lykeen

Thank you! I'm glad I wasn't the only one who thought my words were a form of encouragement as opposed to an attack. To the OP, I really do hope you find whatever it is you need on this forum. We are not trying to "abuse" you, but we'd like to help in any way we can. Therapy/counseling does sound like the best answer at this point.

It's best not to focus on your personal life with patients. You are there to take care of them; keep the focus on them!

Absolutely true! All nurses have had to answer this question at one time or another, now you're in the hot seat! Good luck!

This is very good advice. Remember, to stay organized and keep yourself focused on the task at hand. If you are freaked out about HIPAA all the time, there is no way you can effectively care for your patient.

I agree with the other 2 posters. This doesn't sound like it's necessarily the jobs you are taking. Maybe you just need a reevaluation of your career and goals, and I mean that in the kindest of ways. Does your current employer offer an EAP (employee assistance program)? These programs usually offer counseling services (i.e. therapist) and they are confidential (in other words, the information gleaned does not go back to your employer). Good luck!

Congrats to both of you!

Our hospice did admit a patient on a ventilator. However, there was a continual re-evaluation of the goals of care, and eventually there was a consensus among the patient and the family to discontinue the ventilator. I think in these instances, the importance of the IDT and communication is paramount.

Sounds like you are dealing with compassion fatigue, so make sure you are looking out for yourself! As far as the patient/family situation goes, continue to teach and document the education provided. I agree with the other posters in that a visit from the attending or hospice physician may be in order. Sometimes, people will much more readily take the same information if it's given to them from a physician. Also use your social work and chaplain resources for backup, and make sure you are all on the same page. And just remember, although it's easy for us as clinicians to see the outcome, sometimes families just cannot face the reality of a situation until they absolutely have to.

I don't have a similar story, but that is definitely interesting... Sometimes it's not the clinical interventions that make all the difference.

Yes, definitely funny! In all our seriousness with hospice nursing, we definitely needed that! :)

I also agree with the previous 2 posters. You did the right thing in treating her as if she were in pain. It was just as important to keep the family calm as it was the patient.

I wholeheartedly agree! There is a reason they are called 'amendments'!

I'm a bit confused, as are many of the other commenters here. This does not appear to be a MAR error. If you had given the wrong med, I could see your point. But I tend to agree with CollenRN2B, this was false documentation. You signed out a med, documenting that you actually gave it when you had not. You clearly state that you planned to go back and change that documentation. I'm not placing blame or guilt, but this seems to be a case of not following basic nursing practice or your facility/company's documentation guidelines. Also, you knew you had done this, and went ahead with the other activities of your day. You probably should have at least contacted your immediate supervisor (not the CNA) with your issues and asked for direction. Unfortunately, based on what you have said, you seem to be the party at fault here; not the company.

I completely agree with your interventions during your shift. In hospice care, patient comfort is of the utmost importance. It appears that your dayshift counterpart does not quite understand this concept, and I can understand that, since I came from a cardiac ICU background and went into hospice care. It can be difficult to move away from the routine nursing care that has been drilled into us since nursing school (i.e. turn q2h, etc). Unfortunately, it would have been much better for this patient if he could have been moved to a hospice/palliative care unit or facility earlier to prevent these problems. Many times when these patients remain in ICU, outcomes are not good when it comes to pain control and comfort.

I tend to agree with the comments of the other posters. You should check on protocol first; I would be extremely surprised if your hospital/unit does not have one already in place. Otherwise, call the physician just to cover your own behind. There are standard parameters, but you don't want to do anything that might come back to haunt you later!