Palative Care Still Raw

[LCinTraining]

Let me preface by saying my dear father in law passed away six months ago. I was highly involved in his Hospice care and remember every detail until the moment I held his head in my hands and he breathed his last breath. A sobering memory, but one I cherish oddly. I've slowly come to grips with things in spite of missing him dearly.

Fastforward, my patient at clinicals had a status change from the last time I had her. She is now officially comfort measures only. She had no meds to give (which makes it hard to practice med pass, but I'm not complaining, because it's not about me). She is actively filling with fluid and her legs are triple the size that they were last time I had her. I basically became concierge, since I couldn't really be a nurse. There were no treatments to be had. As per policy, no vitals, no out of bed unless the patient wants to, no nothing without expressed permission from the patient. As I was told "what she wants, she gets".

Honestly I didn't mind, not because I didn't want to work, but because it was what was best for her. I did find myself reflecting A LOT though. I bathed her and remembered bathing my father in law. I sat with her and remembered my last conversations with him. Many of the decisions in conversation I made, I recognized, at the end of the day, were directly related to MY feelings about my father in law's last days. I feel like emotionally today was easier than the last time I dealt with an end of life patient. I didn't cry for hours this time, like I did with the patient I had at work (just a few tears driving home and a heavy heart). I held it together, and treated her with dignity, but wonder if I did everything I should have as her nurse. I've not been in that role. Just the role of daughter in law or aide.

I've told myself the pain gets easier. It's only been six months. But really, does it?

As a student I feel like to bring up death becomes yet another person waving it in her face. I know her primary nurse has discussed it with her. And yet, I'm a student NURSE. I should be learning how to deal with these discussions. However, my mind says don't make her focus on it yet again. It's a strange argument I have inside my head.

I'm probably rambling now. I may just be using this as a place to place my thoughts as I reflect and remember. I may even cry again later, because I miss him terribly, but I need to figure out how to separate my personal emotions from that of patient care or these situations will eat me alive.

If you got this far thanks for the listen. I'm off to finish my post clinical paperwork now.

[BostonFNP, APRN]

With experience both in in-patient and ambulatory PC and ONC, I can tell you it gets better with time and experience. I wouldn't say it ever gets easier, you just get more comfortable having difficult conversations, and more importantly, listening to the patient and family talk.

With time you are able to walk a line between connecting and empathizing with pts and families while remaining objective, but there are times when you can't. Often I will collaborate with other providers in my group if I feel I am too close to a family.

[LCinTraining]

I honestly don't know how you do it. I mean I appreciate all our HOSPICE nurse did, but my heart would bleed out every time. I guess it goes to say it takes a special person to be able to do it. I'm not being trite either. I just feel like, for me, it would be the hardest field to be involved in. I feel too much.

[BostonFNP, APRN]

You really can't focus on the death or it gets depressing (and we go through waves of losing people at times where this is difficult).

It helps me to think about providing comfort and quality of life when quantity of life is short.

[NightNerd, MSN, RN]

I've been working in hospice for almost two years now, currently as a CNA while I go through nursing school. While it doesn't get easier, you get better at handling it. The first few months of my job, I was super-sensitive. Cried at every little thing, even stuff that never would have bothered me before. It's definitely the kind of job/environment that makes you think and reconsider. There are definitely still patients that touch me more than most, and that can be a very raw experience, but now mostly I just remember how hospice is helping them. If someone knows they are going to die and they want the comfort measures our unit provides, that's exactly what I'm going to do. I find that feeling like I can't do anything else for this person is the worst part of my job; so I always find something I can do to make them more comfortable (or, in some cases, make their families feel more comfortable).

It's something you grow into and become more accustomed to. That being said, I look forward to working in a different setting after I graduate! It is definitely a challenge.

[classicdame, MSN, EdD]

Be proud that you can empathize and sympathize with people who are suffering. That is a great skill in a nurse. As for your pain, see if your insurance covers counseling so you can talk to a professional about coping. I believe as you mature this will become a little easier. Good luck in your studies.

[LCinTraining]

I have lost loved ones before. I know eventually it stops and you can remember them and smile. Most times we are there. I know statistically that doesn't even start until around 8 months. So I'm not being too hard in myself for feeling. However when those moments of pain do come, it feels like it will last forever. I've worked codes and never got them back. I've run EMS with death. The difference with the father in law was I was in the thick of it. Bathing, medicating, holding his head. The sounds, the smells, all of it comes right back at times with certain patients. I THINK I am doing ok. I don't cry in front of the patient and I allow it to push me to take better care of them. But I do second guess myself as to my decisions sometimes. And when the time of care is over, I self reflect...a lot. That is normally when the tears fall. I'm doing better with it today. I think. My mind is speaking louder than my heart, even if it is only a little louder, and telling me that it will get better.

[hodgieRN]

You will find a way to deal with those situations. Everyone handles it differently, but I do it by disconnecting myself emotionally. You do what you have to so you can get the job done. There are times where things get to me, but I make myself be neutral. When I worked in the ER, I only did adult b/c I had a hard time seeing infants that were abused by their parents. If I ever saw a baby with shaken baby syndrome, I would become infuriated. I didn't even want to look at the parent. It was something that set me off, so I liked the fact of working in adult. There are feelings you can't control, but that's what makes us human. Presently, it still affects me when I am doing end of life care for pts with cancer because of my own family experiences. But I've been able to become somewhat numb to it. Personally, I find by being somewhat numb, I can concentrate on helping the pt and the family instead of my own feelings. I used to take my emotions home with me and I would even let out my words of frustration at the first person I saw at the door. It isn't healthy. Now, whatever I experience at the hospital, I leave it at the door. Taking it home won't do anything unless you are using it to become a better nurse. I find that feelings are fixed by time. As it goes by, you will learn to control your feelings and offer strength and support to your patients and families.

[KountryPrincess]

I worked in palliative care for 5 years as an RN OCN. When people used to ask me how I could stand doing it, I would explain it like this: downstairs is labor and delivery. The nurses down there have a very important job. They are bringing people into this world the best way they know how. Up here, we are assisting people out of this world. It is no less special than what goes on downstairs, just different. It is a privlidge to be allowed to be a part of a patient and thier family when it is time to say goodbye. At times, because as was mentioned, physical care for the dying is not usually complex, you are nursing the family more than the patient. I felt special to be allowed to participate in such an important event, and I owed those patiemts and their families the best transition out of this world I could give. It does get easier than when you first do it as a student, but some people do have more of a talent for it than others......just like anything else.

[melizerd, ASN, RN]

If she's open to it you can spend your time with her talking about whatever she likes, giving a backrub, foot massage, baths etc. there is so much you can do and still be her nurse.

Being a nurse isn't about med pass and tests etc. it's about being with the person.

I know I want to be a hospice nurse for this reason. Personal experiences can and will always affect you as a nurse and that's okay too.