On a scale from 1 to 10, do you want to know how much I care about your fluid restriction? With 10 being the most care I can muster.
Zero. Z. E. R. O. Zero.
You want coffee this early in the morning? You go right ahead and drink what ever you please, even if it is over your fluid limit for 24 hours, you know the risks of drinking more than your prescribed ml's of fluid a day, but I'm not in the room 24/7 watching what you put in your mouth. Stop harassing the CNA, she is doing her job by asking you what you drank/ate. And yes, yogurt is a fluid. Yes, I had to Google it, but yes, it's a dairy product that melts, similar to popsicles and sorbet and ice cream and coffee creamer. You, the patient, must care about your body more than anyone else. I'll educate you, but I am not going to be your mother.
Do you need anything else? Are you all set? Is there anything else I can do for you? *smile* Okay, you call me if you need anything. You have your call bell. Okay good. Call me if you need anything. I'll be back to check on you soon.
"Now we exhort you, brethern, warn them that are unruly, comfort the feebleminded, support the weak, be patient toward all men." 1 Thessalonians 5:14
Wednesday, May 8, 2013
Coping With Patient Deaths
I read an article about how nurses cope with patient's deaths.
It was really good, I teared up a little relating to their stories. Until I got the the last sentence. "I have never let a patient die alone."
This really frustrates me. Actually it enrages me.
I have heard/read this exactly thing before two of my patients died two weeks ago, on the same night. Before two weeks ago, just thinking about letting a patient die alone was a horrible thought. As if letting a patient die alone would be failure of mine. Or it would be not caring. Or some other word that would mean I was a bad nurse.
Where I work, we do a fair amount of comfort care for dying patients. We were "joking" this week that we should rename our unit to the Hospice unit, instead of GI, because of how much comfort care we do. I have come face to face with death more often than I expected. Months ago I remember asking the charge nurse if I was supposed to spend my whole night in a comfort care patient's room because her family wasn't there and I "don't want her to die by herself." She told me I could, but that it wasn't necessary because I was busy with my other patients.
And who comes first? The patient who the doctor says has 12 hours to live, or the ones who will be going home tomorrow to fill out satisfaction scores?
My first patient died alone. I checked on her every 30 minutes. The CNA checked on her often as well. I called her family to see if they wanted to come in; they didn't. I medicated her to keep her comfortable. But I didn't hold her hand. Actually, her emaciated, cachectic body freaked me out.
Was I a bad nurse for not holding her hand as she died? Did I fail? Could I have done something differently to be in the room so she would go into eternity with someone at her side, with a Christian at her side? Should I have ignored my other patient to be with her? No. Just no. No to all of it.
There was no emergency contact for my other patient. He opened his eyes for a moment when I first got on duty, and I told him my name, told him not to be afraid, that I was going to take care of him, and he wouldn't be in pain. He never opened his eyes again. Late in the night, a family member showed up, and an hour and a half after she got there, he died. I watched him take his last breath. If you can even call that last inhale a breath. And that was it. He was dead.
At least I don't have to work through administering morphine with a "double effect." Double effect is where you give someone morphine (or any other medication) to relieve someone of pain and suffering, knowing that the effect of respiratory suppression and lowered blood pressure would directly lead to their death.
Where do these people work where they have time to hold patient's hands as they die?
This is a hard job. Don't do it if you don't have a strong stomach and a strong constitution.
"He will swallow up death in victory; and the Lord God will wipe away tears from off all faces." Isaiah 25:8a
It was really good, I teared up a little relating to their stories. Until I got the the last sentence. "I have never let a patient die alone."
This really frustrates me. Actually it enrages me.
I have heard/read this exactly thing before two of my patients died two weeks ago, on the same night. Before two weeks ago, just thinking about letting a patient die alone was a horrible thought. As if letting a patient die alone would be failure of mine. Or it would be not caring. Or some other word that would mean I was a bad nurse.
Where I work, we do a fair amount of comfort care for dying patients. We were "joking" this week that we should rename our unit to the Hospice unit, instead of GI, because of how much comfort care we do. I have come face to face with death more often than I expected. Months ago I remember asking the charge nurse if I was supposed to spend my whole night in a comfort care patient's room because her family wasn't there and I "don't want her to die by herself." She told me I could, but that it wasn't necessary because I was busy with my other patients.
And who comes first? The patient who the doctor says has 12 hours to live, or the ones who will be going home tomorrow to fill out satisfaction scores?
My first patient died alone. I checked on her every 30 minutes. The CNA checked on her often as well. I called her family to see if they wanted to come in; they didn't. I medicated her to keep her comfortable. But I didn't hold her hand. Actually, her emaciated, cachectic body freaked me out.
Was I a bad nurse for not holding her hand as she died? Did I fail? Could I have done something differently to be in the room so she would go into eternity with someone at her side, with a Christian at her side? Should I have ignored my other patient to be with her? No. Just no. No to all of it.
There was no emergency contact for my other patient. He opened his eyes for a moment when I first got on duty, and I told him my name, told him not to be afraid, that I was going to take care of him, and he wouldn't be in pain. He never opened his eyes again. Late in the night, a family member showed up, and an hour and a half after she got there, he died. I watched him take his last breath. If you can even call that last inhale a breath. And that was it. He was dead.
At least I don't have to work through administering morphine with a "double effect." Double effect is where you give someone morphine (or any other medication) to relieve someone of pain and suffering, knowing that the effect of respiratory suppression and lowered blood pressure would directly lead to their death.
Where do these people work where they have time to hold patient's hands as they die?
This is a hard job. Don't do it if you don't have a strong stomach and a strong constitution.
"He will swallow up death in victory; and the Lord God will wipe away tears from off all faces." Isaiah 25:8a
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