The Balancing Act: A Dying Patient and a Spouse Who Can’t Let Go

Illustration by McClain Moore Illustration by McClain Moore

The Reflections essay in the March issue of AJN is called “The Balancing Act.” The author describes a situation she faced as an ICU nurse in which her efforts to keep a dying patient comfortable were complicated by a spouse’s reluctance to accept the inevitable. It’s often hard to advocate for a patient while honoring the emotional struggle of a close family member. Here’s the start of the essay.

I have just arrived to work in the ICU and am assigned a patient in respiratory distress. Her name is Darlene and her husband Tom is pacing the room. Within 10 minutes, he drinks three cups of coffee, ignoring the cot provided by the previous nurse so he could sleep next to Darlene. His wife has more than one cancer and both are growing. She left the hospital a week ago for hospice care, but has been readmitted after a decision by her husband to reattempt curative treatment.

[…]

2016-11-21T13:01:24-05:00March 9th, 2016|Nursing, nursing perspective, Patients|2 Comments
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A Nursing Perspective on a Recent NEJM Palliative Care Article

Pam MolloyBy Pam Malloy, RN, MN, FPCN, director and co-investigator of the ELNEC Project, American Association of Colleges of Nursing (AACN), Washington, DC.

I just read a New England Journal of Medicine article by Drs. Craig D. Blinderman and the late J. Andrew Billings that came out on Christmas Eve, 2015. “Comfort Care for Patients Dying in the Hospital” was a thoughtful, informative article and I am grateful that it appeared in a journal that wasn’t focused solely on hospice/palliative care.

2016_ELNECLogoWhile the information in the article is essential for all health care professionals, I would like to take this opportunity to remind my nursing colleagues that we have a tremendous opportunity and privilege to plan, provide, and orchestrate the care that was described in this article—and we have been doing so for some time.

Nurses spend more time at the bedside and out in the community assessing and managing patients with serious, complex illness than any other health care professional. Our interdisciplinary colleagues depend on our assessments and we play a major role in developing plans of care with our diverse team. We are there having difficult conversations with patients—many times in the middle of the night when they cannot sleep.  We […]

2016-11-21T13:01:34-05:00January 8th, 2016|Nursing, nursing perspective, pain management, patient experience|2 Comments
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Unexplained Deathbed Phenomena: Honoring Patient and Family Experience

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

by luke andrew scowen/flickr creative commons luke andrew scowen/flickr creative commons

When my dad died, a special little travel clock that he’d given me years before stopped working. It restarted a week after his death, and continued running for years. I have no explanation for this sudden lapse in timekeeping, but it made me feel closer to my dad.

I’ve heard many other stories of unusual events surrounding the death of a loved one. I was therefore delighted to read this month’s Viewpoint column, “Letting Patients and Families Interpret Deathbed Phenomena for Themselves.” In this short essay, Scott Janssen presents some intriguing research findings and a compassionate argument for speaking openly about these occurrences. He writes:

“It’s an open secret among those of us working with the dying – there’s a lot of strange stuff going on for patients, as well as for the clinicians and family members who care for them, that rarely if ever gets talked about: near-death experiences, synchronistic coincidences (stopped clocks at time of death, for example), out-of-body experiences, and visitations from deceased loved ones.”

Janssen, a former hospice social worker and now a psychotherapist, sees such phenomena as part of “the normal continuum of experiences at the end of life.” He calls upon clinicians to create safe contexts in which patients and families can share these experiences without fear that they will be judged, ridiculed, or dismissed by caregivers.

It’s food for […]

2016-11-21T13:01:59-05:00September 21st, 2015|Nursing, nursing perspective, patient experience, Patients|0 Comments
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An Oncology Nurse’s Heart: Helping Dying Patients Find Their Own Paths Home

Julianna Paradisi, RN, OCN, is an oncology nurse navigator and writes a monthly post for this blog.

Heart Break = Heartache graphite, charcoal, water color, adhesive strip by julianna paradisi Heart Break = Heartache
graphite, charcoal, watercolor, adhesive strip, by julianna paradisi

The disadvantage of building a nursing career in oncology is that a fair number of patients die. Despite great advances in treatment, not every patient can be saved. Oncology care providers struggle to balance maintaining hope with telling patients the truth.

Sometimes, telling the truth causes anger, and patients criticize providers for “giving up on me.” In a health care climate that measures a provider’s performance in positive customer satisfaction surveys, paradoxes abound for those working in oncology.

Providers may also be criticized for delivering care that is futile. “Don’t chemo a patient to death” and “A cancer patient should not die in an ICU” are common mantras of merit.

Maybe because I live in Oregon, a state with a Death with Dignity law, or maybe it’s the pioneer spirit of Oregonians, but I don’t meet a lot of patients choosing futile care to prolong the inevitable. In fact, many patients I meet dictate how much treatment they will accept. They grieve when they learn they have incurable cancer, and most choose palliative treatment to […]

2016-11-21T13:02:13-05:00July 24th, 2015|career, Nursing, nursing perspective, patient engagement, Patients|3 Comments
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Presence, Improvisation, Dark Humor: Crucial Skills of a Hospice Nurse

Illustration by Pat Kinsella for AJN. Illustration by Pat Kinsella for AJN.

Here’s the start of “Molly,” the Reflections essay in the November issue of AJN, written by hospice nurse Thom Schwarz.

Late evening, early spring, the peepers not yet trilling. I am in my car, rain streaking the windshield, reading a New Yorker essay about war writing, an ironic distraction from my visiting hospice nursing work.

This is a piece that doesn’t offer any easy answers for the facts of suffering and death. But it does posit a certain consolation in staying present, undaunted, engaged, and resourceful when faced with the power and mystery of each patient’s encounter with impending death.

All Reflections essays are free, so give it a look.—Jacob Molyneux, senior editor 

2016-11-21T13:03:36-05:00November 3rd, 2014|narratives, Nursing, nursing perspective, patient engagement|3 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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