Hospice is not a place but a state of treatment given by hospice staff. Hospice is carried out in many settings such as the patient's home, nursing home, hospice facility or private care homes. Many times people including nurses confuse Hospice order of Do Not Resuscitate (DNR) means do not treat. This is quite the opposite. The symptoms of the disease that the patient is dying from are treated but most of the time other diseases are continuing to be treated. An example is Atrial-fibulation is treated with anti-coagulants and antiarrythmics and the patient's PT/INR will continue to be monitored. Any comments?
Dee
Dee
ReplyDeleteWhat is your opinion on using anti-coagulants and monitoring PT/INR’s as we see our patients in the final weeks?
Scottie,
ReplyDeleteI have had mixed openion about this practice until I thought out the pathophysiology of not monitoring the PT/INR. If the patient is still able to take coumadin/warfaren orally, I feel that we should go ahead and monitor co-ag levels. I do not think that we should do veina punctures but monitor via fingerstick methods.
We are to treat the whole patient and if preventing a stroke in those last days takes a little monitoring I feel we should do it. After all we are NOT trying to hasten the death but make the passing more comfortable.
Dee
Good Dee--make sure you post consistently and read rubric. MAT
ReplyDeleteDee,
ReplyDeleteThe National Institute on Aging (2010)implied that just because one chooses Hospice does not mean discontinuing all their treatments.
My thoughts include:
Not all Hospice persons are actively dying. Nursing care and treatments should be provided virtually the same as if they were not a hospice client, with the exception of not treating to cure and illness rather treating to comfort the client without hastening nor prolonging death (Autumn Journey Hospice, n.d). I believe lab monitoring should continue as long as the client is recieving medications that alter their blood levels, such as the anticoagulants, antidiabetic medications, and antiepileptic medications.
Autumn Journey Hospice (n.d.). Compassionate care for the body, mind, and spirit[What is Hospice]. Retrieved from http://www.autumnjourneyhospice.com/whatishospice.htm
National Institute on Aging. (2010). Finding care at the end-of-life [Palliative Care and Hospice]. Retrieved from http://www.nia.nih.gov/HealthInformation/Publications/endoflife/02_finding.htm
Mary,
ReplyDeleteGood you have caputred the spirit of hospice. I have had to educate many nurses and families to the fact that the only change between Home Health and Hospice is that we will not be attempting to cure the fatal disease. We offer PT and OT also. The goal of Hospice is to keep the patient as active and comfortable as possible.
I have read many articles that cover such arease of treatment but very few on protecting the dignity of the patient. Many times the patient's hospital bed is placed in the main living area of a home and the pateint feels that they are on display. I have trained nurses when the bed is in the main area they are to do everyting they can do to orotect the patient's dignity and privacy. I feel that this is one very high concern with the patient.
What are your views on this?
Dee