Need to ban a family member from the internet!!! (vent)

Specialties Geriatric

Published

I have now has 4 consecutive (sp?) days from hell! I have an actively dying resident on my unit. She is of a very advanced age with heart problems. It is obvious to all who are caring for her that death is imminent (MD, RN, LPN, CNA, etc); however, one of her family members (the POA) keeps going on-line and coming up with her own diagnoses and tx's! Then, she insists that we follow her wishes.

I just wanted to cry on the way home from work. It has been almost a week that this resident is like this and I probably spent at least 5 hours of my 8 hour shift with her. She is using every accessory muscle to breathe at this point and her lungs are just completely full to the point that she needs suctioning every 15-20 minutes (POA wants fluids even with knowing this!)

And it also doesn't help that there is one nurse at work who keeps giving the family false hope.

I am just SO frustrated! Why is it impossible to let our loved ones die with dignity?

Specializes in acute care and geriatric.

I am sorry that you are going through this, you sound very angry and frustrated, it is hard to care for a person at the end stages of life,

It also sounds like she needs a private duty nurse, you cant possibly be giving quality care to all the rest of your pts if you are 5 hours out of 8 with one.

I would ask the family to pitch in or send her to hospice.

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Specializes in tele, oncology.

I don't really have any solid advice to give to you, but (((hugs))).

I had a patient not long ago, metastatic liver ca, daughter was a real PITA. Told me flat out "I don't care how long you've been taking care of oncology patients, I have THE INTERNET." My reply..."Well, since you're obviously looking at sites which are feeding you misinformation, I would be more than happy to point you in the direction of reputable sites where the content is backed by evidence based practice." I did not make a friend there.

Only allowed me to give him one dose of morphine despite education over THREE HOURS about the dying process and why morphine is one of our first line drugs. "I don't want him to be sedated or get addicted." Hello, he has mere days to live, if not hours, and THAT'S what you're worried about?

His other kids were in the hallway crying b/c they couldn't believe what was going on. I just tried to smile, promised them I would not give up on getting him adequate pain control even if I had to talk till I was blue in the face, and told them that everyone copes with grief differently, maybe this was her way of trying to control what was out of her hands. Her sister looked me in the eyes and said, "No, she's always been a b****, and I'll remember how she treated dad when it's her time." Can you imagine how bad the wake must have been? *shudders* (He ended up dying the shift after mine.)

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Specializes in acute care and geriatric.

If this makes you feel any better, today the doc limited fluids on a pt to 1000 cc a day after receiving blood results, the private duty nurse refused to cooperate and informed the family that we are trying to kill the pt!!!

I had to waste my time and sit her down to find out that what was really bothering her was the risk of constipation, I promised her that I would gladly give an enema if needed but warned her that if she interferes with treatment again she and the pt are OUT!!

I understand that doctors are having it worse - pts who are "overeducated " with all sorts of weird articles from the internet, its amazing how people will beleive anything!!

It all boils down to trust- either you got it or you dont, and if you dont- give the family the option of going elsewhere!!(your Adm. may not agree...)

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Specializes in LTC, Med/Surg, Peds, ICU, Tele.

I've found that this type of DPOA has a misconstrued understanding of what 'power of attorney' means. They seem to think it means that they are all powerful demigods who will be totally and absolutely in charge of every aspect of care, and that all healthcare workers will bow before them in fear and trembling. They believe that their word is the final one in all matters and supersedes any and all medical advise or decisions.

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Has anyone had a chaplain, priest or other appropriate clergy person, social worker, or somebody sit down with the POA and see if they can figure out why she won't let go? Maybe she feels duty bound to do everything possible, maybe she just loves Grandma so much that she can't stand to see her go and doesn't realize that she is probably suffering. Or is she? Is Granny ready to go? Is she conscious and can she participate in making her wishes known at all? Is she suffering, that's what I'd want to know.

Also, why is the doctor giving fluids if it's not in the pt's best interest? Fear of POA suing?

If the POA is really over the top, someone can go to court and apply for guardianship/POA replacement, I should think.

Is there an Ethics committee?

Maybe you can change your assignment?

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Specializes in LTC.
sorry you have to deal with this. i hope she passes in peace.

maybe it would be a good thought on the MD's part to suggest either a private sitter/companion for the patient so that the POA can get some respite if he/she is not interested in hospice services for their loved ones. perhaps he may also mention that drowning in your own secretions is an incredibly uncomfortable way to die.... :(

This is a great suggestion but...wait for it....the POA lives two states away! Why one of the geographically closer family members aren't the POA, I don't know. The MD has explained the dying process and the increased secretions, etc. repeatedly with this family.

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Specializes in LTC.
I am sorry that you are going through this, you sound very angry and frustrated, it is hard to care for a person at the end stages of life,

It also sounds like she needs a private duty nurse, you cant possibly be giving quality care to all the rest of your pts if you are 5 hours out of 8 with one.

I would ask the family to pitch in or send her to hospice.

Yes, I am very frustrated with this whole situation.

I would ask that you not judge my nursing being as you were not there with me physically. I never said how many patients I had to care for or how many nurses there were attending to them. For the record, though, I had 17 patients and there were four nurses during all of this mess (2 LPN's/ 2 RN's).

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Specializes in LTC.
has anyone had a chaplain, priest or other appropriate clergy person, social worker, or somebody sit down with the poa and see if they can figure out why she won't let go?

yes, both a sw and a chaplain have met with the family. the poa is convinced it's "just an infection" and she'll bounce back any day now.

maybe she feels duty bound to do everything possible, maybe she just loves grandma so much that she can't stand to see her go and doesn't realize that she is probably suffering. or is she?

poa was with her for only the first couple of day and then went back home, in another state. no matter how often or how well the nurses and md explain what is happening she just won't accept it.

is granny ready to go? yes

is she conscious and can she participate in making her wishes known at all? is she suffering, that's what i'd want to know.

no, she is not conscious. pupils are fixed. no response to verbal or tactile stimuli. maybe a slight fluttering of eyelids to a sternal rub.

also, why is the doctor giving fluids if it's not in the pt's best interest? fear of poa suing?probably.

if the poa is really over the top, someone can go to court and apply for guardianship/poa replacement, i should think.

is there an ethics committee? i don't think we have one in-house; i work at a very small ltc facility.

maybe you can change your assignment? nope.

and for some reason, when i hit "submit" it says the above post is "too short"???

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Specializes in LTC.

Thanks to all of you who responded and understood that this was me venting more than anything else.

As for an update, my lady is still hanging on. MD direct admitted her to the ICU today b/c the POA called and decided we "weren't being aggressive enough" w/the current treatment regimen. Hopefully, the family will let her go soon.

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Specializes in LTC,Hospice/palliative care,acute care.

O crap-that is terrible...At least you won't have to watch her continue to suffer...Poor soul

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has anyone had a chaplain, priest or other appropriate clergy person, social worker, or somebody sit down with the poa and see if they can figure out why she won't let go?

yes, both a sw and a chaplain have met with the family. the poa is convinced it's "just an infection" and she'll bounce back any day now.

maybe she feels duty bound to do everything possible, maybe she just loves grandma so much that she can't stand to see her go and doesn't realize that she is probably suffering. or is she?

poa was with her for only the first couple of day and then went back home, in another state. no matter how often or how well the nurses and md explain what is happening she just won't accept it.

is granny ready to go? yes

is she conscious and can she participate in making her wishes known at all? is she suffering, that's what i'd want to know.

no, she is not conscious. pupils are fixed. no response to verbal or tactile stimuli. maybe a slight fluttering of eyelids to a sternal rub.

also, why is the doctor giving fluids if it's not in the pt's best interest? fear of poa suing?probably.

if the poa is really over the top, someone can go to court and apply for guardianship/poa replacement, i should think.

is there an ethics committee? i don't think we have one in-house; i work at a very small ltc facility.

maybe you can change your assignment? nope.

and for some reason, when i hit "submit" it says the above post is "too short"???

you received the "too short" message, because you had no post at all......all your responses were within the "quotes".....next time just erase the end quote and see if that works....good luck with this issue (patient) perhaps the adm. should try the legal route.....of course if the patient is lucky the icu nurses will straighten miss know-it-all out

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Specializes in LTC.

morte - thanks for the info on the "too short" route.

My thinking is going something like this: they've admitted her to ICU, since they're wanting aggressive treatment they'll want consults, MD's will come to consult and look at the poor woman and say "nope, not going there", maybe THEN the family will realize that she's ready to go.

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