Hospice Care/Foley usage in the Hospice Patient
I am a Hospice Nurse at a residential hospice house. We have recently changed our medical director and with that change our use of indwelling catheters has also changed. I view the use of catheters as a "comfort measure" for our bedbound, incontinent patients. Our new medical director views them as "taking away the dignity of our patients". For many of our patients, just the slightest movement causes them pain, we are aware of the increased potential for skin breakdown due to immobility, decreased nutritional intake, and moisture on the skin. Our previous medical director also said that increased restlessness was most often caused by urinary retention and more times than not a person's restlessness was decreased once a foley catheter was placed. I am having difficulty finding evidenced based research regarding foley placement as a comfort measure in the dying patient. I would like your opinion and any direction you can provide in foley placement in the dying patient.
Thank-you for being an advocate for hospice patients. I concur with you about use of indwelling foley catheters for end of life pt. I recently had a pt that was restless, night nurse started Ativan and then added rotation of Haldol. The patient became "zombie like" per family report and when catheter was placed restlessness subsided. The issue, she had a residual of 550 ml after voiding. In many cases this is a comfort measure as the muscles relax. As you know the bm's may become incontinent and increased difficulty swallowing.
I am surprised you are have difficulty with EBP articles but with the push to no cath I guess this could be. I think to present this a common sense approach as you have presented would allow this to be a more common practice with your hospice. The increased exposure to concentrated urine on the skin combined with the increase risk of compromising skin integrity as the nutrional intake lowers and the body can no longer process intake of a food source is strong evidence to support catheter. I wonder if the new medical director has their own personal issues.
I did a quick search with use of words "foley catheter at end of life" and "bladder management at end of life" and found articles to support the use of catheter. I am not sure to what extent your physician will be open to this information. One thing I have done when a physician does not want to listen to nurse staff is to elicit another physician to be willing to engage in this type discussion. Another thought would be to have an inservice and invite the MD.
Hope these ideas are helpful in some form. I leave you with one question to pose " Is dignity have a higher level of concern than comfort? I do know much dignity is lost but to what cost and what is the priority of the patient and family?