What do you do for a dying patient/family

mh356, BSN, RN, EMT-B · Jul 31, 2008

S of M,

We recently had a hospice patient on our unit and I was in a similar situation. Palliative Care had stepped in and made sure the pt was comfortable and adjusted the orders. The pt was on a morphine drip, the Palliative Care MD increased it as needed. I was also concerned about turning but another nurse told me that turning could cause fluid to build up on one side. She said that when we cleaned him up-since he was incontinent, that was probably enough turning. We were in there nearly every two hours to clean him up.

I would also recommend the hospice forum for some recommendations on reading and websites. That was our first hospice patient on our floor and most of the nurses did not know what to do either so I went to my favorite resource-allnurses.com!

I hope that helps :specs:

JunebugRN28 · Aug 1, 2008

I am a fairly new nurse, but we often have hospice/comfort care patients on my floor. In my experiences I try to feel out the family for what will help them best. I have found that many just really want to do whatever is best for their loved one at the time. I explain everything we are doing and why. I also explain what signs I am seeing and/or what to look for as someone becomes closer to death (decreased urine output, mottling, respirations, etc.). We also have some great materials that are very helpful to family members. I usually offer these first and ask if they have any questions, then go from there based on what they want to know. If they seem to want to help, I offer suggestions of what they can do to keep their loved ones comfortable. I remind them that their loved ones may be able to hear them if they would like to talk to them. I always make sure to ask them, "Is there anything I can do for you right now? And Please let us know if you need anything" We try to keep the family comfortable during these times as well, offering coffee, blankets, etc. Allowing the families to talk about memories, how they are feeling, and just being there for them is a great help. Chaplains are also a HUGE help for some families!

In terms of the patient, I watch for signs of pain/discomfort/restlessness/anxiety. Our docs are usually great about ordering a good amount of prn morphine, ativan, etc. I give these as often as the pt needs them. We turn and reposition them as needed, but if the pt looks comfortable and hasn't been, we don't necessarily turn them as frequently as we would most patients. Even if the patients aren't alert I tell them everything I am doing. I just do my best to keep the patient as comfortable as possible and help them die peacefully. Although it can be heart wrenching, I have found that caring for these patients and families can be incredibly rewarding. Helping someone die peacefully and comfortably and being part of this intimate part of someone's life is an honor. The strength and love I have seen from these families is incredible.

Also, I try to remember to take care of myself. Another nurse told me that it is important to grieve the death of a patient. I have found that this is true, especially when caring for a patient several shifts in a row. Obviously I won't grieve for them in the same way as a loved one, but I often have cried after a shift (or in the bathroom!). It is still the end of a life, and that is never something that is easy to deal with.

Hope this helps a little :)

SoundofMusic · Aug 7, 2008

That is very helpful, Junebug. I guess you have the ativan or morphine on hand, make them comfortable, put on some 02 (if they'll let you) and that's about it. I like the suggestion of bringing the family members something to make them comfortable as well.

I guess I'm thinking in my mind there is some major intervention, but I guess there really isn't any other than what has been mentioned. I guess you can suction secretions also if they're having a hard time clearing them?

Does it also depend on what they're dying from? If it's pulmonary related, etc? If it's cancer related, I guess they'd be on an oncology floor anyway -- which I'm not on.

I wish dying were easier.

My little 90 year old grandma, as she was getting insurance and paperwork done ahead of time and heading into her last days said, "Heck, I didn't know dying was so much work!" :rolleyes:

Pediatric Critical Care Columnist · Aug 7, 2008

I wish dying were easier.

My sister-in-law died on July 13 from newly-diagnosed Stage IV lung cancer. Her death, while expected, was also unexpected because she had just been admitted to hospice and was still comfortable, lucid and at peace with her eventual passing. The morning she died, she had been out on the deck watching the sun rise with her sister. She asked the staff if she could have a bath and shampoo, so they helped her with that. (Her sister went to do some laundry.) As they were helping her back into bed to rest afterwards, she just died. I think she close her moment and that she didn't want her family to suffer by drawing it out forever, or by having them witness it. (She wasn't know for being noble, but I could see her doing something like that!)

In my world, when we have a child who is close to death, we leave their background infusions of morphine and midazolam going, if they have them, and we give them either a moderate dose of morphine or fentanyl then allow the parents to hold them. We close out as many of the distractions of the unit as we can and offer them privacy. The nurse may remain in the room but in the background, or may sit outside the door and just wait. Any action that suggests compassionate caring is a good one.