Arrow posted "As a hospice nurse who works in a free standing hospice it is good to hear that there are nurses like you out in the hospital setting.
Too many times we receive patients who are in the throws of imminent death only to survive for a few hours once they reach our facility. We have even had cases where death occurred in the transport van. This should not happen and is most shocking for the family and not appropriate for the patient to make a peaceful transition.
Hospital professionals need to learn the signs and symptoms of early imminent death and act appropriately and accordingly for the best interest of the patient first and the family second. Most nurses don't know these signs and symptoms and can not make an accurate early assessment. We know this because we are constantly have to train them in this assessment at our facility.
In our free standing hospice we dread the holidays because we know the hospitals are going to dump on us. The day before major holidays we have upwards of 5 and more admissions. This tells us that routinely throughout the year patients are not referred to hospice as they should be and we suspect because the doctor still views them as a cash cow. But when the holidays come they dump these patients on us because they want their precious time off.
Doctors and nurses need to do more in the hospital setting to evaluate a patients condition more accurately, circumventing false hope and provide a realistic prognosis to patients and families so that hospice can intervene in a timely manner whether in hospital through a community hospice agency or through transport to a hospice facility. When patients come to us with agonal breathing and mottling we know that the hospital team has done too little too late.
We understand that some nurses and doctors fear death and view death as some kind of failure of their work, the system or even of the patient.
It is a paradigm shift to see death truly as a natural process and evolution of the spirit in our face paced hi tech medical world. The death process can be guided so that family and personal issues are resolved in a timely and sometimes expedient manner. It requires trained nurses, doctors and counselors, a team focused on the patient and family, well trained in the hospice philosophy, to assess the pitfalls and provide structure and support for emotional and spiritual transitions as well as proper pain and other symptom management.
This was such a great response to the post below, that I had to print it on the same page. Death and dying are such important issues that nurses should know how to deal with. We are privileged to be there in those times. I only hope that someone will be comfortable enough to make the transition easy for me when it's my time to fly.