Tuesday, November 20, 2012

The one lie nurses will tell

We've had a string of deaths on the unit, majority of them are our DNR's and palliative pt's and surprisingly I'm still a virgin (meaning none of these ppl have died while they're in my care) and tonight when I went to work I found out that one of my pt's I had Saturday night had passed.

I was surprised and when the nurse who had the pt came onto shift I asked about the details. While talking with him we talked about how he informed the family. Another nurse was in the room when I brought this up and gave this piece of advice...

If a family member wants to know if anyone was there when they died, tell them YES - EVEN IF THAT MEANS YOU HAVE TO LIE!!! NEVER EVER tell them that they died alone. Hell, make up a story if you want to, but never tell them they died alone... it's like the #1 fear that family members have when their family member's in the hospital.

Well sure enough, we had a sudden death on our unit tonight.... and what ONE question did that family member have?! Yep, "did he die alone". Thankfully we could answer this one truthfully because she had like 4-5 nurses around her when she took her last breath.

Moral of the story - ALWAYS tell a family member that someone was there when they took their last breath, never leave them with guilt that they couldn't be there when they died. At least the family will take comfort in knowing that at least SOMEONE was around, even if that isn't the truth.

Tuesday, November 13, 2012

The business of being born

Today I watched the documentary "The business of being born" and it's something that I feel strongly about... I don't necessarily think that every woman should have a home birth - but I certainly think that less intervention during labor and birth should be done.

Birth is a natural process IMO - and though I believe in a woman's choice to pain control - I also believe that birth takes time and as shown in this documentary, many hospitals don't give women the time it takes to have a baby.

I know that in this day and age, we want immediate results and as such this has affected how labor and delivery occurs. What is too often seen is a pt getting pitocin or being brought back for a c-section, which isn't always necessary. That's not to say that c-sections aren't required for some circumstances, but I often think that these are being done too often because establishments (hospital policies, doctors, etc) are saying that it's unsafe for a woman to be in labor without changing on a regular basis.

I postulate this - approx. 20-30 yrs ago - my mother's generation, how likely was it to hear that women had labor that existed for DAYS???!!! And this was alright with physicians!!! I think that a page from yesteryear should be brought back.

It's ALRIGHT to let women labor, and to deliver without interventions like vaccums and pitocin augmentation. There is a time and place for these things but it shouldn't be a majority like it is currently.

I think that doctors and hospitals are too concerned that they're going to be sued by patients if they let women labor for too long and if something should happen for mom or baby, then law suites will occur. Nothing will change unless the patients share responsibility and stop suing doctors for things like this.... become informed, take responsibility for your own labor and take the position that if you want to labor for longer than an institutions' policy, then sign off that you're taking responsibility for this and should anything happen, then you can't sue unless malpractice occurs.

Doubt anything will ever change tho, it's sad, it would reduce c-section rates.

Withdrawing care & comfort care measures

I've spoken about this before, but we see it ALOT on our unit. Because we have many stroke patients come through our unit, it really gets to me that ppl don't know how to bring up this subject.

Why is it so hard to talk to ppl about death and dying and being realistic. Why hold out hope that your family member/patient will pull through to just be a burden on the system and the family?! IMO, if God wills this person to live, they will but don't put in a NG/G/Peg tube to prolong the life of ppl. I think it's a pointless to prolong these lives.

There's one family I dealt with who their father had a stroke several years back, he lived for 3 yrs with complications before finally dying. Because of this, their mother indicated verbally (of course not in writing!) that should anything like that befall her, to make her a DNR and let her die! Well go figure, same happens to her and this family makes her a full code!!! Then when she stabilizes, the family is FINALLY persuaded to make her a DNR BUT they want to put in a G-tube.... STUPID!!!! UGH But of course I have to keep my opinions to myself and respect the decisions of this family. After a month or so, the only thng she had done was open her eyes. Not much of a life right?! Another pt we've dealt with is semi-comotose and they put a g-tube in her. It's soooo frustrating.

On the other side of this coin, we've had several where the family decided to withdraw care other than comfort care measures and these people have passed peacefully without having to suffer from bed sores, infections,etc. I relish those times.

I have also dealt with a family who had their loved one come in with pneumonia, possible TB and the person is elderly and cognitively intact and doesn't want to eat or drink. What's going to be their decision???? I think that if ppl can make decisions before they lose their minds, let them do what they want! Provide comfort care measures and end of life support and allow them to pass they way they want to!