penguanne

Ouch - not a comment I'd want my nursing colleagues to see.

Do you look at people's homes when you're on a call notice how messy they are? What do you hate to see in a home?

Thanks, be safe!

Hospice RN here. My experience with patients new to the program, especially oncology patients, is that they often get the "terminal news" very, very late in the game. They've been through 3 kinds of chemo, radiation, and a trial drug, and each time something new is prescribed, they have a renewal of hope. Then when the onco reaches the point of absolutely zero treatment options, hospice is offered as kind of afterthought. I've been to hospitals to see referred patients, read the progress notes prior to seeing the pt./family, and understand very clearly that there's no other options for the patient. But when I walk in and introduce myself as the hospice nurse, it's shock and dismay - "The doctor said I just have to get stronger and get my cell counts up, then I can start chemo again" or some variation.

On the other hand, sometimes patients have received the news early and have been in denial and unable to accept their doctor's recommendation to stop treatment. Those are patients who I see calling 911 more often than any others - they accept hospice as comfort care/quality of life management, but when they start to decline or face an anxiety-producing situation, they panic and revert to acute care. We explain to patients clearly - it's part of our consent forms - that they have to get the OK from hospice to seek acute care related to their terminal illness or else Medicare/insurance won't pay - but again, panic mode. Also, during the consent signing process (when all this is explained), patients and families are spinning in crisis mode. Studies show they only retain about 25% of what's discussed at admission.

Finally, one of the benefits of the hospice model is that each patient has a team - MD/DO, APRN, RN, SW, chaplain, nurse aide, volunteer - and each of those team members work with patients/families to help them work through the issues related to death and dying. Unfortunately, in my 10 years as a hospice RN, I've had cases in which that acceptance was never reached, and the pt. died in an ER because the family panicked and called 911. And as OP stated, the length of stay for some patients is just too short to establish a therapeutic relationship...again, especially those oncology patients, who are often at death's door before their doc (or an unfortunate hospitalist) refers them.

Hospice nurse here, I've visited plenty of those buggy homes, and...ewwww. Take nothing in with you! How about general clutter? In other words, should I straighten up the place between calling 911 and opening the door? :)

Hi Stachetober! First, do you and your crew participate in Movember? That stache gives you a huge head start...

Also, what's something people SHOULD call the FD about, but don't? And do you get annoyed if you go to a call and it turns out to be a false alarm, either medical or fire?

Thank you!!