In Prevention Magazine this month there was a very interesting article about a hospice doctor and what is involved in his end of life care for his patients. Sadly, I threw the magazine away and I can't find the article online, but if you can get your hands on it, it's a good read.
In any event, one of my residents passed away today and it made me think about the article. This resident's family chose to finally just let nature take its course. Unfortunately, in my opinion, they did not put the resident on hospice care. So, for the last three months or so, we have tried to feed this resident when they didn't want to eat, we have cajoled them into taking medications that they probably no longer needed and we did not make any changes to their pain medication routine that were worth mentioning. We just continued on as if they were stable or improving instead of making allowances for the changes they were going through.
Sad.
The thing that really hit home for me was the paragraph where they said that pneumonia is one of the least painful ways to die but, because it's easily treated, we cure the patient. This then forces them to continue to live in pain and subsequently die in a more painful manner.
Did I mention how many times my late resident was on antibiotics over the course of the last year? It makes me wonder how much more pain and suffering we caused them by getting them better as opposed to just letting them go.
I realize that this is a very personal choice. Maybe the resident would have wanted to live for as long as possible. I have seen more than one resident with a DNR change their mind at the last minute and do whatever they could to stay alive, so it's not out of the question. Still, I think the resident's Power of Attorney could have made better arrangements for them. Hospice care with an aggressive pain relief program might have actually extended their life and certainly would have improved the quality of the days they had left.
The list of things I don't understand seems to grow longer by the day.
Thursday, March 15, 2012
Saturday, March 3, 2012
If you want to become invisible...
...all you have to do is lose your mind.
Currently, I'm working with a resident who went to the hospital as one person and came back as another. Before they left, they were sociable, aware, and the village gossip. If you wanted to know anything about anyone in the facility, staff or resident, this was the person you went to see. You would routinely find their room occupied by other staff or other residents when you went in to care for them.
One day they found this resident unresponsive and sent them to the ER. They stayed at the hospital overnight for observation. And when they came back, something was obviously wrong.
Now the resident thinks their spouse is still alive and is looking all over the facility for them. They wander the halls asking for help. They cut holes in their catheter with fingernail clippers. Any stories they tell you aren't reliable in the least. Something in their head went "pop" and because they are nearly 100, there's no hope for repairing it without doing further damage.
Sadly, no one really knows how to deal with this. Instead of gathering in the room for a good gossip, folks are avoiding it like the resident has MRSA. Somehow, the resident still knows our names, but when they call for us, they don't know what they want, or they ask about their long-dead spouse, or they can't think of the word they need. When we can't figure out how to help them, they get angry and tell us we don't care.
It's heartbreaking and frustrating. I've worked with my share of residents with Alzheimer's Disease. This is nothing like that. This is like they've had a lobotomy. It's impossible to find the person they used to be and impossible to relate to who they are now.
I know we need to learn to work with the "new normal". It's just hard when the change is so sudden.
Currently, I'm working with a resident who went to the hospital as one person and came back as another. Before they left, they were sociable, aware, and the village gossip. If you wanted to know anything about anyone in the facility, staff or resident, this was the person you went to see. You would routinely find their room occupied by other staff or other residents when you went in to care for them.
One day they found this resident unresponsive and sent them to the ER. They stayed at the hospital overnight for observation. And when they came back, something was obviously wrong.
Now the resident thinks their spouse is still alive and is looking all over the facility for them. They wander the halls asking for help. They cut holes in their catheter with fingernail clippers. Any stories they tell you aren't reliable in the least. Something in their head went "pop" and because they are nearly 100, there's no hope for repairing it without doing further damage.
Sadly, no one really knows how to deal with this. Instead of gathering in the room for a good gossip, folks are avoiding it like the resident has MRSA. Somehow, the resident still knows our names, but when they call for us, they don't know what they want, or they ask about their long-dead spouse, or they can't think of the word they need. When we can't figure out how to help them, they get angry and tell us we don't care.
It's heartbreaking and frustrating. I've worked with my share of residents with Alzheimer's Disease. This is nothing like that. This is like they've had a lobotomy. It's impossible to find the person they used to be and impossible to relate to who they are now.
I know we need to learn to work with the "new normal". It's just hard when the change is so sudden.
Tuesday, February 14, 2012
Whatever It Takes
(I found this in a pile of my writing. If I posted this already, just disregard it. I couldn't find it.)
Sometimes in the interest of keeping my residents happy, I do things that make zero sense to anyone but the resident.
***
Mrs. A rolled up to me in her wheelchair.
"Let me sign that myself," she said.
"Sign what, Mrs. A?" I asked.
"Sign that paper," she said, like I had any idea what she was talking about.
So, I pulled out a Post-It Note, put it on my clipboard, handed her a pen, and held the board so she could sign it.
"Well, that looks like crap," she said as she returned the pen to me.
"No. I can read it. That's all that matters," I told her.
"That's all that matters," she repeated as she rolled away.
***
"What can I do for you, Mrs. B?" I asked as I entered her room.
"I want to go to bed," she said.
"It's about supper time. How about we wait until after you eat?" I leaned over her chair and turned off the call light.
"No. I want to go to bed now."
"Alright," I said and we got started.
By the time she was done washing up, changing into her pajamas, and brushing her dentures, she said, "I'm hungry."
I snorted. I couldn't help it. "Well, how do you feel about going to supper in your bathrobe?" I asked and held her teeth out to her.
She laughed. "Won't be the worst thing they've seen down there. Remember the time Mr. C took off his pants?"
***
"Here," Mrs. D said, handing me her slipper.
"Want me to put this on for you?" I asked, kneeling down.
"No. It's for you," she said.
"But, it's your slipper."
"You keep it," she said.
"OK. Thank you," I answered, smiling and walked to the clean linen room with her shoe.
Twenty minutes later I returned it to her room.
Sometimes in the interest of keeping my residents happy, I do things that make zero sense to anyone but the resident.
***
Mrs. A rolled up to me in her wheelchair.
"Let me sign that myself," she said.
"Sign what, Mrs. A?" I asked.
"Sign that paper," she said, like I had any idea what she was talking about.
So, I pulled out a Post-It Note, put it on my clipboard, handed her a pen, and held the board so she could sign it.
"Well, that looks like crap," she said as she returned the pen to me.
"No. I can read it. That's all that matters," I told her.
"That's all that matters," she repeated as she rolled away.
***
"What can I do for you, Mrs. B?" I asked as I entered her room.
"I want to go to bed," she said.
"It's about supper time. How about we wait until after you eat?" I leaned over her chair and turned off the call light.
"No. I want to go to bed now."
"Alright," I said and we got started.
By the time she was done washing up, changing into her pajamas, and brushing her dentures, she said, "I'm hungry."
I snorted. I couldn't help it. "Well, how do you feel about going to supper in your bathrobe?" I asked and held her teeth out to her.
She laughed. "Won't be the worst thing they've seen down there. Remember the time Mr. C took off his pants?"
***
"Here," Mrs. D said, handing me her slipper.
"Want me to put this on for you?" I asked, kneeling down.
"No. It's for you," she said.
"But, it's your slipper."
"You keep it," she said.
"OK. Thank you," I answered, smiling and walked to the clean linen room with her shoe.
Twenty minutes later I returned it to her room.
Monday, February 13, 2012
Ugh. Confession Time.
So, I got scratched, slapped, and bit the other day. I accomplished my objective, but neither one of us was happy.
The confession is that, at the time, I wished they would have broken a tooth when they bit me. Not because it would teach them a lesson, because at this stage of their disease-process, they aren't capable of learning. Solely for revenge.
I can't be the only one who feels this way. Still, it bothers me when I feel like I'm losing control. Wishing punishment on someone is not the same as meting it out myself, but thoughts are things and can become actions.
I'm only human, but I expect to be better than that.
The confession is that, at the time, I wished they would have broken a tooth when they bit me. Not because it would teach them a lesson, because at this stage of their disease-process, they aren't capable of learning. Solely for revenge.
I can't be the only one who feels this way. Still, it bothers me when I feel like I'm losing control. Wishing punishment on someone is not the same as meting it out myself, but thoughts are things and can become actions.
I'm only human, but I expect to be better than that.
Friday, February 3, 2012
Baby Steps
"Culture Change" is one of those things that Administration has been talking about for well over a year, but we haven't seen anything change at all, much less the culture. Finally, we have an ETA on our first step. The first week of March, we are changing to restaurant style dining.
The residents got together and picked a name for the "restaurant". We will have one CNA who will waitress during meals. If the residents want to choose their meal, they have to come to the dining room, otherwise, they will get whatever the meal of the day is. We're told that this will reduce the need for appetite stimulant medication and that folks will start gaining weight so we can discontinue the use of extra "shakes" or protein powders as they get back to "normal". It will also eliminate the need to rush everyone to the dining room by 4:45, since they'll be able to eat when they want within the designated meal times. It will also eliminate the snack cart except for the bedtime round because the resident will be able to go in and ask for a snack whenever the "diner" is open.
The other thing, which doesn't affect me since I work second shift, is that the residents don't have to be woken up in the morning and rushed down to breakfast. They have until 1000 to eat. No more of this "get your 5 residents up before you leave" for the third shift CNA's. No more residents who can't get their appetites going in the morning. They should all be able to get up and eat when they're hungry.
I'm sure we'll spend the month of March working the kinks out, but regardless, I'm excited.
The residents got together and picked a name for the "restaurant". We will have one CNA who will waitress during meals. If the residents want to choose their meal, they have to come to the dining room, otherwise, they will get whatever the meal of the day is. We're told that this will reduce the need for appetite stimulant medication and that folks will start gaining weight so we can discontinue the use of extra "shakes" or protein powders as they get back to "normal". It will also eliminate the need to rush everyone to the dining room by 4:45, since they'll be able to eat when they want within the designated meal times. It will also eliminate the snack cart except for the bedtime round because the resident will be able to go in and ask for a snack whenever the "diner" is open.
The other thing, which doesn't affect me since I work second shift, is that the residents don't have to be woken up in the morning and rushed down to breakfast. They have until 1000 to eat. No more of this "get your 5 residents up before you leave" for the third shift CNA's. No more residents who can't get their appetites going in the morning. They should all be able to get up and eat when they're hungry.
I'm sure we'll spend the month of March working the kinks out, but regardless, I'm excited.
Thursday, February 2, 2012
Well... OK, Then...
Sometimes there's just no appropriate response...
"So, the other day, I'm sitting on the commode," Mrs. A began and bent over in her wheelchair, resting her elbow on her knee and her chin on her fist. "You know, like you do. And I looked up and he's sitting in the doorway, staring at me. I wanted to get up and slap the back of his head off."
"Well, I'll bet you did," I answered, struggling to delete the image of Mrs. A making good on her threat.
"He belongs to someone. He's always clean and dressed nice. Why don't they keep him at home?"
"I just don't know, Mrs. A."
(Full disclosure: "He" is not, in fact, a male. "He" is a boxy woman with very short hair. She probably looks like a man if your vision is not what it used to be. And, since there are no locks on the doors, some of the wanderers do get into places they shouldn't. Someday, I'd like to work in a facility that has a separate wing for the residents affected by dementia.)
"So, the other day, I'm sitting on the commode," Mrs. A began and bent over in her wheelchair, resting her elbow on her knee and her chin on her fist. "You know, like you do. And I looked up and he's sitting in the doorway, staring at me. I wanted to get up and slap the back of his head off."
"Well, I'll bet you did," I answered, struggling to delete the image of Mrs. A making good on her threat.
"He belongs to someone. He's always clean and dressed nice. Why don't they keep him at home?"
"I just don't know, Mrs. A."
(Full disclosure: "He" is not, in fact, a male. "He" is a boxy woman with very short hair. She probably looks like a man if your vision is not what it used to be. And, since there are no locks on the doors, some of the wanderers do get into places they shouldn't. Someday, I'd like to work in a facility that has a separate wing for the residents affected by dementia.)
Wednesday, February 1, 2012
Wanna be a hero?
Learn how to program a television remote.
I'm not kidding. I have ladies who wait for me to come to work to fix their remotes when they stop working. You'd think I was Wonder Woman.
I'm not kidding. I have ladies who wait for me to come to work to fix their remotes when they stop working. You'd think I was Wonder Woman.
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