It's Wrong! (A night shift perspective)

Specialties Geriatric

Published

What does it mean when we wake up a sleeping, elderly, demented woman at 0300 in order to place a catheter in her bladder for a UA? When the woman is yelling and can't possibly understand what is going on or why? When in reality she is dying anyway? What is the point of waking people up at 0600 in order to give them a medication such as Prilosec or Synthroid (Tylenol?) - then telling them to "go back to sleep"? (This is done because pharmacy recommends med given at least one hour prior to eating - eating is done at 0700 for the convenience of the kitchen staff.) Where is the sense in placing a frail, 90 year old in an uncomfortable twin sized bed with a plastic covered mattress, in a room with three other people in the same condition? How enjoyable is life when you are hooked up to a feeding tube and cannot taste food or lie flat to sleep because it will kill you? Why must we send a person who is peacefully dying to the ER to undergo some more torture before they finally pass? Why, why why? Where is the gentleness?

The families are not present to see these things - they want "everything done" for their residents - everything except for comfort and dignity and peace. The "corporation" and management only care about what is done on paper, how it will look to the "state", and how many dollars are coming in and also how they can cut staff to the bone to decrease costs and increase their own bonuses. The doctors and nurses must go along with the program in order to not be sued.

I've worked in long term care a long, long time and there is nothing that is right about it and it is all so wrong! I am obviously going crazy at this point and it is obviously time to retire from this madness. Tell me, geriatric nurses, how do you endure?

Specializes in Med/Surg, Academics.

They do it because they are afraid that if they don't, they've caused a loved one's death.

I know that because of a heated discussion with my husband regarding his mother, who is 86 years old, is a tiny little thing, has Alzheimer's, doesn't recognize anyone, has forgotten how to speak English, and speaks gibberish in her native tongue (according to my husband who also speaks it).

My husband is an only child. We are both listed on the DPOA documents--he's primary DPOA, and I am the contingent DPOA. I handle everything for her. One time, the nursing home called to confirm her advance directives. I confirmed that she was a DNR, and I told my husband about the conversation. (We had had the conversation with her PCP when she was first put in the nursing home, but I guess it didn't stick.)

He was upset. I told him the most likely outcome of the nursing staff resuscitating her if her heart stopped or her breathing stopped--her ribs would be broken, a tube would be stuck down her throat, and THEN we would have to make the decision to remove her from life support. If we didn't remove her from life support and she "recovered," she would have the pain associated with broken ribs for a time, and she would most likely be bedbound for the rest of her life, need a tube for feeding, and she would suffer from recurrent aspiration pneumonia because she probably wouldn't even be able to handle her own secretions. I've seen it, over and over and over again."

He said, "So we just let her die?!?!?!" I responded, "If it came to that, her body would decide to die, but WE would decide to keep her body alive to suffer pain and discomfort." She remained a DNR.

Through that conversation, the reasons why families opt for futile care became clear to me. They feel like they are causing a loved one's death by not doing everything possible.

" Much easier for them-try undressing and fighting to put a LOL back in bed "

a LOL???? please don't be demeaning...she's not a LOL...she's a grandmom or a mom or a sister or a friend

I'm sorry but I don't see how LOL is demeaning. It's another way to refer to grandmom. Now it would be different if she was called an old fart. Or walked up to her and called her an little old lady :yes:

(And for all you very sensitive people out there Im not calling the LOL an old fart, IJS!)

seems to me you would be opening yourself up to a sexual assault charge....

Our UA's are collected on 11 to 7 because the lab picks them up at 6am and they need to be as fresh as possible. Also, the resident is usually already in bed. Much easier for them-try undressing and fighting to put a LOL back in bed when she is up and good to go for the day.It's as much of an assault during the day.If you are fast and have the proper help you can get in and out before they are all the way awake.
Specializes in Critical Care, Med-Surg, Psych, Geri, LTC, Tele,.

One of my pet peeves I didn't see mentioned yet is when the family won't allow the hospice pt, who is actively dying to receive pain meds. This bothers me so much! You can see the distress in the Pts labored breathing and restlessness.

Give them some pain relief!

Specializes in Forensic Psych.

I struggled when I first entered the hospital setting for these exact reasons. I was downright haunted by the way we seemed to selfishly be keeping people alive when there was no positive ending in sight - as if we think we can cure old age.

When I participated in my first code in nursing school, it was on an elderly woman from a nursing home who was 96, I believe. We worked on her for over an hour even though there was no real hope , and I felt so much guilt that those were her last moments on earth, not peaceful moments with her loved ones.

When she was pronounced and my instructors and peers heard about it later, they all expected me to be torn up by my first experience with death. I was a little sad that she went in the way that she did, but, on the other hand, who knows what quality of life she was leaving behind?

Specializes in LTC.

Sixty seven.....You are SPOT ON with your post. :yes:

One of my pet peeves I didn't see mentioned yet is when the family won't allow the hospice pt, who is actively dying to receive pain meds. This bothers me so much! You can see the distress in the Pts labored breathing and restlessness.

Give them some pain relief!

Oh yeah.... That's one of my pet peeves as well.

Elderly patients come in and the family say things like "We don't want Mom to have any narcotics because it makes her 'loopy'."

So, you don't want your mom - who has Stage 4 terminal cancer - to have adequate pain meds because she gets "loopy"?

That's when you wish people could be arrested for public stupidity...

I struggled when I first entered the hospital setting for these exact reasons. I was downright haunted by the way we seemed to selfishly be keeping people alive when there was no positive ending in sight - as if we think we can cure old age.

When I participated in my first code in nursing school, it was on an elderly woman from a nursing home who was 96, I believe. We worked on her for over an hour even though there was no real hope , and I felt so much guilt that those were her last moments on earth, not peaceful moments with her loved ones.

When she was pronounced and my instructors and peers heard about it later, they all expected me to be torn up by my first experience with death. I was a little sad that she went in the way that she did, but, on the other hand, who knows what quality of life she was leaving behind?

I hear ya. Some may disagree, but in the case of a 96 yr. Old, that's what a 'slow/show code is for'. I mean, come on.

Oh yeah.... That's one of my pet peeves as well.

Elderly patients come in and the family say things like "We don't want Mom to have any narcotics because it makes her 'loopy'."

So, you don't want your mom - who has Stage 4 terminal cancer - to have adequate pain meds because she gets "loopy"?

That's when you wish people could be arrested for public stupidity...

I had one crazy family member DEMAND to see me right in the thick of my HS SNF med pass just to ask if her 80something mother should really be getting norco for pain, because she read on the internet that can cause people to bee loopy, and mother was slurring her words @ xs. . Mother had had a TIA, mind you. I dropped what I was doing, assesed a 7/10 pain. Me,: 'ok, I have a pain medication I can give you. Would you like that?' "Yes." 'Ok.'

Specializes in Med Surg, Home Health.

Side note: as a person with low thyroid hormone which Synthroid replaces, I wake myself up one hour early to take that med even after working a 14 hour day the day before and heading in to another one. Food drastically decreases that med's effectiveness, and life with low thyroid hormone = feeling like a cranky, depressed, slug with mono. If a patient refuses to be woken up in time to take the meds inactivated by food AND they're mentally competent to make their own decisions, I'll respect that....and inform their doctor, who might want to know.

LTC staffing & timing often makes "extra" med passes such as those before meals hard on everyone, residents and staff alike.

Side note: as a person with low thyroid hormone which Synthroid replaces, I wake myself up one hour early to take that med even after working a 14 hour day the day before and heading in to another one. Food drastically decreases that med's effectiveness, and life with low thyroid hormone = feeling like a cranky, depressed, slug with mono. If a patient refuses to be woken up in time to take the meds inactivated by food AND they're mentally competent to make their own decisions, I'll respect that....and inform their doctor, who might want to know.

LTC staffing & timing often makes "extra" med passes such as those before meals hard on everyone, residents and staff alike.

I understand that a low thyroid resident needs Synthroid, but why not give it to them at HS? That's usually well after dinner, AND they wouldn't have to be woken up early just to get 1 pill.

Specializes in LTC,Hospice/palliative care,acute care.
I understand that a low thyroid resident needs Synthroid, but why not give it to them at HS? That's usually well after dinner, AND they wouldn't have to be woken up early just to get 1 pill.

There are regulations in LTC regarding the timing of meals and snacks and extra fluids (especially on a dementia unit) Finding an empty stomach can be problematic, this is why it is so important to look at the individual resident. We do our best to educate the family and cajole the resident into accepting the med at the optimal time and if that fails we care plan and document out the wazoo (think "War and Peace") Some family members are realistic-they will opt for palliative care rather then see their 97 yr old confused and blind mother tormented with a pill at 6am

+ Add a Comment