OMG! My relief staff keeps pushing the "Coming to Jesus" fact..

[SoCalRN1970]

I am kidding a tad. But really, I just got report on my patient that several of my relief staff members are seeing for me on my days off.

My patient is a 53 year old gentleman who was just diagnosed weeks ago with an aggressive cancer. True he is in poor health, but he is 100% alert. His spouse is supportive but has had "the talk" with me about the denial factor of the spouse. The feeling is, if that makes him motivated to be comfortable and enjoy whatever life he has.. so be it. I concur.

I got report by two separate hospice RN's who challenged the patient belief of his health improving.. in fact they both left a very grim report for me and said " I told the patient point blank" that his wound is infected, "I told him it won't get better".

I am in shock... and really sad to hear this garbage from my fellow staff. I will see my patient first before I take this higher up, but who are we to take away whatever hope there is? Yes, this patient has a massive abdominal wound with a wound vac.. but guess what? I have seen those heal.. so we are not god here.

I am very miffed. Input on how to handle this would be most appreciated.

[Bubbles]

I agree totally with you. That is so sad to try to take a person's hope away. Your patient's denial will most likely go away the closer he gets to the end. I would say just be kind and supportive and diplomatic if and when he asks what you think about his prognosis. No need for the other nurses to be so blunt.

[eternalsunshine]

Wow! I am shocked too!! I don't blame you for being miffed! , I think I would be too! Do these two nurses report to you?

I think they perhaps need to do a refresher course on what compassionate nursing is!

I really don't think it is their place to be so blunt anyway, what happened to respecting a patient . Some people cope with denial, and thats fine if that is how they are coping, we are not there to judge, but to support and care.

You are so right re the VACs, I have seen some shocking wounds which have improved incredibly by using the VACs. As you say, they are not God, how do they know that the wound is not going to heal and is going to be infected. Nothing like a bit of positivity!! Poor guy, I am sure that is just what he wanted to hear!!

Maybe you could talk to the two nurses involved and explore why they felt it was necessary to confront the patient in this manner.

I would probably re-visit the patient too to see how he is doing and if the other nurses' comments left any negative effects. And like you say, if hope is all he has, who are they to diminish it

[ErinS, BSN, RN]

I wonder if those nurses are not burnt out. We have had several nurses leave recently, and they were all talking that way and were burnt out. I try to be realistic with my patients about the eventuality, but supportive of current hope. There is a time and place for difficult conversations, and it is not with alert, managed, hopeful patients (in my opinion).

[SurrealMoment]

I see the complex word "hope" used repeatedly, and wish I knew how you nurses mean it. Hope for full recovery of one's former healthy life is one thing yet hope for a wound to heal while aware of one's body's decline or terminal illness is very different. The lay public seems to use hope as a euphemism for "expecting further treatment for recovery", as in, 'don't talk to me doctor about hospice, you are giving up hope' so, I ask them, hope of what? Perpetual life? Recovery from Stage IV liver cancer? Miracle cures? Sequential clinical trials, further treatments, new chemo, radiation? The truth may be that hope can and does change from wishing for a cure, to hoping for one peaceful day of controlled symptoms and conscious contact with caretakers or loved ones, and then, maybe another... Hope is about anticipation of many complex things...and spiritual care is what I gently suggest to my patients when I encounter strong death fear/ denial of terminal status. If they don't accept the chaplain, then I try to engage about hope for....

[heron, ASN, RN]

Did the relief nurses know about how you were approaching this with him ... or were they just blatantly refusing to follow your plan?

IMHO, if the problem was that they didn't know the background/plan, then seems like the solution involves improving communication.

Has this come up in IDG?

[leslie :-D]

i know of many hospice nurses, who staunchly believe in attempting for the pt to face his/her death.

they don't believe in sugar-coating or minimizing the gravity of their illness.

it sounds like they maybe they didn't read poc...

although i too, have read poc and still dismissed it.

but yeah, keep in mind that everyone has different approaches.

leslie

[Whispera, MSN, RN]

I strongly believe that most dying patients know they're dying. For someone to point it out to them, and insist they "face it" seems kinda pushy to me.