"Gone from my sight" is standard issue in our admission packet. Our case managers take the time to go through this book on admission, admissions usually take 4 hours; but when the symptoms start happening, the families are at a loss. I too am a on call nurse and am amazed at how each family deals with the changes. Pretty much if I'm calm, they are calm. I tell families i've been a nurse for 16 yrs, I don't endorse ivf at end of life, and patients with peg tubes, well, its hard for famlies because they have been used to giving nutrition because that will make them better? I liken the stomach to a big balloon.....we can pump the nutrition in, but if their body isn't using it, patient will start coughing and that balloon will lose its contents up the airway..... I was a case manager before i was an on call nurse---the case managers are sooooooo freaking busy, i HAD to go to on call for my sanity. The Idt meetings every 2 weeks, the incessant calls from the office, i just couldn't take it anymore. A bad weekend on call is light years better than a good week as a case manager. Im sorry you had to spend so much time at one location and the family didn't seem to have a clue what was going on-at a good death, most folks just slow down and fall asleep, but how often does that really happen-maybe 10% of the time? usually there are secretions, and families don't know what to do, I show them its ok to log roll them to one side with a chuk under their cheek to catch secretions (i don't like to use suction because it causes more secretions). I show them its ok to touch the patient, it won't hurt them, and to talk to them even when they are not responding, they still can hear. Kudos for a job well done from another on call nurse....