I think what we have here is a failure to communicate
So, I work as a nurse in Long Term Care. It's not exactly fun, but it pays the bills. I also work 2nd shift, which sucks donkey dongs, especially when you have 3 kids, but what can you do?
At my facility (ok, Nursing Home) our main doctor is pretty realistic. She doesn't often order aggressive treatment and she knows when a person has had enough. She's pretty cool, in my opinion.
With that in mind, we have a lady who was recently admitted to Hospice. She's still on the skilled floor, we still give her her meds and sometimes do her treatment. She has gangrene of the left foot with four toes involved. It's starting to spread up into her ankle. Her antibiotics were stopped in the beginning of October, when she went on Hospice. At that time she got a new order for a Fentanyl patch and her Oxycodone was increased to 2.5 mg at 8 AM and 2 PM and 5 mg at 8 PM. Also at that time, they discontinued her tube feeding. We used to hang it at 8 PM and let it run all morning. She would eat a purreed meal with nectar thickend liquids for breakfast, lunch and dinner. Well, she still gets her purreed meal. This past weekend, I had her and the first shift nurse said nothing about getting her up. All she said was we were doing comfort measures, which involve turning and positioning her every 2 hours, keeping her in bed, feeding her in her room, basically keeping her comfortable.
Now, her family would have to be on board with her going on Hospice. And they have to know how bad her foot is. You can smell it out in the hall, through a dressing, a sock, a podus boot and her covers. As you get further into her room, the smell gets worse. She will go septic from the gangrene and she will die. It's only a matter of time.
So, why then on Sunday as we were feeding people supper, did her daughter come in and freak out that she was being given comfort measures? I thought the daughter knew this. She kept insisting that comfort measures meant there had been a decline, and she should have been informed. I said as far as I knew, we were keeping her in bed. She insisted that her mother had been up for lunch on Saturday. I said how the first shift nurse didn't say anything to me about that. There was nothing about that on report on in the nurse's notes. The daughter could not understand what was going on. I said "but, she's on Hospice." Before I got two more words out the daughter said "yes. The hospice nurse said she's fine." Buh? Yeah, fine as in she's not having shallow breathing and mottling. Not fine as in she's gonna get up and go home, tap dancing all the way. The daughter insisted we get her out of bed. "She has to eat." I explained that just because someone stays in her room does not mean that she doesn't eat, and that one of the aides would be in to feed her mother. Not good enough. Now this woman is on a full body lift, obviously, so it took two aides to get her up. When they went in and asked the resident' "do you want to get up?" she said "no." Her daughter said "oh, no, Mom, you're getting up. How else are you going to get better?" WTF?!? How else she'd get better is by having her leg amputated below the knee, an operation she would never survive.
The daughter said she was going to call and speak to someone on Monday. Please, do. Because you need to understand what is going on here. I know you love your mom, but you need to realize that she is going to pass away. I thought the hospice people and the social worker would have explained all this to her. Maybe they did, and the denial is just too strong for her to believe what's really going to happen. But don't come in and cuss me out because I'm providing comfort measures to a woman for whom they have been recommended, and who needs them.
AAArrrghhhh!!
At my facility (ok, Nursing Home) our main doctor is pretty realistic. She doesn't often order aggressive treatment and she knows when a person has had enough. She's pretty cool, in my opinion.
With that in mind, we have a lady who was recently admitted to Hospice. She's still on the skilled floor, we still give her her meds and sometimes do her treatment. She has gangrene of the left foot with four toes involved. It's starting to spread up into her ankle. Her antibiotics were stopped in the beginning of October, when she went on Hospice. At that time she got a new order for a Fentanyl patch and her Oxycodone was increased to 2.5 mg at 8 AM and 2 PM and 5 mg at 8 PM. Also at that time, they discontinued her tube feeding. We used to hang it at 8 PM and let it run all morning. She would eat a purreed meal with nectar thickend liquids for breakfast, lunch and dinner. Well, she still gets her purreed meal. This past weekend, I had her and the first shift nurse said nothing about getting her up. All she said was we were doing comfort measures, which involve turning and positioning her every 2 hours, keeping her in bed, feeding her in her room, basically keeping her comfortable.
Now, her family would have to be on board with her going on Hospice. And they have to know how bad her foot is. You can smell it out in the hall, through a dressing, a sock, a podus boot and her covers. As you get further into her room, the smell gets worse. She will go septic from the gangrene and she will die. It's only a matter of time.
So, why then on Sunday as we were feeding people supper, did her daughter come in and freak out that she was being given comfort measures? I thought the daughter knew this. She kept insisting that comfort measures meant there had been a decline, and she should have been informed. I said as far as I knew, we were keeping her in bed. She insisted that her mother had been up for lunch on Saturday. I said how the first shift nurse didn't say anything to me about that. There was nothing about that on report on in the nurse's notes. The daughter could not understand what was going on. I said "but, she's on Hospice." Before I got two more words out the daughter said "yes. The hospice nurse said she's fine." Buh? Yeah, fine as in she's not having shallow breathing and mottling. Not fine as in she's gonna get up and go home, tap dancing all the way. The daughter insisted we get her out of bed. "She has to eat." I explained that just because someone stays in her room does not mean that she doesn't eat, and that one of the aides would be in to feed her mother. Not good enough. Now this woman is on a full body lift, obviously, so it took two aides to get her up. When they went in and asked the resident' "do you want to get up?" she said "no." Her daughter said "oh, no, Mom, you're getting up. How else are you going to get better?" WTF?!? How else she'd get better is by having her leg amputated below the knee, an operation she would never survive.
The daughter said she was going to call and speak to someone on Monday. Please, do. Because you need to understand what is going on here. I know you love your mom, but you need to realize that she is going to pass away. I thought the hospice people and the social worker would have explained all this to her. Maybe they did, and the denial is just too strong for her to believe what's really going to happen. But don't come in and cuss me out because I'm providing comfort measures to a woman for whom they have been recommended, and who needs them.
AAArrrghhhh!!