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Partners in care

As nurse-manager in a palliative care unit, I like to make everyone on staff feel like part of the team, including ancillary staff members and even housekeepers. At the same time, I know that sharing privileged information about patients with staff members who don't "need to know" isn't appropriate (or even legal).


How can I make these employees feel like part of the team without violating patient confidentiality?-T.R., N.C.


With tact and discretion. The following experience may give you some ideas.


Recently, I visited a patient, Mrs. O'Grady, who'd been admitted for recurrent colon cancer. Because she was anemic, her health care provider ordered a stool specimen to test for occult blood. As I explained this to Mrs. O'Grady, she interrupted me. "I'm supposed to give a stool sample, but the toilet's dirty. I don't like that. I like things to be clean."


"I'll take care of it immediately, Mrs. O'Grady," I promised.


Walking up the corridor, I saw a housekeeping cart near the nurses' station. As I searched it for cleaning products, a housekeeper named Bridget emerged from room 301 carrying a mop.

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"Do you need something, Joy?" she asked.


"Yes, thanks. Mrs. O'Grady in 310 is upset because the toilet in her bathroom needs to be cleaned."


"I'll do it right now," she replied cheerfully.


"I know you have a routine, working your way down the hall, but I was hoping...."


"Hey, no problem," she said. "I'll do my part so you can do yours."


Thanking her, I made sure to say how much this small act of kindness would mean to my patient. Bridget was smiling as she positioned her cart outside room 310.


By acknowledging her role as a member of the care team, I ensured that Bridget felt valued for an often underappreciated job.



Hospice under pressure to admit

I'm the patient-care coordinator for a not-for-profit home hospice program. Competition for patients is high, so our board suggested we "loosen up" our admission criteria and accept patients who are receiving terminal chemotherapy. This doesn't sound like hospice care to me. What's your view?-L.K., ILL.


I agree: It's not hospice.


I'm saddened to see how the hospice philosophy is being diluted in the name of marketing. Some home hospice programs are now admitting patients receiving "palliative chemotherapy"-an oxymoron if I've ever heard one. Kept in "treatment mode," many of these patients spend their precious final days coping with burdensome adverse drug reactions.


Too often, the prevailing attitude in a low-census hospice is to do whatever the family wants. This might include tube feedings that serve only to prolong the dying process and create an atmosphere of denial. This is a gross injustice to the patient, who receives the unspoken message that he can never become a dying man, but must always remain a sick man. The late writer Stewart Alsop touched on this when he wrote about his own lost battle with leukemia. "A dying man needs to die, as a sleepy man needs to sleep, and there comes a time when it is wrong, as well as useless, to resist."


Our society and even some hospices deny the dying man his final act. At the end of life, we must constantly pose the question of burden or benefit. I once thought that hospice would always be there to answer the question to the patient's benefit. Now I'm not so sure.