care Archives - Shania Lynn

“Life is pleasant; Death is peaceful. It’s the transition that is troublesome”- Isaac Asimov

Palliative care is a field of medicine that focuses on an individual’s and family’s quality of life as they suffer from a chronic illness. It involves ensuring the individual is knowledgeable about their disease process, has all of the resources they need to succeed, and can ultimately end with Hospice care.

Palliative care candidates are those who suffer from chronic illness such as heart failure, COPD, multiple sclerosis, cancer, etc. Hospice is a subset of the umbrella of palliative care, but not all palliative services involve hospice.

Palliative care enables individuals to have the best quality of life for their illness. With the knowledge they need to succeed, individuals with palliative care often live longer, go to the hospital less, and have a higher life satisfaction.

The team involves MDs, RNs, social workers, case managers, and more. They all work together to provide an extra layer of support and listening ears. The team may assist with arranging resources, pain control relating to the illness, advanced care planning, end of life wishes, among many others things.

Today, I got the opportunity to witness a beautiful conversation between a palliative care nurse and a wife of her very ill husband at the bedside in the ICU. The RN opened the conversation to the wife and the wife had unrealistic beliefs regarding her husband’s medical condition. The RN was able to answer questions regarding his diagnosis/prognosis, provide options, pray, and truly listen to the wife’s concerns. Here are a few questions/concerns the wife had that were answered:

What will happen if we turn off the machines?
Will the doctor say, ‘I told you so’?
Will he gasp for air?
How will I live without him?
I never lost hope in God. This just isn’t in his plan and that is so hard.
How do I tell my 3.5 year old granddaughter that papa is not coming home?
How do I call and start this conversation with my family?
He isn’t getting any better, but my heart hurts so much.
I know he wouldn’t want to be on life support, but how do I know when to stop it?

The Palliative Care team gives families and individuals the opportunity to discuss their concerns in a safe environment and the support when they may not even realize they need it. It is a heartbreaking field to be in, but it is truly a calling and the opportunity to witness this interaction was such a blessing.

Do you have any patients or family members that may benefit from palliative care?

Until next shift,

Shania

Nurses always say how nurses are the worst patients. One may think this to be silly since nurses can relate to the work, however it has proven to be true more often than not. Emotions run high in the hospital and having a nurse either as a patient or a controlling family member often proves this statement to be true. From every safety step to every decision, the off-shift nurse at the bedside watches the primary nurse’s every move. And when the patient is actively dying, the nurse family member is even harder to handle.

Watching a patient decline, converting them to comfort measures, and switching them to hospice is one of the many tough aspects of nursing. When this patient is a family member, the decisions become harder to make as the wishes of the family conflict with the wishes of the patient and/or the patient’s best plan of care.

I recently had a patient for weeks who originally presented with an ileus and GI bleed. She was NPO for two weeks and connected to an NGT with suction. Throughout the stay her bowels began to function, while her kidneys began to fail. She became sicker and sicker by the day until it did not seem like she would survive the weekend.

She was originally having full conversations and working with PT, then quickly progressed to 1-2 word sentences and was using all of her energy to breathe. Her daughter was a nurse and was active in her plan of care. Throughout this decline, she ordered every lab and test to be completed even if it did not seem to be in the best interest of the patient. Her mother appeared to be actively dying and the daughter stated how she knew in her brain that what she was ordering was probably irrational, however her heart could not let go.

One shift the patient woke up enough when the doctor and daughter were communicating to clearly state her wishes. I will never forget this moment. It was as if she took all of her energy to tell her family that it was okay. She looked at her daughter and said, “Please don’t cry. It is okay. I am ready to go home.”

Everyone in the room started to tear up- daughter, MD, and me included. The patient had the biggest smile on her face. This brought comfort, closure, and the next steps in the plan of care.

When many of the previous nurses complained about the controlling daughter, it is moments like these to make me take a step back and empathize with her feelings. All she was trying to do was ensure that we were providing the best care and holding onto any last hope to prolong her mother’s life. Anybody would react this way, not just nurses.

Palliative Care: A Day in the Life

When you don’t want to let go

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