Saturday, May 7, 2016

Undue pressure on end-of-life patients

I hear stories from my rural clients and their families. Many are complaining about hospital staff. What staff need to do is to have palliative assessments done and, in response, admit patients to a palliative care bed. They deserve this. This is Canada. This is 2016.

Treated curtly

dying patients deserve to be in hospital
their families have earned this right
There is a lack of understanding of a palliative treatment plan, not communicated to the family. The hospital avoids the topic, preferring to insist that clients aren't sick enough to be in hospital. When you are clearly dying, isn't that the best time for nursing care, comfort care?

Palliative patients need small amounts of food, if any, they need to wear an incontinent pad, have their catheter bags emptied, the colostomy bag needs careful cleaning. Some, in a coma, need to be turned regularly. Many palliative patients get this type of care. Others are abused by staff, and a system that fails to comprehend what a good death should look like.

One client: at end-of-life, with end-stage COPD, oxygen tube for comfort, catheter, colostomy bag from a 3-year previous cancer, is taken to hospital since there isn't enough support for a spouse to cope.

Palliative Care room

Spouse takes the patient, clearly waking and sleeping, drifting in and out of consciousness, into
Sandra Winspear, ED Hospice Muskoka
Dedicates a palliative care bed in hospital
hospital. She is placed in the palliative care room. It is comfortable, with a couch and fold-out recliner. Hubby sleeps in the chair, a son visits from another city. The room is comfy, large, and can easily accommodate extra family members. This is the purpose of a palliative care room. They are beds dedicated to those who are dying. Most hospitals have them.

Staff are rude to these families. They tell the spouse the patient has to be removed and sent to long-term care. There isn't a place. They tell the spouse the patient is turning the corner, improving, and moves her to a room down the hall. The oxygen tube falls off the patient's face and it's up to the spouse to replace it.

'Here she is dyin' on you, and they move her to another room.'

There should be a PPS test done on a regular basis by staff. This doesn't seem to happen. She's at 30% when I visited her last at home, no better (20%) when I visited two weeks later in hospital.
Developed by the Victoria Hospice Society
They moved her down the hall, checking on her at 4:30 a.m., 'she was fine', by 9:00 a.m. she was gone, leaving a bullied husband to cope with arrangements. In addition, they charge him $1700 for the room.

A good death

good death is one in which the four dimensions of good death are met: 
  1. Physical (pain control, breathing, fatigue, bedsores),
  2. Spiritual (accepting death, doing a life review, seeing meaning on one's life, finding peace), 
  3. Social (being conscious; communicating with family/friends, careworkers; communicating needs, wishes; sharing thoughts, feelings; having closure; saying farewell; a quiet, private atmosphere) and 
  4. Emotional/psychological needs (accepting help; not being a burden; being peaceful; having self-esteem; enjoying simple pleasure by releasing hope by gaining peace; making choices).Death is complicated and complex. We know how much it impacts a family when someone takes their own life, or dies in a sudden incident. It takes time to come to terms with impending death, and there is a reason for this.


Christine said...

Thanks for doing this post, such a sad state of affairs.

Christine said...

very nice profile photo btw