how to speak to pt regarding prognosis

[fusster]

Hell, I am a new nurse (been working about 5 months). A couple of days ago I had a patient who was end stage COPD. She had been off the ventilator for about 4 days and was on BIPAP when I received her on our cardiac step-down unit (she was also afib with RVR).

I'm guessing she knew her prognosis was poor. She kept asking me if she would ever get off of the BIPAP, and all I could think of to say was that nobody knows, she has had some improvements, but her lungs are bad and she is very sick.

She had guilt about being a smoker, saying that she wished she had never started, but I did my best to comfort her by reassuring her that she didn't know how bad smoking was when she had started, and that there was absolutely no reason to blame herself.

Then she finally broke down crying and told me that she just didn't know what to do. She told me about her breast cancer in the past (15-20 years before) an how she had gotten the diagnosis and treatment (including mastectomy) without even telling anyone, without ever crying, but that she could not take this. She didn't believe she would ever get off the BIPAP, and she hated how she had no control and couldn't breathe on her own. I told her to think about what her wishes would be at this point, and to let her doctor know if her wishes were to change (she was a full code).

I guess my question is, how do I speak to a patient about their prognosis, and where do I draw the line when talking to them about their prognosis (since this is really more of the doctor's territory in the acute care setting)? What do I tell patients in this position? What is my responsibility to this patient? I believe this patient should be hospice, but I just don't have the experience to really know. Nursing school certainly didn't prepare me very well for this!

[leslie :-D]

it is not up to you to do this.

the md is supposed to.

once said conversation has taken place, then you can expound on what was discussed betw pt/md.

just be an active listener, carefully assessing all her fears/concerns.

best of everything.

leslie

[nurselearner]

Do you have a palliative care team at your facility? Our hospital does and any one can order a palliative care consult - it is not just for "hospice" but also for symptom management and decision making. Are her family inviolved? If so- they may be able to talk with Dr with her permission.

It's a difficult situation. Frequently DR's don't want to open these doors and have a frank discussion.

[Sabby_NC]

it is not up to you to do this.

the md is supposed to.

once said conversation has taken place, then you can expound on what was discussed betw pt/md.

just be an active listener, carefully assessing all her fears/concerns.

best of everything.

leslie

Totally agree. Being a good listener and not saying anything, in some instances, is the best you can do.

Sounds like you said all you needed too and I am thankful you gave her great information about sorting out her wishes and informing the Doctor of these. Good for you :)