Wednesday, October 19, 2011

Barriers to a good death

Yes, I've seen a few. And while the system isn't 'broken', there are barriers to having a good death.
The primary one being having money, and a patient navigator.
The next is that healthcare only works well five days a week. Truly. This barrier is a brick wall on weekends.
What makes a good death?
  • Communication between agencies, continuity of care, PSWs who smile, comfort measure, compassion, nurses who go beyond the call of duty, physicians who make house calls, adequate pain management, physicians who understand geriatrics, treatment plans, care plans that work, palliative pain management nurses, a functional family, respite for family caregivers, friends who know what to say or do.
What are the barriers?
  • Disrespect between healthcare professionals, nurse bullying, nurses who state "This isn't my job", physician ignorance, physician abandonment ("I'll prescribe pain medication, but I'm not going to do anything else."), infected wounds, pros ignoring the signs of pain, PSWs who won't speak to the powers-that-be.
One simple barrier is home care that sends one personal support worker (PSW) at a time to a client, who is a two-person lift. In some situations they can roll the patient, but if you are already in pain, upset with being woken up to be turned every two hours, you get grouchy. Who blames them?

Another barrier? Transfer Payment Agencies who are unable to communicate effectively, e.g., Bayshore health who sends a nurse, Red Cross who send a PSW). Not that they are NOT doing their jobs, but they don't seem to communicate with one another. There are no case conferences. I tried having one for my Dad, but the doctor had to go to an accreditation meeting for the hospital. He was very hard to reach.

And while we know there is disrespect between doctors and nurses, imagine the disrespect that occurs between nurses and PSWs! Job descriptions are very specific these days.

Now, the nurse talks to the doctor, after seeing the patient, and requests that the doctor send order for, say, morphine. Every palliative client in pain sees morphine as their friend. The doctor doesn't return calls, isn't available, isn't at the [insert one: office, clinic, hospital] ______ and staff won't take a message. This isn't uncommon, either. I fought 3 days to get morphine for my dad. It took a pharmacist who counselled me at a break during choir practice. Fight for your dad, he said.

Since GPs may not be a pain specialist, or isn't familiar with the case, or hasn't treated this particular condition before, or hasn't done a house call in weeks, s/he may have no idea what is what in the home. Some see this nurse as interfering with the doctor doing their job, and won't put the patients needs upppermost.

Friends have written extensively about the competition between healthcare pros: doctors and nurses, as well as nurse practitioners (NP) and physician assistants (PA).
In a hospital, LTC or larger center, the behaviour is there for all to see. Nurses Behaving Badly, or Nurse attitudes, for example.

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