I'm a nurse case manager. An attending physician has been pressuring me to convince a family to accept hospice. The patient, 87, has end-stage heart failure and is hospitalized frequently. The physician wants me to tell her sons and husband that she needs to just be kept comfortable at home.
Mrs. Fields knows she's terminally ill. But she still has good days and wants to be hospitalized for "tune- ups." I sympathize with her wishes but feel caught in the middle. What can I do?-S.W., ARIZ.
This difficult situation warrants patient advocacy. To do this effectively, assess your patient's situation based on her condition and her wishes, not her age.
Elevate the professional relationship by truly "seeing" your patient. Find out who she is and how she lives her life. This is how I approached the daughter of an 89-year-old patient with a rare hematologic disorder. His oncologist insisted that I convince his daughter, with whom he lived, that it was time for hospice.
"He's severely anemic and has to be admitted about every 3 weeks for transfusions," he said. "I've spoken numerous times to Terry about this but she refuses to stop. If anyone can get through to her it's you."
I appreciated his confidence in my abilities but he certainly wasn't pleased with the results of my visit.
Mr. Irving sat in high-Fowler's position listening to his daughter read to him while a unit of blood dripped into his vein. He smiled and shook my hand when I introduced myself. I listened intently as both Mr. Irving and his daughter spoke of their lives and how the past year of illness brought them closer.
"Daddy knows there's no cure, but he feels so much better after a transfusion."
"Like night and day," said Mr. Irving.
"Dr. Rivera wanted me to talk with you about hospice," I said.
"Daddy isn't ready for hospice, and neither am I. Did Dr. Rivera mention that he told us Daddy needed to stop getting blood because there's a shortage? As if Daddy's taking it and doesn't deserve it!!"
"You know what I said to that?" Mr. Irving asked indignantly. "I said that my family donated blood for many years, and so did I, before I got sick. Now it's my turn."
"You know folks, I think you have every right to keep on the way you want," I said. "I support you and am available if you need an advocate."
Terry rose from her chair and hugged me. Tearfully, she whispered, "Thank you, so much."