Survey: Do you feel that your facility allows for compassionate care for the dying?

Jay-Jay, RN · Jul 16, 2000

I work as a community nurse, doing home visits, and I have a very heavy palliative caseload. Our company uses a nurse manager model of care, so the same nurse is going in to see the patient 90% of the time. You get to know the patient and family very well, and are in a position to give them a great deal of compassionate support. Given a choice, most people would prefer to die at home, surrounded by family and friends, instead of in a hospital.

Now, this bring me to the BIG problem with all this. The government does not provide enough support to allow patients to do this. The number of hours allowed per week for in-home care, either by a nurse or a health care aide, is limited. Anything over and above a certain maximum must come out of the patient's pocket. The family/ significant other is put in an awkward position, struggling to make sure someone is always there for the dying person, as they grow weaker and less able to care for themselves. I have heard of people losing their jobs because they stayed home to care for a dying family member. Often, the patient winds up dying in hospital, because the home care system just won't provide the round-the-clock care they need.

Everyone knows it's cheaper to care for people at home...why isn't the government willing to make the funds available??

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Nancy1 · Jul 18, 2000

Hi, I work in a small nonprofit LTC facility. We are fortunate to be able to offer compassionate care for our dying residents. It is part of our philosophy. We are a Lifecare facility and the resident have lived in our apartments until they have become too frail then they move to my unit for skilled care. There have been times when our residents do not want to go to the hospital, even if it means it is the begining of the individuals dying process. They chose to stay and have the staff they know take care of them. the families think this is wonderful. We have apartment residents who will sit with someone if there is no "blood" family.

I feel fortunate to be able to work where I do. NA

bunky, BSN, RN · Jul 20, 2000

Gee you mean some places actually acknowledge that someone is going to die?! NO there is not adequate care for that! We are swamped by caring for the patients who need us, and voice it. I think this is disgusting, but many times the dying are not given a great deal of nursing attention. Prioritization of tasks with too many tasks for anyone to complete means that the dying become lower priority if they have family at the bedside. Sad and sick but true.

leslie :-D · Aug 2, 2000

Nancy,

I, too, work in a ltc facility that encourages nsg. to be extremely involved with the dying and the dying process. That IS the priority here and unless someone is acutely ill, nsg. will let everything else wait whether corporate likes it or not. I'm not saying we have the luxury of extended, bedside sessions, but our devotion towards these pts. is heartfelt and their needs and their families' needs are the priority. It is wonderfully holistic and I am fortunate enough to work with a group of nurses who genuinely will prioritize what is needed and whether our facility vindicated us or not, it would not stop us from trying to ensure a most peaceful and dignified passing.

normarae · Aug 14, 2000

Unfortunately the many docs are not informed about the Advance directives and the hospital personnel including many RNS/LPNs do not quite understand the need for this document. Then once in a while you will get a doc who gives the patient the pain medication for his needs and we can care for their palliative needs while letting them go in peace. But I have found it to be rare. Hospice is the best organization but I'm not up to date regarding the insurance and medicare payment of these facilities. They should be helped because as the other nurse said - to be able to die at home with experienced help is the best way to go. It takes a lot of time to educate the public and family regarding these issues and as busy as nurses are these days you don't have the time for these conversations in hospital setting.

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Ajsand42 · Aug 17, 2000

Where I work death/dying carries a large price tagg... the patients/family pay for test and treatment that brings no effective outcome... the prognoisi is still the same... upon the demise of a patient there is a cramble for the room/bed for the next client... the families are not given ample time to digest the passing of a loved one before administrator are calculating the cost lost while a family is siting in the room with the deceased.

No I dont think this facility has compassion for death/dying of their clients.

Originally posted by bshort:
This months survey question:

Do you feel that your facility allows for compassionate care for the dying?

We encourage your comments and discussion on this question. To post your comments, just click on the "Post Reply" button.

Also, please take a minute and answer our survey question at the bottom of our homepage at: https://allnurses.com/

Thanks

duckie · Feb 15, 2001

At the LTC facility I work at, I feel we have a wonderful support system for patients that are nearing death. BUT it doesn't stop with the patient. If we have a resident that is dying, every member of the unit cares for this person. All staff members take turns and every 15 minutes someone enters their room, to give oral care or fluids is tolerated, position changes at least hourly. Our doctors are wonderful to give the necessary orders to keep our residents as pain free as possible. We have ministers always on call that live within the facility so they are more than happy to come and sit with the resident, pray with them and their family and also, to pray with the staff. All meals are provided to the families free when they want to stay, even those with special diets and health concerns. We keep rotating snacks and beverages available, blankets and pillows when needed and the staff also tries to be their as often as we can to give them support. We always place music in their rooms to comfort them and each staff member speaks to the resident as though they were totally alert at all times, explaining everything we are doing. We encourage our family members to stay if they can but if they cannot, we assure them that their loved one will be constantly monitored and all of their needs are provided for, at priority. I am proud of the care or residents recieve, during this time especially. I am a very "spiritually concerned" person, so I call upon our ministers frequently and they are wonderful. We have a great team and all of the staff goes above and beyond what many would expect.

Zee_RN, BSN, RN · Feb 15, 2001

To tell the truth, I don't think my facility (community hospital) has any real consistency on this issue. It all depends on the nurse caring for the patient and the 'bed status' of the hospital. If a patient in ICU has a status change and they decide to make the patient a "no extraordinary measures" sometimes that patient is hustled out of ICU and onto an understaffed Med-surg floor. Other times they will stay in ICU until they die where staffing is (somewhat) better. And then it depends on the nurse's attitude...I happen to enjoy 'death & dying' nursing and am thinking of hospice nursing so I really throw myself into their care & family involvement. Others may see the NEM pt. as a 'write-off.'

Of course, as mentioned in earlier posts, issues with death & dying only come up when we actually ALLOW some poor soul to pass on to the other world.

Stargazer · Feb 15, 2001

Some of the docs I have worked with in ICU seem to have a real problem with death and dying and in particular with ordering sufficient pain meds in relation to. One doc I know WILL NOT under any circumstances order an MS drip (many of his pts are vent-dependent and end-stage)--in fact, he was heard shouting at a floor nurse who wanted to put a DNR pt on an MS gtt that "she was trying to kill [the pt]"--but he will order Dilaudid suppositores q4-6hrs. Guh? Wha? Another doc, the pt's GP, came in after we instituted "comfort measures only" and questioned my giving the pt MS. "It says here 'prn for discomfort'. How do you know she's uncomfortable if she's unresponsive?" Um, because every single muscle in her body is straining to take the next breath? And the next?

Until docs (and some nurses)stop equating compassionate end-stage pain management with euthanasia, we will continue to have dying pts suffer needlessly. Duckie, your care facility sounds wonderfully progressive.