New nurse in Rehab./Ltc/Hospice

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i have been a nurse for four months and am trying to understand my role as a nurse in a facility with hospice patients. my hospice patients have company's that come out to bath them and nurses to evaluate them twice a week.my patient had a change of condition which i called and reported to the hospice company. she has a hx of copd and her o2 dropped to 73% on 3L of O2. What is my role in her care since she is DNR and on hospice. i am struggling with providing appropriate care without risking that i am not providing enough care.

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Have you discussed this with the Hospice Nurse? I worked in hospice and I answered these questions all the time, we even did work shops in facilities to train the staff. We were always happy to guide staff through the process.

Its a hard question to answer because what you do varies patient to patient. Is she a strict DNR? If it dropped to 73% in general you don't do much, sit her up if she isn't already (or put pillows under her back to get her in semi fowlers- this eases breathing), give liquid morphine, and just watch her. If you aren't sure call the hospice.

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yes strict DNR.she is on scheduled ativan , duoneb, morphine and typically a talkative woman.i spoke with the hospice nurse and she just said she has a right to remove her oxygen if she wont wear it at times.also if she seems to be in distress give her some of her prn to assist with the resp.distress.i am a very black and white person.i have a hard time if my role with her care is not clearly spelled out as i am afraid of being considered incompetent. hospice nurse said also to report any changes in her condition which is why i called her out. do you know of any material i can read to feel more confident in what interventions i should and should not do?

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I never used a book specifically but there are tons, maybe just start reading about palliative care and researching youtube videos for nurses on it?

I can however point you to this site: The 30 minutes before and after death | Dr. Marilyn S-Stoner

Email Dr. Stoner and she will probably be able to point you to an excellent reference. She is amazing and a nursing school teacher.

Essentially its all about comfort, will the intervention make the patient more comfortable? Yes? Do it. When in doubt, call hospice.

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