garbsa13

Hey! Great questions! My name is Andrea and I have been a certified hospice nurse for 9 years and prior to that I worked in ICU/CCU. The situation you describe is something we see very often. When a loved one is focused on curative treatment rather than palliative/hospice support with the focus on comfort and quality of life; it generally means several things; there are issues surrounding the "denial" whether they be family issues or personal issues for the loved one making the decision; support issues of the decision maker not wanting to lose their loved one;not understanding what hospice is and what hospice it not. If the patient is on a hospice service then I would recommend, as others have suggested, the hospice team meet to discuss what the MSW and Chaplain suspect is the block and create a team plan to address this. That being said; there are some people, no matter what information you provide or how skillfully and compassionately you provide that information, people will still refuse hospice for their loved one and "fight" until the last breath. As nurses who know the power of support that hospice can bring, it is very hard to accept we "can't get through" to some people. A gentle reminder, our role is not to force, push or influence our patients and family's to make the decision we think is best for them but, rather, to provide as much information and support to meet the patient and family where they are in this moment in time to allow them to make the decision that is right for them. As a nurse, this is the hardest thing I have to come to terms with and, no matter how many times it happens, every time it happens, it always feels like the first time to me. I hope this helps! THANK YOU TO ALL OF YOU FOR EVERYTHING YOU DO EVERYDAY!

Hi cyc0sys, I can offer you my experiences as a hospice nurse for 5.5 years and prior to that ICU. In the medical profession, we all want to treat, fix and cure. I am in complete agreement with that as long as several things are met; the patient, family if the patient does not have capacity, understand all options and choose a course of treatment based on information of ALL choices. You talk about your patient, in long term care, with multiple comorbidies, not sure how old the patient is but is sounds like older, who came to your facility to rehab a recent hip fx, developed DVT and verbalized she didn't want to continue living. That is the gift this patient gave to you and to her family;she made her wishes known, she no longer wanted to continue with the treatments and wanted to experience a peaceful death. I say this is a gift because so often, when my team and I are taking care of our hospice patients, the patient has not made their wishes for end of life known and this presents a difficult decision for some families. Because this patient was able to verbalize her wish, we are now able to provide the kind of care she wants. The main article talked about the difference between palliative care and hospice care. The goal of hospice is to provide the best quality of life everyday for how ever many days someone has to live and support the patient and family with a peaceful death. The quality of life peace is supported by symptom management with medications but also with quality time like arranging for a last look at the beach, or one patient I recall on a pureed diet with thickened liquids only wanted to have coffee and a donut with her daughter as they had so many times before; this was her wish so we made it happen for her. She passed away peacefully not long after. So you see, hospice is not just about caring for the dying, it is about how the dying want to be cared for. We are all going do die, the question is, how will that happen. Our goal is always a peaceful death spiritually, physically and emotionally not only for our patient but for the family as well. I hope this sheds some light on the very important and passionate support my hospice team and I provide everyday. It is difficult every day, sometimes, VERY difficult but the most rewarding and blessed honor to have, to be at someone's bedside when they die, a true privilege every day.