Dying with dignity –sometimes dying at home isn't a good choice
Posted Sep 06 2013 12:00am
With all I have seen, all my client experience, I have come to the conclusion that dying in hospital is going to be my choice. Yes, we have fabulous palliative care programs; Home First, with nurses who visit the home; pain management specialists (CCAC nurses) who make house calls to assess pain and find management strategies; PSWs who visit twice daily to clean and refresh the patient.
There is much in place in Ontario to permit a palliative patient to pass peacefully in their homes. More often than not, this is the case. You can read many obituaries that state such, 'died peacefully at home.'
However, there are protocols that palliative nurses understand, and family members may not be able to manage. The protocols are clear and research-based.
The clients I have supported in hospital have a CAD pump, which puts morphine into their systems on a regular basis, keeping them out of pain.
The nursing staff come in, two at a time, to turn the patient, to prevent or reduce bed sores, when they are no longer able to move themselves, or when they are in a coma.
Nursing staff understand the need for regular pain management. Yes, the Charge Nurse for a CCAC Home Care client can order a Symptom Management Kit, a small amount of morphine (usually) that is easily accessible at 2 a.m. when a patient needs pain relief on an emergency basis. A doctor is not usually available for a home visit at that time. And a trip into the ER is a horrific thing at this stage of life.
We want the palliative patient to be kept clean, dry, hydrated, medicated, relaxed and comfortable. Some staff and caregivers hesitate to provide regular pain relief, to keep on top of the pain, due to pain management myths. Caregivers may misunderstand agitation , when it is a sign of pain, and expect their loved one to tell them when they are in pain. See also
Pain Management in Palliative Care Patients
Many stoic seniors refuse pain management. My father couldn't articulate his pain, as his tumour was in the area of language. Another client would pick at her clothes, her daughter suspected she was in pain, but one weekend nurse disagreed and complained to my supervisor that I did not know what I was saying.
There may come a point, despite the patient's wishes, when they are better off dying in hospital, in a bed, not in an ER.