It Takes A Village
Silence. Abandonment, Isolation. Fear. No one wants to be alone. Neither did Mr. Johnson.
When Mr. Johnson arrived at a local skilled nursing facility, the facility called Arbor Palliative Care. Mr. Johnson was residing in their acute observation room after being discharged from the hospital following a flare up of his chronic obstructive pulmonary disease and pneumonia. He was experiencing extreme physical decline, increasing difficulty breathing and heart failure. And Mr. Johnson kept saying he was afraid - afraid of being alone.
Arbor Palliative Care Nurse Practitioner, Danielle, MSN, FNP, spoke with Mr. Johnson's physician and the facility staff about her assessment. Mr. Johnson's difficulty breathing could be improved with the addition of morphine sulfate.
"I spent time explaining the benefits of morphine for individuals with difficulty breathing," said Danielle. "Spending one-on-one time with the facility nurses was valuable. Comfort medications are very different from other medications. It is normal for facility staff to be unfamiliar with them and how they can enhance quality of life."
Danielle also spent time educating Mr. Johnson and his brother about his declining health at the end of life. They discussed Mr. Johnson's goals for care. Danielle learned that Mr. Johnson did not want to go home. He was tense and afraid.
"Mr. Johnson was hospice appropriate," Danielle said. "No one had talked to Mr. Johnson or his brother about their goals for care. These are difficult conversations to have. They take time. Patients and families have a lot of questions. I was able to explain how Mr. Johnson could stay in the facility and receive all of the services from a hospice team. He would be comfortable and at peace."
Together, the facility, Arbor Palliative Care and the patient's physician were able to achieve Mr. Johnson's goals. He stayed at the facility where he was surrounded by familiar caregivers, he received additional support from Arbor Hospice and comfort care in his last days.