Taking the time to educate the families

[jeannepaul, BSN]

I am an On Call nurse and I just returned from a call where the family stated the patient stopped breathing so they were rubbing her chest to get her to breathe. I was so taken aback at our own hospice nurses who have not taken the time to educate and let them know what to expect. (and what not to do)

I was there 1.5h, and as I was assessing, I would tell them what I was doing and why. I didn't say anything negative in front of the patient and told them I would take them to another room to explain the things I couldn't in front of her. I will not do into detail what I said as that would take a book, but I explained every symptom that could take place, why it happened (I did not have all the answers to that one, and told them so) and actions they could take and what meds to use, I didn't feel as though I did anything special, just my job.

They were so grateful and really understood what was going on with their mother and what could happen next. It is always better for them to say "oh, that's what she was talking about" than "oh my goodness, what is this"

It may take a little longer up front, but it will put their minds at ease and not be so anxious when things arise.

Please teach them not only what may happen, but teach them what to do about it. I know most hospice nurses do this, but some don't as they are too stretched, on time constraints, or whatever, but it makes such a difference for them.

Thanks for listening, I feel better now!!!!!

[AtlantaRN, RN]

"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....

[AtlantaRN, RN]

"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....

[jeannepaul, BSN]

We have that book also and it is great, but as it is given, I don't think our nurses sit them down and talk about it. I don't mind spending time talking to them, I do seem to be a motormouth anyway, but I feel bad that the families have to go through the anxiety before someone talks to them.

I also did case management for 4years before I went to On call. It's been 6yrs now on call and although I would like to be home on the weekends, I like it better. It's like being a grandma, I get to care for them a bit, but then I get to give them back on Monday!!!

[unicorn40d]

I am transitioning from long-term care to hospice nursing right now. I did recently in my ltc position come into a shift where a resident had a sudden change and was actively dying. Luckily I had a slow shift and was able to spend time with the family at bedside, make sure the resident was comfortable, and explain what was happening and what could come next. They were very greatful and she did die on my shift. In my orientation I have witnessed the nurse educating the family and I agree that it is of the utmost importance for holistic care.

[tewdles, RN]

We use a caregiver handbook that has lots of useful information for families in caring for loved ones with declining functional status. The handbook identifies typical problems and outlines suggestions for care. We teach from that at admission and throughout the hospice experience. The staff date and initial the handbook as well as noting the topics of teaching in their notes. We also use the Gone From My Sight booklet but the bulk of our teaching is from our handbook.

In my estimation, education is one of the central elements of hospice nursing, and one of the ways we empower the patients and families to remain independent in their homes.