We in hospice have a lot of educating to do

[duskyjewel]

This exchange took place earlier today on the thread about "choosing a date to die." I think it's clear that those of us who work in hospice need to work harder to educate not only the general public, but also fellow health care workers.

We withdraw fluids and nourishment allowing people to die slowly of dehydration and starvation. If they are alert we often forbid anything by mouth in fear of aspiration so no last meal. Some doctors and nurses are overly cautious of giving pain medications. We do a terminal wean on a ventilator patient to extubation and then try to decide whether the patient will die within the next hour or if they have to be moved to the floor to free up the ICU bed. The patients linger on and on. The family watches the patient gasps and gurgles. The family leaves the bedside stressed and often the patient dies alone. But, as long as we don't call our actions "assisted suicide" we can justify what we put these patients through.

What GrannyRRT described is what hospice does.

[traumaRUs, MSN, APRN]

I do sincerely agree that hospice is a vital part of care for many of our patients. Here are some resources:

Hospice and Palliative Care Nurses Association https://www.hpna.org/Default2.aspx

Hospice and Palliative Care Resource Center Resources | Hospice and Palliative CareCenter

Medscape article on Palliative Care Medscape: Medscape Access

How many years have you been working as a hospice RN?

Palliative care teams really becoming the focus of care in the US. Palliative care is applicable to all chronically ill patients. Palliative care can often become a bridge to hospice when needed.

[TheCommuter, BSN, RN]

Palliative care teams really becoming the focus of care in the US. Palliative care is applicable to all chronically ill patients. Palliative care can often become a bridge to hospice when needed.

I wanted to clarify your salient point. Palliation can be applicable to all chronically ill patients, even those who have not been diagnosed with a terminal illness.

[traumaRUs, MSN, APRN]

Yes indeed. Good point.

I work with ESRD pts and all of them when they are hospitalized (with the exception of hospitalization for transplant) are given palliative care consults. These consults focus on symptom management as well as coordinating their care while hospitalized and then continue to the output environment also.

[duskyjewel]

I'm a hospice CNA, hoping to be a hospice nurse at some point. I have two years of hospice experience now and achieved CHPNA earlier this year. It upsets me to hear the erroneous ideas the general public has about hospice, and it seems from the comment I quoted that many of those ideas dwell comfortably among those working in health care.

[SionainnRN]

This exchange took place earlier today on the thread about "choosing a date to die." I think it's clear that those of us who work in hospice need to work harder to educate not only the general public, but also fellow health care workers.

So other than pulling quotes from the other thread, are you going to educate us? It's customary when complaining about lack of knowledge in a certain subject, to provide some knowledge to help educate the people you're complaining about. What would you like us to know about hospice?

[duskyjewel]

We do NOT withhold fluids or nourishment in hospice. We do NOT forbid anything by mouth. Most hospice care takes place in people's homes, so we couldn't forbid anything even if we wanted to. But even in our inpatient units, if the patient wants to eat or drink, we bring them food and drinks.

I have never met a hospice nurse who was overly cautious in the use of pain medication. If anything that's more of an issue with the families. Our nurses work with patients to find dosages that strike a balance between pain control and alertness and adjust as needed. When the patients get very near the end, I've watched my nurses seek and get orders for pain and anxiety meds and use them to keep people comfortable.

When patients gasp, the nurses treat for SOB. When they gurgle, we reposition, sometimes the nurses use meds or suction to help, but we also educate the families about what's happening and why. We never encourage families to leave the bedside if they want to be there, and if they are stressed we do our best to minimize it. Having a family member die is stressful though, we can't do it perfectly.

In my organization, we try to make sure no one dies alone, the point of assigning CNAs who are willing to serve in that capacity to 11th hour shifts, where we sit with a patient who is actively dying and has no family or friends available to be present.

I have no doubt that the described scenario happens in ICUs all the time. But another poster claimed that that's what we do in hospice, which couldn't be further from the truth.

[Veronica Cheney]

I have worked closely with palliative care patients and their families for several years. What I have noticed is that many nurses that are new to the facility automatically think that the palliative care MD kills patients. However, after some very thorough education they quickly change their minds. Ignorance in our profession is not bliss.

I recently completed a research project regarding this topic. You can find it here, Palliative Care: A Nursing Response.

There is a link on this post to the PDF file version.

I hope this helps.

[traumaRUs, MSN, APRN]

@Veronica - thanks so much for this well thought out research project. Excellent!

[brownbook]

I think this is a great thread, I wish it had more nurses responding.

I have posted this before but a misconception I heard from a unlicensed, but very good, well educated (I thought) care giver was, "we don't want her on hospice....hospice told another patient I care for that the family could not call an ambulance."

Well.....yeah you don't call an ambulance when you or the nurse can tell the patient is dying. Does not mean you cannot call an ambulance if the patient has some type of accident....a bad burn, cut, sprained joint, or broken bone, etc. things relatively easily fixable so the patient can return home.

[ktwlpn, LPN]

That post is FULL of mis-information

[Spidey's mom, ADN, BSN, RN]

We still have a long way to go and sometimes it is personal.

My own mom has dementia and fell numerous times recently - sent to an acute care facility ER and had a CT Scan which found fractures to pelvis, tailbone, hip. The docs say "no surgery" and she's been able to get up and start walking using a walker and standby.

Another family member is her POA and when the doc mentioned hospice, this family member got upset. Their idea of hospice is we swoop in and kill the patient.

duskyjewel - good response above about what we do not do.