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Caring with Intention: Palliative Care and the Human Family

Vivian Dee, APRN-BC, RN, lives in Texas. She works on a bone marrow transplant unit and is and a doctoral student in the DNP program at Walden University.

In 2008, our organization created a new palliative care wing. No one was certified yet or knew much about caring for palliative care patients. The leadership scrambled to put together learning instructions in the form of PowerPoints and seminars.

In the midst of this flux, our unit admitted a homeless man as one of our first patients. Larry was an alcoholic who’d been out on the streets for many years. His health had deteriorated, and he’d developed liver cirrhosis. Since he couldn’t afford medical care, he’d opted for palliative care.

Larry was unpretentious and polite, and he soon became one of my favorite patients. I met him at the initial team meeting, where we established goals of care. As the days passed, I got to know Larry and his wishes, dreams, and desires. He would talk about his family, his cousins, and his mother. How he longed to see them one more time. To ask forgiveness and to say goodbye.

Days soon turned into weeks, weeks into months. Larry became weaker. Soon it was apparent that it would only be days before Larry took his last breath. […]

2018-03-22T08:25:34-04:00March 22nd, 2018|Nursing, Patients|0 Comments
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The School Nurse

by rosmary/via Flickr

They march into my heart like little soldiers. There are lads and lassies, rich and poor, sporting bling and brawn. Sometimes they leave the bus and walk into my office as soon as they get in the front door. The litany continues daily.

“I don’t feel good.”

“My stomach hurts.”

My responses follow the pattern.

“Did you tell your parents you didn’t feel good?”

“Did you eat breakfast?”

“Were you up late last night?”

The thermometer comes out. Triage begins. Some came in under the power of suggestion.

“My mother said if I didn’t feel good to come to the nurse’s office.”

Children always think that’s a free ticket to get out of the remaining school day. The sick ones are directed to cots in the back part of the office. Some will rest awhile. Some will have crackers or granola bars to offset the empty stomach they came to school with. Charts come out. The search begins. Some phone numbers are accurate, and parents can be reached. Some, sadly, can’t be contacted. The phone messages become trite.

“The person at this number is not taking calls now.”

“This number is no longer in use.”

I have to put my Sherlock hat on. I search all sources to see if there is a parent or relative who can come and pick up their child per […]

2018-02-01T08:23:45-05:00February 1st, 2018|Nursing|5 Comments
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Honoring the Moral Concerns of Caregivers Afraid of Giving Morphine

Joan’s breathing relaxes as the morphine starts working. Her son Travis, on the other hand, is clearly upset as we sit at her bedside where she is dying. Despite his mother’s intense respiratory distress before he gave her the morphine, he’s convinced that he’s just made a big mistake. “I’m sorry, mama,” he whispers.

He turns his head my way. “I wish you hospice folks had never brought that morphine out here,” he says. “Now she’s dead for sure and it’s my fault.”

A sometimes essential medication.

For caregivers with this level of fear about morphine, it’s a painful dilemma. If you don’t use the best, sometimes the only, medication we have for getting acute respiratory distress in terminally ill patients under control, both patient and caregiver suffer. But if giving morphine is freighted, as it is for Travis, with a belief that it causes death and/or signifies giving up on, even betraying, a loved one, it can intensify a caregiver’s distress.

The hospice nurse had already given the standard education, assuring Travis that in patients near the end of life morphine is safe and effective when used as prescribed. We had given him written information debunking some of the common myths about morphine—“it kills you”; “makes you crazy”; “it’s addictive”—when used appropriately with hospice patients who have active symptoms. We had […]

2018-01-22T10:19:38-05:00January 22nd, 2018|Ethics, family caregiving, Nursing, pain management|0 Comments
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An Unusual Privilege: A Patient’s Memorable Grace

Jonathan Peter Robb works as a district nurse for the National Health Service in London and has published two essays in AJN‘s Reflections column in recent years, “How I Built a Suit of Armor as a Nurse (and Stayed Human)” and “Verification.”

I was working an evening shift and it was five o’clock when my mobile rang for a call-out. The patient was a woman I’d seen before, who’d been on and off our books for the past few years. She was old, and unwell, and when she last returned home, we were told she was dying. She had been made palliative. Her name was Ruth.

Even with her fluctuating health, Ruth remained incredibly sharp. She was also persistently positive. Ruth was the type of patient you could talk to and forget they were a patient. She asked me questions about myself. Despite the number of people I care for and my enquiries into their health and lives, it is a rare person who asks questions about my life.

I headed out […]

2017-12-01T14:06:39-05:00December 1st, 2017|narratives, Nursing, nursing stories, Patients|3 Comments
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The Fraught Journeys of Those Fleeing Hurricanes

AJN received this guest post last week, when the effects of Hurricane Irma were still in the headlines, from Kathryn Jackman-Murphy, EdD, MSN, RN, professor of nursing at Naugatuck Valley Community College in Connecticut. The challenges she describes here are not specific to Hurricane Irma—they are faced again and again by those forced from their homes and communities by storms and other natural disasters, and they often happen out of sight of the media.

by patchy patch, via flickr

Right after Hurricane Irma began to hit Florida, I checked in with one of my son’s adult friends. He was searching for a safe landing site for himself and his elderly parents, as his initial plans to stay had been compromised by the hurricane. He was now in Tennessee, with no idea of where they would be able to stay until it was safe to return home. The dad is a Vietnam-era veteran with PTSD, hypertension, and diabetes. The mom also has diabetes and some limitations with mobility related to arthritis and walks with a cane.

How can nurses help?

Watching the devastation in Florida and Texas, I was searching for something to do to help. That’s what nurses do—we help. Being so far away in the Northeast, I felt not only helpless but acutely aware that […]

2017-09-20T13:33:35-04:00September 20th, 2017|climate change, environmental health, Nursing, Public health|0 Comments
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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