Patient comfort best practices

[Boho]

I have several thoughts on this topic:

I've heard hospital patients complain about not being allowed to get out of their beds and the roller-things their put on when no rooms are available. They're stuck, sometimes for days, laying on their back. Sometimes they can't turn over on their own. Are patients given the opportunity to at least sit up in the presence of a nurse as often as they should, just for comfort reasons? I remember my grandmother, and someone much younger in my grandmother's room, being disallowed to get out of bed and they were very uncomfortable there. They were fully awake and not sedated so they had to experience this.

For patients who can't communicate, is their temperature checked for comfort reasons and their bedding or AC adjusted accordingly in a timely manner? I read a few years ago that some hospitals don't have thermostats. That's not a hospital I'd want to be stuck in. Even with a thermostat, a person could be overheating in bed like I often am, but at least I'm not hospitalized and I can adjust the fan and remove blankets and clothing. I read about someone who had a bad heat related dream, then it turned into a cooling off dream and it turned out that nurse responded to his overheating by placing something cold on his feet.

I read about some alternative to intubation that's more comfortable that not all hospitals have. That's a no brainer. I assume every hospital would prefer to have that device. I forgot what it's called.

Anesthesiologists say they should be utilized more rather than other medical staff making anesthesia decisions. I wonder if there's underutilization of certain kinds of anesthesia because it's more expensive. I wonder if the government should fund all anesthesia for hospitals to make sure hospitals don't skimp on patient comfort just because it won't hurt their stats.

At the end of life, if the machines are turned off and it's believed the patient won't survive, should the patient be given something to prevent any chance of suffering? I read about a long series of bad dreams someone had while intubated. If he was disconnected, it would be easy for the family to think "he was out so he's not suffering" but that's not necessarily the case.

 

[pacergal]

A bit confusing. Are you talking about comfort care for end of life?

For care in general, when I was in hospital nursing (this was 40 years ago), at minimum we turned and re postioned comatose patients every two hours, massaged skin, added pillows, blankets, etc. Heck, even alert patients we encouraged/cajoled/ patients to get up out of bed, sit or walk as they could frequently. Not only helps decrease risk of pneumonia, but also muscle atrophy. Vital signs checked either every 4 hours or every shift, so you knew rather soon if someone was starting a fever.

End of life comfort care/hospice care is a whole entity in itself.

 

[Calico]

I don't know where or when you "have heard about" or "have read about" these random, anecdotal examples of poor hospital care.

Every time I have been in the hospital as an inpatient (and it's been a few times over the last 20 years) I have received stellar care.

Not only that, but every single time the nurses were on me to get up and about ASAP, for all sorts of health reasons. I may have called them some names (quietly, under my breath!) thinking it was too soon, but of course every single time they were proved right. Nurses are usually right!

I have been anesthetized several times and there was no skimping.

I don't know if the OP is anticipating a hospital stay, and therefore looking for problems where they don't exist.

If you spend enough time on Google you can find anecdotal evidence of anything happening to someone, somewhere, some time. That doesn't make it so in the majority of cases.

 

[Vacation4us]

I think the OP is pretty clueless.

If you haven’t personally experienced a problem your basing your opinion on, what?

 

[Boho]

I think the OP is pretty clueless.

If you haven’t personally experienced a problem your basing your opinion on, what?

If it's not what I've seen it's what I read from a source I believed. I may be able to provide more information on one of my points if someone's interested. I have a lot of notes.

The lack of thermostats in some hospitals should be easy enough for me to re-research. If I'm way too hot in bed I don't want to wait up to four hours for my temperature to be checked. This one is personal experience: my grandfather was unable to speak in the hospital but he gestured something that my father finally figured out (hopefully correctly) meant he wanted the window opened. My father opened the window, but it's impossible to know whether that alleviated my grandfather's discomfort. Maybe the temperature of a patient who can't communicate should be constantly monitored and there should be some kind of alarm when it reaches the point of discomfort. If so, something effective should be done.

 

[MrsHaloFIRE]

For end of life, research hospital palliative care. Not familiar with them unplugging ppl and walking away. Generally there is some sedation and painkiller as I understand it. Just like with hospice care.

Good nursing and good family member observers should be able to pickup on new needs through assessment.

Not familiar with restricting patients in beds. They will code you as a fall risk if you are and want to be with you when you move.

As far as thermostats in individual rooms allow me to save you some time: some hospitals have them, some don't. And some only have them in new wings. Ive seen both. In my experience hospitals are kept cool i think to inhibit germ growth. I can tell u the military hospitals do not tend to have thermostats but the nurses know this and ive had them literally blow hot air under my blanket in recovery but DH was told prior to wear a jacket bc he was on his own. I love nurses. A good nurse will save your life and your comfort. They have tricks you never expect.

 

[Boho]

For end of life, research hospital palliative care. Not familiar with them unplugging ppl and walking away. Generally there is some sedation and painkiller as I understand it. Just like with hospice care.

I have personal knowledge of someone for whom a DNR order was issued when he lost consciousness. He was breathing but needed CPR and was seemingly unconscious (by the looks of it from a non-medical professional). Sedation was requested by the family at the time of the DNR order and two doctors/nurses dismissed the need. They just let him be until he died. He was possibly on morphine already but there was no upgrade in pain killer in light of the fact that he was expected to die. And it's not like they scanned his brain to see whether it was possible for him to experience discomfort such as from losing the ability to breathe due to heart failure.

 

[ivinsfan]

I have personal knowledge of someone for whom a DNR order was issued when he lost consciousness. He was breathing but needed CPR and was seemingly unconscious (by the looks of it from a non-medical professional). Sedation was requested by the family at the time of the DNR order and two doctors/nurses dismissed the need. They just let him be until he died. He was possibly on morphine already but there was no upgrade in pain killer in light of the fact that he was expected to die. And it's not like they scanned his brain to see whether it was possible for him to experience discomfort such as from losing the ability to breathe due to heart failure.

Well if this is the best you can come up with, you need to dig a little harder. There are enough holes in this story to drive a truck through.


Keep better notes...

 

[MrsHaloFIRE]

LOL's boho. Cpr on someone who is breathing....

 

[Boho]

LOL's boho. Cpr on someone who is breathing....

Yes. It's done. You're not supposed to wait until a person stops breathing. He needed CPR, shocks, and/or a breathing tube. He was deprived that due to the DNR order, and he was also deprived extra sedation.

 

[ivinsfan]

Yes. It's done. You're not supposed to wait until a person stops breathing. He needed CPR, shocks, and/or a breathing tube. He was deprived that due to the DNR order, and he was also deprived extra sedation.

What on earth are you trying to say here? It makes no sense.

 

[harley]

Yes. It's done. You're not supposed to wait until a person stops breathing. He needed CPR, shocks, and/or a breathing tube. He was deprived that due to the DNR order, and he was also deprived extra sedation.

Just to make sure you understand, DNR stands for Do Not Resuscitate. Three words, not a one of which implies intervention. So what are you talking about?

Personally, I'm going to a Medicate Into a Stupor order, but that's just me.

 

[Boho]

Just to make sure you understand, DNR stands for Do Not Resuscitate. Three words, not a one of which implies intervention. So what are you talking about?

Yeah, I mean rightfully "deprived." My point is that chest compressions and shocks are sometimes given when the patient is known to be breathing. Even conscious.

 

[ivinsfan]

Yeah, I mean rightfully "deprived." My point is that chest compressions and shocks are sometimes given when the patient is known to be breathing. Even conscious.

You are messing with us now,right?

 

[Boho]

You are messing with us now,right?

I'm not even in the hard to believe realm yet. I have stuff in that realm but you're not ready for it.

Look it up.

 

[youbet]

I'm not even in the hard to believe realm yet..

Really? Well, I guess it depends on the reader. It's been hard for me to believe from the get-go. Just sayin' ............

 

[Boho]

Really? Well, I guess it depends on the reader. It's been hard for me to believe from the get-go. Just sayin' ............

I've been researching this topic for years and I can probably give references to anyone who cares to be specific. But some of this stuff is pretty easily Googlable by anyone.

 

[harley]

You are messing with us now,right?

He's right.

 

[Calico]

I've been researching this topic for years and I can probably give references to anyone who cares to be specific. But some of this stuff is pretty easily Googlable by anyone.

Thereby confirming my post #3.

PLEASE keep all of this "stuff" to yourself.

 

[RobbieB]

No more stuff is needed thanks.

 

[Boho]

What are you even talking about, that CPR isn't done on someone who's breathing? And you reject theoretical references before you even see them. WTH...I think every doctor and nurse knows this about CPR. That's not even the point. A large percentage of people may die in immense discomfort because they're not given sufficient sedation. That's the point and it shouldn't be dismissed.

 

[EastWest Gal]

I stayed out of this thread, but became frustrated by your lack of actual knowledge of the subjects you are bring up. As someone who has dealt with these issues, fortunately very rarely, I will respond to two points only:
The point about sedation and the point about DNR and CPR.

Your last post:

What are you even talking about, that CPR isn't done on someone who's breathing? And you reject theoretical references before you even see them. WTH...I think every doctor and nurse knows this about CPR. That's not even the point. A large percentage of people may die in immense discomfort because they're not given sufficient sedation. That's the point and it shouldn't be dismissed.

You seem to be refuting someone who said CPR is not administered to someone who is breathing. You said it twice before.

I have personal knowledge of someone for whom a DNR order was issued when he lost consciousness. He was breathing but needed CPR and was seemingly unconscious (by the looks of it from a non-medical professional). Sedation was requested by the family at the time of the DNR order and two doctors/nurses dismissed the need.

Yeah, I mean rightfully "deprived." My point is that chest compressions and shocks are sometimes given when the patient is known to be breathing. Even conscious.

This shows a complete lack of knowledge about what CPR actually is. CPR and defillibration are never administered when people are breathing and conscious. It is administered when there is no respiratory effort and when there is an absent pulse. The person has no oxygenation or circulation to the brain and cannot be conscious. You may be confusing this with a procedure called cardioversion, which is a therapy for some cases of atrial fibrillation and supraventricular tachycardia. This has nothing to do with CPR and defibrillation. Take a CPR/AED course (everyone should). You might learn something, and you may even save someone's life someday.

Regarding your original point about sedation:

At the end of life, if the machines are turned off and it's believed the patient won't survive, should the patient be given something to prevent any chance of suffering? I read about a long series of bad dreams someone had while intubated. If he was disconnected, it would be easy for the family to think "he was out so he's not suffering" but that's not necessarily the case.

If you are withdrawing supportive care, you aren't going to continue to provide assisted ventilation. If they are already intubated and you are not withdrawing respiratory support but stopping short of chest compressions, as in a DNR order, then they will remain appropriately sedated for the discomfort of intubation and supported. There are many levels of withholding further support, and there are detailed Advanced Directives (when the patient has one) and ethics procedures in place at every hospital to guide physicians. Whole books and journals and ethics committees are devoted to this topic. It is a very complicated topic and cannot be dealt with on a forum like this one.

You are advocating for high dose sedation for an unconscious person with no evidence of distress. Increasing sedation will hasten death. This is euthanasia, which is treated as either murder or manslaughter depending on circumstances, and can result in life imprisonment. The doctors and nurses who "dismissed the need" were entirely correct to do so.

 

[Boho]

CPR and defillibration are never administered when people are breathing and conscious.

Not true!

You are advocating for high dose sedation for an unconscious person with no evidence of distress.

Yes.

Increasing sedation will hasten death.

I don't believe that's the case with ketamine.

This is euthanasia, which is treated as either murder or manslaughter depending on circumstances, and can result in life imprisonment.

It's not necessarily either. It depends on the state. And it's even more complicated than that. I can provide more details in the morning.

 

[EastWest Gal]

Ketamine is a general anesthetic that can cause disturbing hallucinations and a dissociative state. Pointless in an already unconscious person.

And there is a difference between euthanasia and physician-assisted suicide.

I’m done.

 

[ivinsfan]

Not true!

Yes.

I don't believe that's the case with ketamine.



It's not necessarily either. It depends on the state. And it's even more complicated than that. I can provide more details in the morning.

Do you often have occasions when you are 100% right and everyone else is either wrong or stupid? If so,you might want to take a close look at what else you have going on... repeating something endlessly does not make it true.