 93.6 F. I got an overhead warmer for her, and placed her on a disposable warming blanket.

After her family left, I was chastised by my Charge Nurse. She stated that I was delaying this infant's death by warming her up. I stated that to me 'comfort care' meant that I did everything I could to help this baby's passing be as pain-free as possible. This included caring for her family's needs.

If this infant were my daughter, I would be distraught if a nurse caring for her could do something simple to help her, and me, and refused to do anything because it would "delay her death". I am not God. And at least one of her parent's final memories is of holding their warm, beautiful infant. Not holding a baby who was ice cold to the touch.

[CrufflerJJ, BSN, RN, EMT-P]

Thank you for that response. Many years ago we had an infant in our NICU who was on comfort care, due to birth defects that were incompatible with life. She was dressed warmly, swaddled, and in a bassinette. Her parents came in to visit, and were very upset b/c she was so cold to touch. Her temp. was 93.6 F. I got an overhead warmer for her, and placed her on a disposable warming blanket.

After her family left, I was chastised by my Charge Nurse. She stated that I was delaying this infant's death by warming her up.

Good for you! There's nothing wrong (in my opinion) with delaying death, as long as your pt is kept comfortable to the best of your ability.

[Vespertinas]

I don't agree that we should insist on turning. If a patient's death is a matter of days and moving is very painful, sometimes the patient PREFERS to be left alone. Also, pain medication does not necessarily mask all the pain as much as we'd like to imagine it does. I've heard more than a few times that especially opioid narcotics don't touch the pain as much as they just affect one's reaction to it.

Assuming the patient can make a decision and express it, I believe it would be kind to allow them at least that control over their situation. Who am I to tell a dying patient that I know what is better for them at that moment? If they can't express, I default to turning.