Med-Surg Topic of the Week .... The HOSPICE Patient/Family

nursenatalie, ADN, RN · Sep 23, 2004

Our floor is strictly surgical so it is not often that we have a hospice patient but last winter we had a medical overflow COPD patient who became hospice and we didnt transfer as she wasnt expected to make it long. The family came in droves, they would talk loudly, laugh, let the children sleep in the floor...the list goes on. I had the ultimate respect for the situation but it was getting out of hand. I was in charge on the weekend when it seemed that every family member that had not made it before came in, there were at least 20 outside the room which was also a fire exit. I had to go and speak with what seemed to be the oldest son. I explained to him that I didnt want to cause anyone not to see their loved one but that unfortunately we were bound by the rules of the facility. The conversation went over well and the son expressed his desire to take the family member home, we were able to arrange that the next day. The family was actually appreciative that the issue came up because they said the option of going home was not given to them before (I think they truely didnt think there would be time) but we heard the patient lived for 6 more days at home.

RNPATL, DNP, RN · Sep 23, 2004

Yes, it can be a tough situation. I think the balance tat the nurses have to maintain is difficult. We want the patient to be comfortable and have their family in attendance, but there are other patients to consider as well as fire rules. I am not talking about a couple of family members .... you know the scene ....10-15 family members draped all over the hallway, chiar, bags, purses, food, coffee cups .... it can really be a tough management issue.

I think having the patient go home was a great decision and in most cases, it would be nice to have the patient go home and die with their family by their side.

mattsmom81 · Sep 23, 2004

I wish management would take control of this matter and empower nurses to restrict the open visiting...I get sooo many complaints from this type thing, plus concerns over HIPAA violations, privacy issues. Then theres the blocking of essential movement in case of emergency. I've had to ask families to stay out of our patient nourishments, stay off our crashcart and stop using it as a table. Stop their children from running screaming up and down the halls. They get mad when I tell them its a fire dept violation for them to be sleeping all over the floors. They take over empty rooms necessitating a reclean when an admit comes in, and complaining when I ask them to leave. We are too often accused of being unfriendly to family if we try to set ANY limits.

I would push for one free family member meal tray even in hospice...how can your facility afford to feed all these people free?? Perhaps involve the dietary manager in this effort...her budget MUST be feeling this... :uhoh3:

As a hospice daughter, I believe in home hospice care whenever possible, but some families/patients cannot work this out.

In the push to be 'family friendly', once again management has made it the nurses' job to keep everybody happy at all costs...an impossible job.

barefootlady, ADN, RN · Sep 26, 2004

I understand the pain a family feels when a loved one is dying before their eyes and NOTHING will stop that slow slide into death. I always try to treat the family with respect and will break a few rules but for the most part and for my own sanity, rules are rules, 2 visitors at a time, no kids under the age of 14 unattended, no blocking for stairs, hallways, fire exits, no peeking into other rooms or asking questions regarding other patients problems. All visitors not in the room need to be in the designated lobby, they can manage the who gets in now trauma, I will arrange for a coffee pot from the kitchen at about 10 and 3, but no meals unless they talk with the social worker, that is her job, no extra snacks sneaked from other patients trays, no case of soda a day for visitors, and no loud TV or radio. I sound very hardnosed, I know, but you will never know how many times I have been thanked by family members, they appreciated that my job was to take care of their loved one first and I did that to the best of my ability. I would give them support and a few pointers but I kept that professional distance, I am a nurse, NOT a waitress. By the way the bathrooms for all visitors were at the ends of the hall. No in another patients room who might be just as ill.

RGrif · Oct 6, 2004

At my last job, we had a hospice area of 6 beds, so I have had some experience with this. I think the most difficult aspect of hospice is trying to keep both patient and family happy---it is such a difficult time for the family. When I took care of a hospice patient, I would ask family members to leave in order for me to make care of the patient (turn them, mouth/skin care, etc...) I did have times where family members were literally overflowing from the room, but I would usually try to work around them as best I could. I would set up a little schedule with them---for example tell them "I would like to come in at x time to reposition her, etc". I would make sure that they knew what to expect, and I would be honest if I thought the patient might not live through the shift. I made myself approachable in terms of their needs.

It can be a dangerous situation if things get too overcrowded and crazy, however----I will never forget I was working one night and another nurse had the hospice area---One room had about 10 family members in it when the patient passed away---well one of the family members was so upset and started having chest pains/shortness of breath, feel to the floor--- and ended up needed to be sent to the ED where she ended up coding---it was utter confusion trying to get all those people out of the room, and all the furniture, and trying to transfer this patient onto a stretcher to get her out, as you can imagine!