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Hospice Nurse argued with me about my father's Directives to not supply oxygen or inhalers for his breathing, I had to go over her head.
90 yr old late stage ALZ and Dementia father. In a care center. Multiple health issues: COPD, asthma, black lung, multiple bed sores that stay infected over 4 months now. two broken hips in the last 19 months, last hip could not be repaired. Couldn't walk before the hip breaks. Failure to thrive. Lost 60 pounds the past year, barely eating or drinking. Cyanosis (blue) hands most of the time. Poor cardio vascular health. Bed ridden for months, cannot support himself out of bed one bit. ZERO short term memory. Atherosclerosis vascular disease in both legs. If he sits up in a wheelchair just a few minutes, his feet turn purple from the vascular disease but pink back up once horizontal in bed. Peripheral neuropathy both feet. And more.
Went under Hospice 30 Mar 2015.
His signed health directives state on one section that if he suffers from breathing difficulties, take no action, make him comfortable, no oxygen, etc.
He had a bad asthma attack last week Wed 29 July 2015 , the Hospice Nurse called me and gave me a very visual description (which was cruel IMO to have to picture his distress) of how he was and insisted I give her permission to administer oxygen, nebulizer, inhalers. I said 'no'. she wanted to argue with me. 'No'. Hospice Nurse then tells me, 'I have a 93 yr old father and I know what I'd do if he was in this state'. I'm telling her 'you are a Hospice Nurse, right? He's dying which is why he is under Hospice care. He has signed directives in his chart, NO oxygen. Give him morphine per the Hospice Care Plan to help make him comfortable. She wanted to argue. I cut her off.
She then told me 'I told the doctor you would not agree, so doctor asks that you call her ASAP and discuss, then please call me back'. Hmmmm, okay.
So I called the doctor, who was an on-call doctor who had never seen my father, never seen his chart, wasn't familiar with his case. I explained the why's and his wishes. Doctor tells me that she wasn't briefed on any of this, just had a call from Hospice Nurse saying he needed oxygen and inhalers so she approved the treatment as a standard protocol. On-call doc was 4 hours from the care center.
On-call doctor agreed with me after hearing his complete medical history and said she agreed with me. I called Hospice Nurse back. told her what the on-call doctor said.
Hospice Nurse STILL wanted to convince me to give him medical care. She again went into the 'if you could see how he was clutching at my hand, begging me to help him, it broke my heart....".
I again refused to administer oxygen, etc..
She said she had started morphine care plan to ease his breathing and it was helping SOME but he needed oxygen. I said NO.
I told Hospice Nurse that I was on my way, it would take an hour to get dressed and get there. When we got there, she had left 15 minutes prior.
My father was sitting up, not laboring for breath, didn't even remember he had been wheezing or pulling for breath, didn't remember the nurse being in his room for over an hour. So he was fine.
Next morning same Hospice Nurse called me and I told her 'thank you for taking care of XXX but it seems the morphine did the trick and the oxygen and inhalers were really not needed' and that started yet another argument.
Hospice Nurse then tells me that she is turning this over to her Operations Manger and I would be getting a call from her. And I did. And we talked for over an hour.
I voiced my concerns about the nurse comparing what she would do for her father versus what my father's health care directives read, I am following his orders. I told her I would sue for emotional distress due to being told over and over the very descriptive status of my father begging for help and clutching the nurse's hand...that I felt like she was trying to guilt me.
After our conversation, she sided with me 100%, she was not familiar with my father's medical history and his wishes.
She immediately changed his care plan to no oxygen, etc., and had it signed by my father's doctor.
He has since had another asthma/wheezing attack which was handled by morphine. And was fine the next morning.
The same Hospice Nurse is now siding with me and agreeing with the new care plan.
But the stress of having to deal 2 full days of numerous phone calls, arguing, not being HEARD took a toll on me, mercy.
When you say 'no', why is that not enuf?

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This nurse may have felt strongly that O2 would alleviate his suffering and therefore was willing to go to bat for her beliefs. You say he is in a care centre, is it strictly hospice or are there other levels of care provided there? She may have been unaware of his advance directives or unfamiliar with the hospice process.
That said it is unfortunate that you had to deal with this, I'm glad you were able to make your voice heard.
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I just wanted to say that from a professional RN's opinion that hospicenurse was EXTREMELY INNAPROPRIATE I have worked hospice and I don't put in my subjective feelings into the situation.Families are under enough stress/guilt as it is. I would have thrown her out of the house, and there is no way she would have continued to work with my loved one.Also since you have your paperwork in order this really should have not happened.Any nurse working with you r loved one should be immediately made aware by their supervisor that the patient that they are careing for has a DNR and comfort care measures only that are agreed upon by the patient ,MD,and family,--the hospice nurse is not supposed to take it on themselve to "do it their way" because that is what "they would do for their elder' that just crawls all over me that you had to put up with that.You are under enought stress.I also can't believe the company is still hiring her, that would have been terms for termination because it really was VERY inappropriate what she said to you very unprofessional.I was always there to support the patient and the family,with paperwork inorder I didn't decide to just start "practicing medicine".If I had a concern I would check with my supervisor for direction, keep the family informed and call MD if needed. My main goal was to not cause more stress for the patient or the family.
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Also with COPD patient's actually turning up the O2 can make their respiratory center shut down. Rule of thumb you don't turn up the O2 greater thatn 4lt/min.Their body's respiratory drive at this point is driven by their hi CO2 levels that their body has gotten use to, if all of a sudden they get hit with hi oxygen it can actually knock out the only respiratory drive they have.
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cwillie: this Hospice nurse is relatively new to the Hospice world, I believe that she has a lot of her previous nursing career 'do no harm, save the patient' thoughts (and any other time, I would commend her for that). The care center is a facility somewhat between Assisted Living and Skilled Nursing Home care, but there are multiple Hospice patients there. The nurse even said to me 'I know last week you and the doctor signed a new contract for NO oxygen or other means to ease the breathing...BUT..." speech. so she knew the directives and doctor's orders. What hurt (and made me angry) so much is that this same nurse had repeatedly done the "if this was my father who is 93..." . speech to me numerous times prior to the asthma/wheezing attack. I know she loves her father but she needs to keep her personal life out of her dying Hospice patient's life and the family. I know that sounds cruel, sorry. She is new to Hospice methods. I pray that she works out with Hospice coz she really is a good nurse in so many other ways. Thank you.
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timbukto: thank you from the bottom of my heart, for your professional opinion. That is exactly what I told her Operations Manager, that this is so hard as it is, to be the Bad Guy, saying 'no'. Even family has turned against me. I am doing my best to honor my father's wishes and follow his directives. But this Hospice Nurse made me feel like I was dirt, ya know? Even tho my father is NOT the best man in the world (he was a child abuser, drunk, drug taker, cheater, liar, narcissist, egotist...name it...he was it) but I don't care who you are, you honor that person's wishes, no matter what you think. Being a care giver, POA is HARD, and you fight battles every day. Thank you once again for your professional and personal opinions, they mean so much to me.
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KalaFW, thank goodness you are an intelligent, articulate and confidant advocate for your father. If not, this would have gone a different way. All I can say is thank goodness it was straightened out. I would not want that worker in my home again, even if she seems to have changed your mind. I would not trust that. She has some things to learn and I hope that her employer gets her that training ASAP. I would not place her anyway until she gets it.
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Nurses are people too, and in hindsight we can look back and see that they lack experience or training or are just having a bad day, but when we are in crisis and have to deal with that it just makes things so much harder. I'm glad you got things straightened out, I'm wishing you and your father peace on your journey.
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KaylaFW, it seems she changed her way of thinking and agreeing with you PROBABLY After she had a good Talking To from her Superiors! And is now trying to cover her butt. I guess to some degree you have to cut her some slack, as it must have been very difficult to have been there and witnessed the situation, and having come from the Typical' do no harm' background of Nursing, and her putting her own Familiar Paternal instinct into the equation, it should never have happened that way. You are correct, he made those difficult decisions about his own wishes, you are given the power to enforce those decisions, and yet it is so very difficult to always do exactly that. May God help you through your journey with your Father, you are doing everything Right!
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Thank all of you for your input. I'm taking a break for a while from agingcare.com. My father passed away a few days ago. thankfully, Hospice DID step up to the plate at the end and helped us thru his transition to death. I've enjoyed the many articles and advice over the past 2 years. Thank you.
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