TranquilityRN
Tuscumbia, AL
Female, 40
I have been a hospice Registered Nurse for about ten years. Hospice is similar to home health except specializing in care of the terminally ill, dying patient. A hospice nurse provides palliative care for the patient during their last months, weeks, days, or hours so they may pass in the comfort of their home and with their loved ones present. I provide comfort and dignity for the the patient and comfort for the caregiver. Following the peaceful passing of the patient I provide postmortem.
Patient can refuse it absolutely!! Usually that's because if not accepting the shape they are in and/or fear of dying. I have went and admitting a patient later that has refused when they finally accept the inevitable or when the patient is non responsive at the request of family members.
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Not usually. Not from a terminal illness unfortunately! However there are those that give up of the disease is way more than they can fight.....and there are those that have a very strong will to survive and fight. It's amazing to see what people "hold on" for, like usually mothers not wanting to leave children or men not wanting to leave his wife behind to care for herself. I have had to discharge patients from hospice and refer to home health for what is called a failure to decline. Which means the disease did not run its natural course and cause death within what guidelines are placed on the retention of a patient!! But in a sense that's a good feeling and doesn't happen very often.
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Honestly usually we are successful in managing all the symptoms necessary that there is not alot of suffering. However, people with bone cancer or colon cancer can be hard to manage pain. COPD patients are difficult or me personally because I always felt as though I was suffocating. I think the worst deaths to witness so far have been cirrhosis when the patient develops esophageal varicese and bleed copious amounts. Although the RN prepares for possibly bleeding out by placing darker sheets on the bed and darker clothing to camouflage amounts of blood in case it happens. The family is educated prior to the potential so they are not shocked.
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No not usually, it happens, but most of my patients are general somewhat comatose at the point they start to pass and usually this is predicted and a time frame predicted using the training a hospice nurse receives! Therefore they family is aware and normally at the bedside as they take their last breath. I have had patients pass in their sleep and the family find them. But if its a natural death nothing acute NORMALLY the family is educated by the RN of the sign and symptoms of impending death and know its occurring. Most families also tend to take shifts at the bedside which I personally tell them isn't necessary because often I have seen patients especially mothers not want to pass with their children looking on. Better for family to keep routines as close as possible for the patient sake.
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That depends because there are hallucinations which come with impending death! I have had a couple of patients confess to being in love with a spouse that passed prior to them yet they have a new spouse they love dearly. One man confessed to not always being true to his wife but other than that nothing but regrets or wishing they were closer to certain family. Alchoholics wishing they had lived life different and hadnt ran family off. In the case of confessing a murder that would be an obligation on my part to call in social worker and us team together to assess this further. But I'm sure it would have to be reported and investigated.
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I have had families report this to me and ask that I speak with them and educate on the fact of whether or not the patient is competent enough to be doing such, however, I have seen families fighting over things before the patient ever passes. Very sad.
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One old man asked me why I remarried twice being such a sweet lady with amazing calling in life.......I told him I was afraid to die alone! In his final few hours he told me while holding my hand that noone dies alone!! Amazing! I had a military vet in a nursing home and I never met any family, as I approached his bedside for a visit he looked at me so lovingly that I asked him what is it? He said I thought you were my wife, she came to see me last night, looked just like the day I bought her wedding dress, she was wearing it, hair black as coke like yours. I said oh my how wonderful did she come to get you? His reply with a sad look on his face was "she says its not time," I have so many!! I learned true love can exist and even on the other side.
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