Archive for Nurses

A Hospice Chaplain is Quantifiably Wrong

(*Photo by John Rothwell.)

“The nurses do things that can be quantified,” one of our hospice chaplains announced, “which is not like what us chaplains or the social workers do.”

With hospice, a patient is supported by a “team” of doctors, nurses, social workers, chaplains, home health aides, and volunteers.

Was the chaplain, a person and a professional I respect, correct?

What is quantified? It’s a word describing precision, numbers, and comparisons.

A nurse may ask a patient what her or his pain is like on a scale of 1-to-10 or (especially if a patient can no longer talk) to choose from a range of emoji faces depicting happy smiles to grim anguish. Nurses increase or decrease the precise dosages of medications based on experience, information, and established guidelines.

The medical staff in hospice—and this is one of the tough parts of patient care—needs to regularly report how a patient is declining. If a hospice patient demonstrates consistent improvement in their physical health, they certainly still have an illness (and can’t stop the aging process), but they may no longer be eligible for the hospice benefit.

  • Is the patient losing weight?
  • Does he require stronger doses of pain medication?
  • Is she eating less, or only liquids, compared to last week or month?

Yes, nurses quantify, with specifics, to discern a patient’s changes. Read More →

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In Hospice, MAC Isn’t About Comfort Food

Mac & Cheese is comfort food, but sometimes . . .

While discussing a new admission, the hospice medical director reminded the patient’s nurse to get a mac.

The nurse immediately nodded. Complete agreement.

A mac? What did the doctor mean? They couldn’t mean a Macintosh computer from Apple, could they? That didn’t make sense. But thoughts of digital apples made me think about real food . . . did they mean Mac & Cheese? Though not a big fan of that packaged pasta and cheese, it is one of my wife’s favorite comfort foods.

My food wondering continued. What about a “Big Mac?” Could the doctor have been recommending a fast food burger? (When younger, I loved McDonald’s flagship burger. The Big Mac debuted, with fanfare and a high calorie count, around the time I started college. If I could scrape together a few extra quarters, I’d always go for the extra all-beef patty and special sauce!)

But we hospice professionals couldn’t have been talking meal deals . . . right?

Ever ignorant, I asked the doctor, “What is a ‘mac?’” Read More →

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Drugs, Doses, Dread & Delivery Options

pills

Around breakfast time, I usually shake out several pills into the palm of my hand . . .

The nurse arrived and sat beside my mother in the dimly lit hospital room.

One of the first things he said was, “This won’t hurt.”

He lied.

He was there to place a peripherally inserted central catheter (PICC, or “pick”) into Mom’s upper right arm. She’d been offered Dilaudid—a brand name for hydromorphone, a narcotic stronger than morphine—for pain management. The medication would be housed in a CADD pump (Computerized Ambulatory Drug Delivery) connected to her PICC line. The linked pump and the catheter would give a predetermined, regular amount of medication to ease her physical agony. A “button” could be pressed on the CADD pump for additional dosages.

Are your eyes glazing over with all the medicalese?

Mom’s body was riddled with cancer and the two surgeries undertaken to “relieve” discomfort had added complications. As I calmly write this three years after her death, I understand why she said “Yes” to that PICC line: she wanted the wrenching pain to end and she was ready to die.

But the nurse, who seemed rightly weary in the near midnight hour when he entered Mom’s room, first caused more pain.

He swabbed her arm with disinfectant and inserted a needle.

She grimaced.

I held her left hand. Watching her tore my heart apart. Read More →

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