Patient care question

[LadybirdRN]

I'm a Med/surg tele nurse and recently had a patient who is on hospice. He was admitted for failure to thrive and having a G tube placed. Once he was at goal for the feeds he was going back to his home. He was extremely emaciated and had advanced cancer with mets. I'm not an expert in this area but I doubt he'll be alive a month from now. He needed to be turned Q2 hours, hated wearing SCD's and was uncomfortable with his heals floated. I turned him, gently and not too much, but left the SCD's off and let him keep his heels flat on the bed. I just considered it a refusal. He was oriented and capable of making decisions. He was only in the hospital overnight so I didn't really urge him to comply; I was primarily focused on keeping him comfortable; frequent pain assessments, bringing warm blankets, oral care, ice chips etc. But it made me wonder, what is the general practice with very advanced ill hospice patients? If patients don't feel well and just want to sleep, do you leave them alone or wake them up for care? Do you let them just make informed decisions that are detrimental to their health and leave it at that? A pressure ulcer would just be one more cause of pain and cause further deterioration of the health. It's also below the standard of care for nurses. How do you approach these issues, such as turning, DVT prophylaxis, leaving urinary catheters in so they don't have to get up to urinate, etc? I'm just curious and I'd also like to know in the event I ever care for a patient who will be admitted for longer than just a day or two. Thanks.

[LadybirdRN]

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[LadybirdRN]

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[LadybirdRN]

You think. Do you know what the patient thinks?

No I don't know what he thinks. That's why I said "I think". Is this a courtroom or something? I've given facts, observations and opinions, doing my best to figure something out that will lead me to best care for any similar patient in the future. I'm KNOW that I'm not trying to offend anyone over this. But thanks for your extremely important input on this matter.

[LadybirdRN]

I re-read my initial post. I didn't mean to make it sound like an order. I meant " you might want to consider editing your post" Sorry didn't mean it it to come across that way. You're right no one would probably be able to figure it out. I'm probably over paranoid. Again I'm sorry.

Its ok, I appreciate the sentiment, no worries.

[Anna Flaxis, BSN, RN]

I don't mean to make you feel interrogated with my direct, concise approach. I'm simply trying to point out that sometimes, we impose our own lens over a patient situation, when we should be meeting the patient where they are at. You cannot do that if you don't know where they are at. For you, the situation looks as you've described. But we do not know the situation from the patient's point of view. From my experience working with Vietnamese people with terminal illness, your story does not surprise me in the least. This man most likely views his situation in a way completely different than you do.

If you like to read, I cannot recommend "The Spirit Catches You and You Fall Down" highly enough. This true story illuminates how cultural differences impact the delivery of health care, and how critical cultural competence can be.

With a better understanding of this person's background, culture, beliefs, and attitudes, you might have had a completely different experience caring for him.

[RNKPCE]

If you like to read, I cannot recommend "The Spirit Catches You and You Fall Down" highly enough. This true story illuminates how cultural differences impact the delivery of health care, and how critical cultural competence can be.

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I read this book in the last 6 months. It should be read by all healthcare providers. It was an assigned reading for a nursing student I know and so glad it was shared with me.

[graceelinor01]

Old hospice nurse here, artificial feeding used to be considered aggressive treatment but it has been designated now as palliative measure for hospice patients. As a hospice nurse I would educate the pt/family regarding the potential detrimental outcomes. Medicare will pay for tube fdgs and allow the pt to remain in hospice.

If I elect the Medicare hospice benefit, will I be prohibited from using a feeding tube?

The Medicare statute and regulations do not prohibit Medicare coverage of hospice care for beneficiaries with feeding tubes, nor do they prohibit the use of feeding tubes for people who are receiving Medicare hospice coverage. The pertinent legal question for Medicare coverage of all hospice care is whether or not the beneficiary has a life expectancy of six months or less if the terminal illness runs its normal course. Thus whether or not Medicare will cover hospice care for a terminally ill beneficiary with a feeding tube depends on the facts of each case and specifically how use of the feeding tube will contribute to the beneficiary's individualized palliative care plan.

Hospice - Hospice and Feeding Tubes

Artificial nutrition and hydration, also called ANH or tube feeding, may be offered to someone who is unable to swallow food and liquids without choking. Hospice Foundation Of America - Home

[nurseontheway]

Wow, I can certainly see where that would be challenging. It sounds like some families are really in denial.