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Hospice nurse reveals people's last words before they die

A hospice nurse has revealed the number one thing people say in their final moments before they die. Healthcare expert Julie McFadden, who makes online videos discussing death to help break the taboo around dying, has shared the three most common regrets patients share on their death beds. Speaking to NHS surgeon Dr Karan Rajan on his podcast, Julie said these final discussions tend to centre around what they've taken for granted. "The first one I hear all the time is that they regret not appreciating their health while they had it," Ms McFadden said, reflecting on her 15 years of working in the health sector. "That's the number one thing people say to me, I wish I would have understood how amazing it is to have a working body." The second regret she often hears is people admitting they "worked too much" and wish they hadn't worked their life away, and rather spent time doing things that brought them joy. Finally, she revealed in the clip shared to Instagram, that many dying patients have regrets about relationships. The nurse explained people either wish they had maintained certain relationships and friendships, or regret holding grudges. Dr Rajan responded to Ms McFadden's insight with a story of a young patient that made him realise we are not 'immortal' and we should not take our life "for granted". In the clip shared with his 1.5million followers he said, "A few years ago when I saw a young woman come in with pancreatitis in her 20s, within three hours this young woman is in the intensive care unit, she's intubated, ventilated, and the next day, she had passed away." "That just made me think wow, I'm in my 30s now, I'm 34, life can just go in a flash. So yes, truly don't take it for granted, we sometimes have this tendency to walk around like we're immortal." Image credits: YouTube

Caring

Hospice nurse shares what happens to the body after death

A hospice nurse has revealed the reality of what happens to our bodies in the minutes, hours and days after we die. In her efforts to break down the taboo around conversations about death, Julie McFadden, a hospice nurse from the US, posts candid videos about death and dying to help us be more informed and prepared. In Julie’s latest video, she explains exactly what happens to the human body in the moments, hours and days after someone dies. Nurse Julie said that in the immediate moments after death, the body completely relaxes, beginning the first stage of decomposition, called hypostasis. “All of the things in your body that are holding fluids in, relaxes. That's why death can be messy sometimes.” She clarified that because of how relaxed the body becomes, those who have just died may urinate, have bowel movements or experience bodily fluids coming out of their nose, mouth, ears or eyes. Nurse Julie added, “I like to talk about it so people aren't surprised if that happens - very normal and to be expected sometimes.” This is also when the stage of decomposition called autolysis, or “the self-digestion” stage, occurs and enzymes begin to break down oxygen-deprived tissue, also causing the body temperature to drop. As the body settles in the hours after death, Nurse Julie said the blood will begin to pool downward toward the ground. She said, “If you let someone lie there for long enough - which we do sometimes; you don't have to hurry up and make sure your loved one leaves the house - if you turn them you will notice usually the back of their legs the whole backside of them will look purple or darker that's because all their blood is pulling down.” “Gravity is pulling it down. So they will eventually get a darker colour tone of skin on their backside.” One to two hours after death is also when rigor mortis - or the stiffening of a body’s muscles - sets in and continues for about the next 24 hours Nurse Julie said, “I have seen people become very stiff almost immediately - like a few minutes - after death and other people, their body takes longer.” Additionally, about 12 hours after death, the body will feel cool to the touch. About a day to a day and a half after a person dies, rigor mortis subsides and the body will begin to loosen again, as Nurse Julie said the body's tissues relax and cause the stiffness to break down. By this time, the body is usually in the mortuary, which will prepare the body in whichever way the family has requested, whether it is for burial or cremation. She added, “In a world where people didn't have access to a mortuary or a healthcare system and they just died naturally, our bodies are built to, after death, decompose.” Image credits: Shutterstock / Instagram / YouTube

Body

Hospice nurse shares the four physical stages of dying

A hospice nurse has shared the four things that happen to your body in the months, weeks and days before you die. Julie McFadden, who specialises in end of life care, shares videos about death and dying on social media to open up the conversation on the taboo topic, to help better prepare people for death. In her latest video, a viewer asked Julie what the dying process actually looks like, as the nurse explained that it all depends on how, when and why you pass away. However, she said there are four things that happen to the body as the end draws near. The first stage of dying is slowing down, which can happen up to six months before you die, with the symptoms being very "generalised". Julie says, "For instance, you’re just going to be generally tired, generally lethargic, not eating and drinking as much, probably being less social." According to Julie, the second stage is a sharp decline in strength, as she explains, "The closer you get to death – let’s say three months out – you’re going to be more debilitated." "It’s going to be difficult for you to leave the house, you probably are eating and drinking very little throughout the day, and you’re sleeping more than you’re awake." <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">Before the last stage of life, Julie describes a period of "transitioning" which happens around a month before death and can include a phenomenon known as "visioning". <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">The nurse says, "This is when people will start seeing dead relatives, dead loved ones, dead pets, things like that." She says that typically, someone "can be up and having a normal conversation with their family", all the while "saying they’re seeing their dead father in the corner who is smiling and telling them he’s coming to get them soon and not to worry." <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">According to Julie, this final stage of death is considered the most "distinct time in the dying process" when the body starts to fully shut down. <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">"The actively dying phase is what scares people, because they’re not used to seeing it and they don’t know what the heck’s going on," she says. <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">‘Metabolic changes’ such as a difference in skin colour, high and low temperature, or the ‘death rattle’ – a gurgling noise (also known as terminal secretions) caused by a buildup of fluids in the throat and upper airways – follow before they later pass on. <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">However, while it’s natural to find these things upsetting, Julie assures people this stage is a "normal part of death and dying", and "it’s not hurting your loved one." <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">"It’s important to be educated about what death actually looks like. Movies and television don’t do it justice, then people see it in real life when it’s their loved ones and they freak out," she said. <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">Image credits: YouTube / Instagram

Caring

Hospice nurse reveals the key to a peaceful death

Hospice nurse Julie McFadden has shared her best advice for ensuring a peaceful death, after learning from her patients in their final moments. The healthcare professional, who is known for her YouTube channel where she shares information about death to break the taboo of conversations around dying, shared a video about what you can do in life to ensure a peaceful passing. In the recent clip, she shared what you can do in order to have a peaceful death, and she says it comes down to preparedness and acceptance. "That's one of the biggest things I see," she explained. "People who plan for death will tend to have a more peaceful death than those who do not plan for death." "A prepared death versus a non-prepared death - that's the one thing that I've seen in all of my patients," she explained. Julie said she noticed the patients that were "willing to talk about the hard stuff" had a more peaceful death. <iframe title="YouTube video player" src="https://www.youtube.com/embed/qoFvKkfIo00?si=Ba5BnxuaKsBVaGAe" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe> "[That means] willing to ask the questions about, 'how long do you think I have? What can I expect? What should I do before I die to make this easier for my family?'" she listed. Julie went on to share a story of when a patient of hers died peacefully surrounded by his family, explaining that the patient was in hospice and had started to decline around 20 minutes after she arrived. "He started having weird changes in breathing, so this was a sudden decline and it looked like he may suddenly die," she recalled, adding the abrupt change was "uncommon actually" in hospice care. "What I noticed was because this family - and him - were so prepared, instead of the family [being] chaotic and reacting in an emotional way - which is very normal - they flipped along right with him," she explained. "[They laid] in bed with him. They understood immediately what was happening. They didn't panic," she shared. Julie said the man was surrounded by his loving family and it was an overwhelmingly emotional experience. "It makes me cry every time I think about it - that vision of them all being able to understand what was happening, even though it was a change they didn't want," she explained. "By the end of that visit he died, so he went from kind of looking okay to dying which is hard - but that family made it a beautiful moment," she said. Image credits: YouTube

Caring

Hospice nurse reveals six unexplainable "death bed phenomena"

Hospice nurse Julie McFadden has lifted the lid on six unexplainable "death bed phenomena" that occur within a person's last weeks of life. The LA-based nurse, who specialises in end of life care, explained that as a person nears the end of their life, they will experience a range of unusual things, including hallucinations, random bursts of energy and even choosing when they're going to die. McFadden once again took to her YouTube channel to educate people on what happens when you're on your death bed, detailing each of the six strange occurrences. Julie explained that patients often experienced "terminal lucidity", "hallucinations", "death stares", and more in their final weeks. She began by explaining the first wild thing that happened at the end of life was terminal lucidity, in which people get a "burst of energy" in the days before they die, sharing that it happens "very often". She said, "Just enjoy it and expect that maybe they will die soon after because that's the kicker with terminal lucidity, it looks like someone's going to die very soon then suddenly they have a burst of energy." "They maybe have a really great day, they're suddenly hungry, they're suddenly able to walk, they're suddenly very alert and oriented, and then shortly after usually a day or two they will die, so that can be the hard part if you're not ready for it, if you don't know what's coming you can think they're getting better and then they die, which can be very devastating." Julie then described how most people in their final days will encounter "death visioning" or "hallucinations", as many people describe seeing the ghosts of loved ones in their final days. "I wouldn't have believed it unless I saw it for myself over and over again," the nurse admitted. "Number three, this is really crazy - people choosing when they're going to die. I have seen some extreme cases of this, people just saying, 'Tonight's when I'm going to die I know it, I can feel it,' and they do. There's also a time when people will wait for everybody to get into town or get into the room arrive at the house whatever it is and then they will die," the nurse explained. The fourth phenomena is known as the "death reach", according to Julie. She explained, "It's when the person's lying in bed and they reach up in the air like they're seeing someone or they're reaching for someone either to hug them or to shake their hands. A lot of times they'll hold their hands up for a long time, like they're seeing something that we're not seeing and they're reaching for someone that we can't see." Julie then listed "number five is the death stare," explaining that the death stare and the death reach often "go together". "It usually looks like someone is staring off into the corner of the room or the side of the room basically looking at something intently, but if you're snapping your finger in front of their face or trying to say their name to kind of snap them out of it, they won't," she said. The last wild thing the nurse has seen is known as a "shared death experience" and is "most impactful", according to Julie. She explained, "A shared death experience is when someone who is not dying feels or sees or understands what's happening to the person who is dying." "It's kind of like the dying person gives you the sensation of what they're going through. From what I experienced, it was a very good feeling. It was like the person was giving me these feelings of freedom and joy and kind of telling me that they were okay." "At the time, I was shocked, I didn't know what was happening, but I've come to find out that that's called a shared death experience." Image credits: YouTube / Instagram

Caring

Hospice nurse explains why we shouldn't be afraid to die

A hospice nurse has shared why we shouldn't be afraid to die, explaining all the ways in which our bodies "shut off" to make for a "peaceful" death. Julie McFadden, a nurse based in Los Angeles, has long been sharing videos and explanations about end of life care in an attempt to destigmatise the conversations and fear around death and dying. In her latest YouTube video, McFadden got candid with her followers as she confessed she isn't afraid to die and why no one else should be either. She went on to explain all the ways in which our bodies are supposed to "shut off" in our final moments, making for a "peaceful" and "natural" death. " "I'm not afraid of death and here's the science behind it, our body biologically helps us die, so here is what I've seen and learned as a hospice nurse over the years - our body is literally built to die," she said. The hospice nurse revealed that bodies began to slowly shut down in the six months leading up to death, explaining that a person nearing the end of their life would start "eating less, drinking less, and sleeping more." "Why is that happening? Because calcium levels in the body are going up and because calcium levels are going up the person is getting sleepier," Julie said. "Our brains have built in mechanisms to make us hungry and thirsty. Biologically, when the body knows it's getting towards the end of life those mechanisms shut off, so the person does not usually feel hungry and does not usually feel thirsty, which is helping the body slowly shut down." <iframe title="YouTube video player" src="https://www.youtube.com/embed/CJEkzA0gt6s?si=CIzcf3xchddKtf1D" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe> She put minds at ease by debunking a common concern, saying that while certain diseases could make death more uncomfortable, dying in itself wasn't painful. "There are times when the disease that the person is experiencing can cause symptoms and it's more difficult because they're dying from a certain disease, but the actual process that the body is going through to help it die is actually helping that person," Julie added. "There have been many times as a hospice nurse that I have watched someone slowly die on hospice and I have not needed to give them any medication because their disease was not causing any symptoms - no pain, no shortness of breath, they were just more tired and weren't eating or drinking." "They still did all of the things any other person on hospice would be doing, like they slowly go unconscious, they slowly stop eating and drinking. I didn't have to give them any medications. They were perfectly comfortable and died a very peaceful death." Julie explained that death was even "comforting" in a way because when you're about to take your last breath, your body released endorphins, making you feel euphoric in your final moments. "The body slowly goes into something called ketosis, which releases endorphins. In that person's body those endorphins dull pain, dull nerves, and they also give that person a euphoric sense, so they feel good," she said. "There are many reasons why I don't fear death. Yes, I have had some pretty crazy spiritual experiences as a hospice nurse that led me to not fear death, but there are also biological, metabolical, and physiological things that happen in the body that truly, truly comforted me." She concluded, "Our bodies are built to die. The less we mess with that, the more peaceful it will be." Image credits: YouTube / Instagram

Caring

Life behind bars for serial killer nurse

British nurse Lucy Letby has been handed a life sentence for the murder of seven infants and the attempted murder of six others in a neonatal ward located in Chester, England. Justice James Goss, adhering to the strictest punishment allowed by British law, issued a whole-life order, ensuring that 33-year-old Letby would spend the remainder of her life incarcerated, as capital punishment is not applicable in the UK. In a trial that spanned ten months, Letby was found guilty of killing five male and two female infants and causing harm to other newborns within the neonatal unit of the Countess of Chester Hospital between June 2015 and June 2016. This conviction ranks her among the most prolific child serial killers in the UK's history. Despite her absence from the sentencing proceedings, Justice Goss emphasised the calculated nature of Letby's actions, stating, "There was premeditation, calculation and cunning." He further highlighted the malevolence and absence of remorse in her demeanour, emphasising that no mitigating factors were present. Prosecutors detailed Letby's disturbing actions during her tenure in the neonatal unit. As the hospital witnessed an alarming increase in unexplained infant deaths and health deteriorations, Letby was consistently on duty during these incidents. Prosecutors painted her as a constant, ominous presence when these infants experienced collapses or fatalities, using tactics that were difficult to detect. She even deceived colleagues into believing these incidents were normal. The anguish and outrage from the victims' families were palpable during the sentencing, compounded by Letby's absence from the proceedings, which is permitted under British legal protocol. The mother of a girl identified as Child I said in a statement read in court: "I don’t think we will ever get over the fact that our daughter was tortured till she had no fight left in her and everything she went through over her short life was deliberately done by someone who was supposed to protect her and help her come home where she belonged." Because of Letby's absence at the sentencing, calls for legal reform quickly emerged, urging that prisoners should be compelled to attend their sentencings. UK Prime Minister Rishi Sunak expressed his government's intention to address this matter. Medical professionals raised concerns about Letby's behaviour as early as 2015, but their apprehensions were not heeded by management. Some argue that had these concerns been acted upon promptly, lives could have been saved. An independent inquiry will delve into the hospital's response to the alarming rise in deaths and the actions of the staff and management. In conclusion, British nurse Lucy Letby's life sentence for the murder of seven babies and the attempted murder of six others has sent shockwaves through the nation. Her calculated actions, lack of remorse, and absence from the sentencing have ignited discussions about legal reforms and the responsibility of institutions to heed early warning signs. Images: Cheshire Constabulary

Legal

Hospice nurse shares the specific things people see before they die

A hospice nurse has revealed the very specific things people often see before they die. Julie McFadden, a 39-year-old end of care nurse from Los Angeles, shared a now-viral TikTok about what people see in the moments before they pass away. Julie cares for terminally-ill patients near their end-of-life, keeping them comfortable in the months leading up to their death. In the final weeks of someone's life, people are often visited by lost loved ones and pets that give them the encouragement to cross over. The 39-year-old said most of her patients report apparitions of relatives who offer them comforting words such as, "We're coming to get you soon," or, "Don't worry, we'll help you". After working in hospice care for over five years, McFadden has learnt a lot about death and dying, and how people handle the last days of their life. She revealed that dying patients see family, friends and pets who have passed away so often it is noted in educational packets given to the patient and their relatives, "so they understand what's going on". McFadden also added that medical professionals don't know why these apparitions happen, and don't know how to explain it in a logical sense. These apparitions usually appear a month before the patient dies, she claims, and can either present in dreams or the person being able to physically see them. The nurse said patients will often ask, "Do you see what I'm seeing?" Rather than being scared of what they're seeing, Ms McFadden claims patients often find the visits "comforting". Julie went on to say that she doesn't believe these "visits" are hallucinations, as she says the patients are normally "pretty alert and oriented, they're usually lucid". "It's not like they're saying a bunch of crazy things that don't make any sense," Ms McFadden added. "They're usually functional and logical and questioning me, 'Why am I seeing my dead mom, do you see her?'" Ms McFadden ended her video by saying that for many people in their final days, these visits from loved ones can help a person feel a sense of calm and contentment around dying, rather than a sense of fear of the unknown. Image credits: Shutterstock / Instagram

Caring

Should we move our loved one with dementia into a nursing home? 6 things to consider when making this tough decision

Almost <a href="https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/summary">400,000</a> Australians are living with dementia. A million or more family members and friends care for and support them. About two-thirds of people with dementia live in the community. Deciding to move a loved one into a nursing home is an incredibly difficult one. I found it difficult and stressful considering this move for my own loved one, even with 20 years of experience in dementia and aged care. Sometimes the decision has to be made quickly, such as when the person is in hospital. Sometimes the decision takes much longer and is made over months, or even years. There are some important things you should consider when trying to decide the best option for you and your loved one. I’ve outlined six here. <h2>1. Your loved ones’ views around going into care</h2> We don’t want to force our loved one to do something against their wishes. It’s unusual for someone to want to go into a nursing home. It may take many conversations and a decent amount of time before your loved one accepts they might need more care and that a nursing home is the right place to get that care. <h2>2. Your loved one’s current quality of life</h2> If you think your loved one has an overall good quality of life, and that their quality of life may decrease when they go into a nursing home, this could be a sign you should keep trying to support the person to live at home. However, if their quality of life is currently poor, particularly if this is due to not having enough day-to-day physical care, health care or emotional support, then moving into a nursing home might help meet their daily needs. Spend some time observing to figure out <a href="https://theconversation.com/home-for-the-holidays-and-worried-about-an-older-relative-make-observations-not-assumptions-173782">how your loved one is doing at home</a>. You could perhaps make a list of the things they need to lead a good life (company, three square meals, help taking medicines, going out into the community) and see if these are currently being met. <h2>3. Risks if your loved one stays at home</h2> People often <a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-7-13">go into a nursing home</a> because we think they are no longer safe living at home. It might be possible to reduce some of the risks of them being at home through <a href="https://www.enablingenvironments.com.au/home.html">modifying the home</a> and <a href="https://www.alzheimerswa.org.au/about-dementia/living-well-dementia/assistive-technology-help-sheets/">using technology</a>(personal emergency alarms, GPS trackers, stove timers) or services (meals on wheels, community care, physiotherapy for mobility). <h2>4. Capacity of your loved one’s family and friends to keep supporting them</h2> The availability and capacity of family carers is probably the most crucial part in supporting someone with dementia to keep living well at home. Carers often have other responsibilities such as work and children, which means they can’t support their loved one as much as they would like. Being a carer is physically and emotionally demanding, and over time caring can take its toll. Carers should seek help and support from other family and friends, learn more about <a href="https://forwardwithdementia.au/">dementia</a>, use services including <a href="https://theconversation.com/respite-care-can-give-carers-a-much-needed-break-but-many-find-accessing-it-difficult-183976">respite care</a> and <a href="https://www.dementia.org.au/support">Dementia Australia</a>. Carers often face a difficult choice between their own health and wellbeing, and supporting their loved one to remain at home. If carers are caring as much as their time, energy and physical and mental wellbeing will allow, and that care is not enough for their loved one’s needs, then more help is needed – and residential care is one way of getting that help. <h2>5. Alternatives to nursing home care</h2> Community care services are government-subsidised services to support older people to keep living at home. You can get up to 14 hours of care a week depending on need, though there is an assessment process and often a waiting time for services. You can pay for community care privately as well, although this can be very expensive. An <a href="https://www.cota.org.au/information/aged-care-navigators/who-can-use-aged-care-navigator-services/">Aged Care Navigator</a> (or from 2023 an “aged care finder”) can help you search for suitable available home care services. Some families choose to move in with the person with dementia, or have them move in with family. This may be an option if there is suitable accommodation, and they are able to live together comfortably. <h2>6. Availability of quality nursing home care</h2> It’s emotionally easier to place a loved one in a nursing home if carers are confident the home will provide suitable care. Often, family want a nursing home that is geographically close so they can visit, has a suitable room (such as a single room with an ensuite), sufficient and kind staff with training in supporting people with dementia, a pleasant environment, nutritious appealing food, and quality clinical care. It takes time to visit and pick a <a href="https://theconversation.com/when-choosing-a-nursing-home-check-the-clothing-and-laundry-100727">suitable nursing home</a>, check it’s appropriately <a href="https://theconversation.com/how-to-check-if-your-mum-or-dads-nursing-home-is-up-to-scratch-123449">accredited</a>, and understand how much it will <a href="https://theconversation.com/so-youre-thinking-of-going-into-a-nursing-home-heres-what-youll-have-to-pay-for-114295">cost</a>. You might have to wait for a bed in a quality home. You can often trial the nursing home by having your loved one stay for two weeks of respite care. When your loved one enters nursing home care, you’ll still be caring for them. You want to ensure you can continue to support your loved one emotionally and practically in partnership with the nursing home. <h2>Getting help</h2> Usually there is no “right” or “wrong” decision. You might struggle and there might be family conflict around what the “right” decision is. Speaking to a counsellor at <a href="https://www.dementia.org.au/support/counselling">Dementia Australia</a> might help work through the options and your feelings, you can talk to them as an individual or attend as a family. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/should-we-move-our-loved-one-with-dementia-into-a-nursing-home-6-things-to-consider-when-making-this-tough-decision-189770" target="_blank" rel="noopener">The Conversation</a>.

Caring

Hospice nurse explains the “very comforting” thing that happens just before death

A hospice nurse has shared the “very comforting” thing that happens to a lot of people in the last moments of their life. Julie McFadden, a 39-year-old healthcare professional from the US, supports people who are coming to the end of their lives, going into specialised homes to make sure they remain as comfortable as possible in their final days. Throughout her career, she said more than half of those she has looked after experienced “visioning”, which is when people who are often fully lucid see deceased friends, family and pets in the moments leading up to death. “It happens most of the time at the end of their life, but they aren’t delusional,” the former intensive care nurse said on TikTok. “It’s often very comforting for the person. It’s never scary - if they’re scared, it’s likely they’re experiencing delirium or paranoia, not visioning.” “People don’t talk about it much but it’s really common and more than half of people I have looked after have experienced it.” “It’s so normal to fear death and I’ve had several patients who have expressed their fear - but then a family member came to them and they were no longer scared.” Julie went on to share a further explanation as to why people experience “visioning”, and the other-worldly power behind it. “We have no idea why this (visioning) happens and we are not claiming that they really are seeing these people,” she explained in one video. “We have no idea. But all I can tell you, as a healthcare professional who’s worked in this line of work for a very long time, (is that) it happens all the time.” “It happens so much that we actually have to educate the family and the patient about this topic before it happens so they’re not incredibly alarmed,” she added. “Usually it’s a good indicator that the person’s getting close to death - usually about a month or a few weeks before they die.” “It brings me comfort. I hope it brings you some comfort,” she concluded in her video, which quickly amassed more than 400,000 views. Image credits: TikTok

Caring

Moral injury: what happens when exhausted health workers can no longer provide the care they want for their patients

Healthcare workers in New Zealand already face life-and-death decisions daily. But as multiple winter illnesses add pressure to a system already stretched by COVID, staff now also have to deal with <a href="https://www.stuff.co.nz/national/politics/local-democracy-reporting/300534812/covid19-union-and-frontline-worker-say-staff-at-middlemore-hospital-facing-increasing-abuse" target="_blank" rel="noopener">daily abuse</a>, acute <a href="https://www.newshub.co.nz/home/new-zealand/2022/05/christchurch-hospital-cancels-surgeries-as-it-hits-112-pct-capacity.html" target="_blank" rel="noopener">staff shortages</a> and <a href="https://www.1news.co.nz/2022/06/17/dhb-clashes-with-union-over-stretched-palmerston-north-ed/" target="_blank" rel="noopener">unsafe working conditions</a>. At times, they cannot provide the care they would like for their patients. The impact on health workers is often described as <a href="https://www.nzherald.co.nz/rotorua-daily-post/news/great-minds-health-workers-on-covid-19-frontlines-burnt-and-bled-by-two-years-of-virus/T7JXOXGXEKKCICUNOMUJYT4QWM/" target="_blank" rel="noopener">stress and burnout</a>. The consequences of this prolonged pressure can be seen in the number of <a href="https://www.nzdoctor.co.nz/article/undoctored/acem-welcomes-111b-health-nz-budget-urges-fixes-health-workforce-crisis" target="_blank" rel="noopener">doctors</a>, <a href="https://www.nzherald.co.nz/nz/nursing-shortage-nurses-broken-while-sector-faces-thousands-of-vacancies/L7NUXOPG4AB472OKXOH5QJSUMU/" target="_blank" rel="noopener">nurses</a> and other <a href="https://capsulenz.com/be/therapist-shortage-nz/" target="_blank" rel="noopener">health professionals</a> leaving their jobs for overseas positions and the private sector, or being lost to their professions completely. Many of these healthcare workers may well be suffering from a more serious form of psychological distress than burnout: moral injury. <a href="https://www.phoenixaustralia.org/wp-content/uploads/2020/07/Moral-Stress-Healthcare-Workers-COVID-19-Guide-to-Moral-Injury.pdf" target="_blank" rel="noopener">Moral injury</a> refers to the psychological, social and spiritual impact of events on a person who holds strong values (such as caring for patients) and operates in high-stakes situations (hospital emergency care), but has to act in a way inconsistent with those values. Examples include having to turn patients away despite them being in pain or discomfort; being unable to provide adequate care due to staff shortages; having to care for a dying patient isolated from their loved ones while wearing full protective gear. Symptoms of moral injury can include strong feelings of guilt and shame (about not being able to uphold healthcare values, for example) as well as high levels of anger and contempt towards the system that prevents proper care. High levels of self-criticism, loss of trust in people and organisations and a weakening of personal relationships are further <a href="https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(21)00113-9/fulltext" target="_blank" rel="noopener">symptoms</a> of moral injury. It can be viewed as a <a href="https://www.afta.org/wp-content/uploads/2019/07/Physicians-aren%E2%80%99t-%E2%80%98burning-out.%E2%80%99-They%E2%80%99re-suffering-from-moral-injury..pdf" target="_blank" rel="noopener">more severe form of burnout</a>. But while burnout can happen in most workplaces, moral injury requires the three core components listed above. From war to the operating table The term moral injury arose in <a href="https://www.ptsd.va.gov/professional/treat/cooccurring/moral_injury.asp" target="_blank" rel="noopener">military psychology</a> to refer to situations where, for example, soldiers were unable to intervene to save lives in case they risked breaching the rules of engagement. More recently, the term has been adapted to apply to healthcare. Viewing the experiences of health workers through this lens can help us understand why they may experience a seesawing emotional state and the confusing conflict of simultaneously wanting to be at work while wishing they were anywhere but. For healthcare workers, understanding the <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6752815/#:%7E:text=Over%20time%2C%20these%20repetitive%20insults,is%20in%20some%20way%20deficient" target="_blank" rel="noopener">concept of moral injury</a> may help reframe it as something that is happening to them rather than because they don’t have the skills to cope. The latter can sometimes be a mistaken implication of the term burnout. <figure class="align-center "><img src="https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/471254/original/file-20220627-22-u7c2tg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" alt="Exhausted nurse" /><figcaption>Staff shortages can take health workers beyond exhaustion and burnout. Getty Images</figcaption></figure> While healthcare workers are largely at the mercy of the organisations they work for, there are some steps individuals can take to alleviate moral injury. Firstly, simply recognising they may be suffering from this condition can reduce confusion and validate their experiences. Secondly, reconnecting back to an individual’s values and beliefs can help refocus and re-energise, at least temporarily. Reminding themselves why they got into this job in the first place is a useful place to start. Organisational responses Organisations and businesses must play a lead role in preventing and treating moral injury. Many of the factors leading to it (lack of resources or staff, a pandemic or peak flu season) are outside the control of individuals. Most modern businesses will be aware they have a legal responsibility under the 2015 <a href="https://www.legislation.govt.nz/act/public/2015/0070/latest/DLM5976660.html" target="_blank" rel="noopener">Health and Safety at Work Act</a> to look after their employees’ mental and physical well-being. At a high level, organisations can advocate for systemic change and increases in funding and resourcing, where needed. But these higher-level changes take time to achieve. In the meantime, it is important healthcare workers are protected and supported. Broad steps an organisation can take to prevent or reduce moral injury include removing the burden of difficult ethical decisions from frontline workers and instead adopting evidence-based policies to guide an organisation-wide response. Where possible, rotating staff between high and low-stress environments may help. Providing funding for workers to access professional psychological supervision is another practical step businesses can consider. At a team level, it can be helpful to have leaders who are visible, validating and can help make sense of the moral conflict. Leaders can also play a role in keeping alive professional values and modelling their own struggles with the situation. The general public also has a role to play in supporting healthcare workers. Any steps we can take to protect our own health and thereby reduce pressure on the system can have a cumulative effect on the well-being of doctors, nurses and allied health clinicians. The health of our nation rests with those who work in this field and it is in all our interest that their health is protected and prioritised.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/185485/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/dougal-sutherland-747623" target="_blank" rel="noopener">Dougal Sutherland</a>, Clinical Psychologist, <a href="https://theconversation.com/institutions/te-herenga-waka-victoria-university-of-wellington-1200" target="_blank" rel="noopener">Te Herenga Waka — Victoria University of Wellington</a> This article is republished from <a href="https://theconversation.com" target="_blank" rel="noopener">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/moral-injury-what-happens-when-exhausted-health-workers-can-no-longer-provide-the-care-they-want-for-their-patients-185485" target="_blank" rel="noopener">original article</a>. Image: Getty Images

Caring

Terminally ill nurse caught in desperate waiting game

A nurse who has months to live as a result of her diagnosis of motor neuron disease (MND) is “virtually paralysed” and waiting for the NSW government to decide how she will die. Sara Wright had been a nurse for 33 years before she was diagnosed with amyotrophic lateral sclerosis (ALS) - a subtype of MND - two years ago, and is now dependent on a carer 24 hours a day. “The disease started as a weakness in my right foot, travelled up my right leg, then my left foot and leg,” the 54-year-old told <a href="https://7news.com.au/news/public-health/virtually-paralysed-nurse-waits-for-nsw-parliament-to-decide-how-she-will-die-c-6699939">7NEWS.com.au</a>. “Then it travelled up my torso affecting my upper body, firstly my abdominal muscles, and now it affects both of my arms and hands, my lungs and my swallowing and speaking muscles.” Ms Wright, who shared her story via dictation since speaking is difficult and painful, is waiting to see whether voluntary assisted dying laws (VAD) will be passed in the NSW Upper House next week. If they don’t pass, she says she will likely “have to deal with suffocating or choking to death”. “It’s a terminal illness and the average life expectancy is three to five years,” she explained. “Given I have already been living with the disease for three years, and the progression has been faster than I ever could have expected, I don’t know how long I will live. “I don’t think that I will live for more than another six to eight months, as my breathing capacity is reducing very fast and I do not wish to have a tracheostomy (an operation where a breathing hole is cut into the front of the neck and windpipe).” ALS/MND is more common among adults aged between 40 and 70 years, with 384 people diagnosed each day according to the <a href="https://www.als-mnd.org/what-is-alsmnd/" target="_blank" rel="noopener">International Alliance of ALS/MND Associations</a>. Ms Wright’s career as a nurse made her all too aware of the “limitations of palliative care in the final stages of terminal illness”, so she initially planned to book into Dignitas, a non-profit organisation in Switzerland that offers a range of end-of-life services. But, the COVID-19 pandemic derailed her plan with the closure of international borders. She then considered moving interstate, where VAD is legal, but she worried about uprooting her 15-year-old daughter, Ester, from her home and friends, especially since most of their family is UK-based. “(Ester) is now 15 and she needs to have her community around her for support when I die,” she said. “Obviously this is an incredibly difficult conversation to have with your own child. “We have not specifically spoken about what could happen to me if the laws aren’t passed … but I have tried to assure her that family in the UK will fly out to be with her as soon as they can if I die unexpectedly.” Ms Wright’s fate is tied to the voluntary assisted dying bill, which passed through the NSW Parliament’s lower house last year and is legal or will soon be legal in <a href="https://end-of-life.qut.edu.au/assisteddying" target="_blank" rel="noopener">every other state</a> except NSW. “I know that all my family, my parents, my brothers, my ex-husband are all in support of voluntary assisted dying and helping me relieve my suffering,” she said. “But none of us want to break the law or risk anyone being imprisoned if they helped me.” Since the bill entered the upper house last March, it has been debated passionately and passed through a second reading stage last week. It has even divided the state’s core leadership, with Premier Dominic Perrottet opposing the bill in favour of improving palliative care and Health Minister Brad Hazzard supporting it - despite opposing euthanisia for 29 years. Ms Wright, a strong supporter of VAD laws, has been brought close to the death of others during her nursing career and said she was “pretty certain” that if members debating the bill had seen people die uncomfortable, drawn-out deaths like she had, they would support the bill. “I have seen far too many people, elderly people, in the middle of the night in a ward without anyone there to hold their hand because nobody knew that was going to be their time to die,” she said. “I think that most people don’t think enough about death because we are all frightened of it. “And this could be the reason that some people are refusing to consider VAD laws, because it’s a topic that is deeply uncomfortable and taboo. “If we as a society were more mindfully aware and thoughtful about death, as it is the only certain outcome of life, then perhaps people would develop more compassion.” Though the laws could still be passed at some point if it fails to pass in next week’s final vote, Ms Wright said it would affect her whole family if it was too late for her to take advantage of it. “This will not only cause suffering to me but also to all of my family,” she said. “I wonder how many people have really stopped to think about what they would like, if they were in a position where they were going to die of (an) unpleasant and drawn-out death.” Image: 7News

Caring

Nurse who lost both legs to Russian landmine gets married in hospital

The first dance is a big moment for any bride and groom, but it was even more special for Oksana and Victor. Oksana lost both her legs on a Russian landmine in March, in their home town of Lysychansk, located in the Russian-occupied eastern Ukraine region of Luhansk. The explosion didn't injure Victor, although they were together at the time, but the bride lost both of her legs as well as four fingers on her left hand. Oksana underwent four surgeries and was later evacuated to Dnipro to recover and prepare for prosthetics, and eventually to Lviv, in the west near the Polish border. As she waited for the next part of the healing process, the couple, who have two children together, took the opportunity to wed in a Lviv hospital last week. “Life should not be postponed until later, decided Oksana and Victor, who in six years together never found time for marriage," Lviv Medical Association said, sharing video of the couple's special moment. <blockquote class="twitter-tweet"> ❤️🇺🇦 Very special lovestory. A nurse from Lysychansk, who has lost both legs on a russian mine, got married in Lviv. On March 27, Victor and Oksana were coming back home, when a russian mine exploded. The man was not injured, but Oksana's both legs were torn off by the explosion. <a href="https://t.co/X1AQNwKwyu">pic.twitter.com/X1AQNwKwyu</a> — Verkhovna Rada of Ukraine - Ukrainian Parliament (@ua_parliament) <a href="https://twitter.com/ua_parliament/status/1521194382682202113?ref_src=twsrc%5Etfw">May 2, 2022</a></blockquote> The footage was also shared by Ukraine's Parliament, which wished the couple well in their new life together. The sweet dance shows the groom carrying his new wife in his arms as she buries her head in her husband's neck. The couple are said to have wed at a local registry office before the hospital reception took place. Oksana is set to travel to Germany for further treatment. Image: Twitter

Relationships

Ukrainian nurses care for surrogacy babies underground

A makeshift bomb shelter in the Ukrainian capital of Kyiv has become a temporary home for babies born to surrogate mothers whose new parents can’t enter the country to take them home. At least 20 babies - including some that are just a few days old - have been taken underground where they are well cared for by the many nurses from the surrogacy centre also stranded in the shelter, as reported by <a href="https://7news.com.au/news/conflict/surrogate-babies-wait-out-war-in-ukraine-c-6135483" target="_blank" rel="noopener">7News</a>. With Ukrainian troops fighting off Russian forces in Kyiv’s suburbs, it has become too dangerous for the nurses to travel between the shelter and their homes. “Now we are staying here to preserve our and the babies’ lives,” said Lyudmilia Yaschenko, a 51-year-old nurse. “We are hiding here from the bombing and this horrible misery.” <img src="https://oversixtydev.blob.core.windows.net/media/2022/03/surrogacy.jpg" alt="" width="1280" height="720" /> At least 20 surrogacy babies are being cared for in an underground bunker as the war rages on above them. Image: Getty Images Ms Yaschenko said they could leave the shelter for brief periods to get some fresh air, but that they worked constantly to look after the children. “We are almost not sleeping at all,” she said. “We are working around the clock.” She also worried for her two sons - aged 22 and 30 - who were fighting to defend the country. Ukraine is one of the few countries that allows foreigners to use surrogate services, with <a href="https://www.bbc.com/news/world-europe-60824936" target="_blank" rel="noopener">most</a> of the 2000 children born through surrogacy every year are matched to foreign couples from Europe, Latin America and China. Though Ms Yaschenko wouldn’t say how many children are still waiting to be united with their parents or how many surrogate mothers are expected to deliver soon, the nurses have plenty of food and baby supplies to continue caring for them as they wait for the war to end. Image: Getty Images

Caring

Trainee nurse sprints into action to save toddler

A trainee nurse on his way to work has been hailed a hero after jumping into action and saving a toddler. Nicholas Jensen did not think twice when he heard a mother screaming for someone to help her two-year-old daughter who was turning blue and foaming from the mouth. The 44-year-old nurse grabbed the motionless toddler and placed her in the recovery position before rushing to the Princess Alexandra Hospital emergency room in Brisbane. CCTV from the hospital carpark captured the heroic moment he ran to the hospital with the girl’s mother following behind. Inside, he is seen running through the emergency department where he is directed by a fellow nurse through a door where he is met by seven other nurses. They rush him into a room where the toddler is placed on a bed and resuscitation begins to save the child. The nurses saved the toddler’s life and found she had suffered an atypical febrile convulsion which can be caused by a viral infection and fever, <a href="https://7news.com.au/news/qld/incredible-moment-trainee-nurse-saves-motionless-toddler-in-brisbane--c-6007072" target="_blank" rel="noopener">7News</a> reported. Doctors ordered the toddler to stay for two days for observation and is now doing well, thanks to Nicholas’s quick thinking. “In the moment adrenalin and my training kicked in,” he said. “This is why I got into this job, great job satisfaction. It is a meaningful career.” Images: 7News

Caring

Conflicts between nursing home residents are often chalked up to dementia – the real problem is inadequate care and neglect

Frank Piccolo was a beloved high school chemistry teacher in Ontario, Canada, until his retirement in 1998. “His trademark was to greet all of his students at the door at the start of class to make sure everyone felt welcomed there,” <a href="https://www.saultstar.com/2013/02/21/remembering-frank-piccolo--oconnor">wrote a former student</a>. “He had extensive knowledge of his subject matter, passion for his craft, and empathy for his students.” But after Frank’s retirement, he developed dementia. When his condition declined, his family moved him to a Toronto nursing home. One evening in 2012, another resident – a woman with dementia – entered Frank’s bedroom. She hit Frank repeatedly in the head and face with a wooden activity board. Staff found Frank slumped over in his wheelchair, drenched in blood. He died three months later. The Ontario Ministry of Health and Long-Term Care investigated. It found that the woman had a history of pushing, hitting and throwing objects at staff and other residents. But the nursing home didn’t address the woman’s behavioral expressions for weeks before the attack on Piccolo, <a href="https://s3.documentcloud.org/documents/21048374/inspection-report.pdf">the agency determined</a>. “There were no interventions implemented, no strategies developed,” the report stated. <img src="https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" alt="Frank Piccolo and his wife, Theresa, standing near each othe, on vacation, with a hillside village and the sea behind them." /> Frank Piccolo and his wife, Theresa, traveling together in Italy in 2001. Theresa Piccolo, <a href="http://creativecommons.org/licenses/by-nc-nd/4.0/" class="license">CC BY-NC-ND</a> As a gerontologist and <a href="http://dementiabehaviorconsulting.com">dementia behavior specialist</a>, I’ve <a href="https://www.healthpropress.com/product/understanding-and-preventing-harmful-interactions-between-residents-with-dementia/">written a book</a> on preventing these incidents. I also co-directed, with dementia care expert Judy Berry, a documentary on the phenomenon called “<a href="https://terranova.org/film-catalog/fighting-for-dignity-a-film-on-injurious-and-fatal-resident-to-resident-incidents-in-long-term-care-home">Fighting for Dignity</a>.” The film sheds light on the emotional trauma experienced by family members of residents harmed during these episodes in U.S. long-term care homes. <h2>Reporting and stigmatizing</h2> <a href="https://doi.org/10.1111/j.1532-5415.2008.01808.x">Resident-to-resident incidents</a> are defined by researchers as “negative, aggressive and intrusive verbal, physical, material and sexual interactions between residents” that can cause “psychological distress and physical harm in the recipient.” These incidents <a href="https://doi.org/10.7326/M15-1209">are prevalent</a> in U.S. nursing homes. But they are <a href="https://www.statnews.com/2021/11/29/resident-to-resident-incidents-hidden-source-nursing-home-harm/">largely overlooked</a> by the Centers for Medicare and Medicaid Services, the federal agency overseeing care in approximately 15,000 nursing homes across the country. Consequently, such incidents <a href="https://doi.org/10.1080/08946566.2017.1333939">remain untracked</a>, <a href="https://doi.org/10.1016/j.jamda.2015.10.003">understudied</a> and largely unaddressed. <a href="https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" alt="An elderly man with severe injuries, including cut marks and bruises, across his face and forehead." /></a> Frank Piccolo sustained severe injuries to his face and head after a woman with dementia entered his bedroom and hit him repeatedly with an activity board. Theresa Piccolo, <a href="http://creativecommons.org/licenses/by-nc-nd/4.0/" class="license">CC BY-NC-ND</a> These interactions don’t just result <a href="https://doi.org/10.1001/jama.291.5.591">in injuries</a> <a href="https://doi.org/10.1177/0733464819863926">and deaths</a> among residents. They also leave behind devastated families who then must <a href="https://www.washingtonpost.com/business/2021/08/20/nursing-home-immunity-covid-lawsuits">fight for answers</a> and accountability from nursing homes. Making matters worse, <a href="https://www.gao.gov/products/gao-19-433">government reports</a>, <a href="https://doi.org/10.1017/S0714980815000094">research studies</a> and <a href="https://doi.org/10.1177/1471301220981232">media coverage</a> commonly describe these episodes with words that stigmatize people with dementia. Researchers, public officials and journalists tend to <a href="https://www.startribune.com/when-senior-home-residents-are-abusers-minnesota-rarely-investigates/450625693/">label the incidents as “abuse</a>,” “violence” and “aggression.” They call a resident involved in an incident a “perpetrator” or an “aggressor.” News outlets described the attack on Piccolo by the woman with dementia as “aggressive” or “violent.” And when reporting on <a href="https://www.thestar.com/news/gta/2013/02/09/more_than_10000_canadians_abused_annually_by_fellow_nursing_home_residents.html">the phenomenon</a> in Canada, the Toronto Star called it “abuse.” <h2>Getting to the root of the real problem</h2> Most incidents, however, do not constitute abuse. A growing body of evidence suggests the true cause of these injuries and deaths is inadequate care and neglect on the part of care homes. Specifically, there is a lack of the specialized care that people with dementia require. Two of every three residents <a href="https://doi.org/10.1016/j.jamda.2021.02.009">involved in these incidents</a> have dementia. One study found that the rate of these episodes was nearly <a href="https://doi.org/10.1001/jama.291.5.591">three times higher</a> in dementia care homes than in other long-term care homes. A recent study also found <a href="https://doi.org/10.7326/m15-1209">an association</a> between residency in a dementia care home and higher rates of injurious or fatal interactions between residents. But for these residents, the conflicts occur mostly when their emotional, medical and other needs are not met. When they reach a breaking point in frustration related to the unmet need, they may push or hit another resident. My research in the U.S. and Canada has shown that <a href="https://doi.org/10.1080/08946566.2018.1474515">“push-fall” episodes</a> constitute nearly half of fatal incidents. Another U.S. study found that as residents’ cognitive functioning declined, they faced <a href="https://doi.org/10.1001/jama.291.5.591">a greater likelihood</a> of injury in these incidents. Those with advanced dementia were more susceptible to inadvertently “getting in harm’s way,” by saying or doing things that trigger angry reactions in other residents. The Centers for Disease Control and Prevention has stated that what it calls “aggression” between residents <a href="https://www.cdc.gov/violenceprevention/pdf/ea_book_revised_2016.pdf">is not abuse</a>. Instead, the CDC noted that these episodes may result when care homes fail to prevent them by taking adequate action. And a study on <a href="https://doi.org/10.1177/0733464819863926">fatal incidents</a> in U.S. nursing homes has shown that many residents were “deemed to lack cognitive capacity to be held accountable for their actions.” <iframe width="440" height="260" src="https://www.youtube.com/embed/gk5iEo-s_6M?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe> An undercover yearlong investigation into nursing homes in Ontario, Canada, revealed shocking instances of abuse and neglect by staff members. <h2>How incidents often occur</h2> In one study, researchers examined <a href="https://doi.org/10.1177/1054773813477128">situational triggers</a> among residents with cognitive impairments. The strongest triggers involved personal space and possessions. Examples include taking or touching a resident’s belongings or food, or unwanted entries into their bedroom or bathroom. The most prevalent triggering event was someone being too close to a resident’s body. That study also found that crowded spaces and interpersonal stressors, such as two residents claiming the same dining room seat, could lead to these episodes. <a href="https://doi.org/10.1177/1471301213502588">My own work</a> and a different <a href="https://doi.org/10.1177%2F0733464820955089">Canadian study</a> came to similar conclusions. Other research shows that when residents are bored or lack <a href="https://doi.org/10.1177%2F153331750502000210">meaningful activity</a>, they become involved in <a href="https://doi.org/10.1177%2F1471301213502588">harmful interactions</a>. Evenings and weekends can be particularly dangerous, with fewer organized activities and fewer staff members and managers present. <a href="https://doi.org/10.1080/08946566.2018.1474515">Conflicts between roommates</a> are also common and harmful. <img src="https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="With a smiling staff member looking on, two nursing home residents enjoy conversation while having coffee." /> Residents with dementia who are meaningfully engaged in activities are less likely to become involved in harmful incidents with other residents. <a href="https://www.gettyimages.com/detail/photo/caretaker-with-senior-people-in-nursing-home-royalty-free-image/489582967?adppopup=true" class="source">Morsa Images/DigitalVision via Getty Images</a> A growing body of research suggests that most incidents between residents are preventable. A major risk factor, for example, is lack of adequate supervision, which often occurs when staff are assigned to caring for too many residents with dementia. One U.S. study found that <a href="https://doi.org/10.7326/M15-1209">higher caseloads</a> among nurses’ aides were associated with higher incident rates. And with <a href="https://doi.org/10.4137/hsi.s38994">poor staffing levels</a> in up to half of U.S. nursing homes, <a href="https://doi.org/10.1080/08946566.2018.1474515">staff members do not witness</a> many incidents. In fact, one study found that staff members missed the majority of unwanted <a href="https://doi.org/10.1080/13607863.2016.1211620">bedroom entries</a> by residents with severe dementia. <h2>Residents with dementia are not to blame</h2> In most of these situations, the person with dementia does not intend to injure or kill another resident. Individuals with dementia live with a serious cognitive disability. And they often must do it while being forced to share small living spaces with many other residents. Their behavioral expressions are often attempts to cope with frustrating and frightening situations in their social and physical environments. They are typically the result of unmet human needs paired with cognitive processing limitations. Understanding the role of dementia is important. But seeing a resident’s brain disease as the main cause of incidents is inaccurate and unhelpful. That view ignores external factors that can lead to these incidents but are outside of the residents’ control. Frank’s wife, Theresa, didn’t blame the woman who injured her husband or the staff. She blamed the for-profit company operating the nursing home. Despite its revenue of $2 billion in the year before the incident, it failed in its “<a href="https://www.thestar.com/news/gta/2013/02/09/more_than_10000_canadians_abused_annually_by_fellow_nursing_home_residents.html">duty to protect</a>” Piccolo. “They did not keep my husband safe as they are required to do,” she said.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/173750/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/eilon-caspi-1298265">Eilon Caspi</a>, Assistant Research Professor of Health, Intervention, and Policy, <a href="https://theconversation.com/institutions/university-of-connecticut-1342">University of Connecticut</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/conflicts-between-nursing-home-residents-are-often-chalked-up-to-dementia-the-real-problem-is-inadequate-care-and-neglect-173750">original article</a>. Image: CasarsaGuru/E+ via Getty Images

Retirement Life

Hospice nurse reveals the three words many people say before they die

A hospice nurse on TikTok has revealed that many of her patients say the same three words before passing away. Posting to the social media site, @hospicenursejulie revealed that her patients often believe they are seeing visions of spirits belonging to their deceased loved ones before they die, prompting them to say ‘I love you’ or to call out to those relatives. "There is something most people say before they die and it's usually, 'I love you,' or they call out to their mum or dad who have usually already died,” she revealed. She explains that patients who are otherwise completely lucid will tell her they can see spirits or angels of loved ones who’ve passed away up to a month before dying themselves. These visions will often urge the patient to “come home”. <blockquote style="max-width: 605px; min-width: 325px;" class="tiktok-embed" data-video-id="7007617336870046981"><a rel="noopener" href="https://www.tiktok.com/@hospicenursejulie" target="_blank" title="@hospicenursejulie">@hospicenursejulie</a> Reply to @birdsthewordchicktok <a rel="noopener" href="https://www.tiktok.com/tag/hospicenursejulie" target="_blank" title="hospicenursejulie">#hospicenursejulie</a> <a rel="noopener" href="https://www.tiktok.com/tag/nurse" target="_blank" title="nurse">#nurse</a> <a rel="noopener" href="https://www.tiktok.com/tag/nursesoftiktok" target="_blank" title="nursesoftiktok">#nursesoftiktok</a> <a rel="noopener" href="https://www.tiktok.com/tag/learnontiktok" target="_blank" title="learnontiktok">#learnontiktok</a> <a rel="noopener" href="https://www.tiktok.com/music/original-sound-7007617113468734214" target="_blank" title="♬ original sound - 💕 Hospice nurse Julie 💕">♬ original sound - 💕 Hospice nurse Julie 💕</a></blockquote> In another video, Julie sought to demystify what dying looks like. She explains, "Breathing patterns change towards the end of life during the actively dying phase, which is usually a few hours to a few days before death. "Most families think this indicates something is wrong but nine times out of 10 it doesn't. Changes in skin colour, which is also called mottling, where the extremities turn a little purple also is something people think indicates something is wrong — but it doesn't. "Terminal secretions, AKA the death rattle, this is just a collection of a small bit of saliva in the back of the throat that just sounds really bad. Fever happens a lot, too, because we lose the ability to control the core temperature so our temperature will fluctuate at the end of life. "Again, it's all very normal and part of the death and dying process if you are dying naturally at home." Image: David Sacks/Getty Images

Caring

“Liars killed her and her baby”: Desperate nurse’s anguished accusation

A nurse has shared her own horrific story of losing a 14-year-old patient to coronavirus. The US intensive care unit nurse, Jessica, revealed the young teen’s parents were anti-vaxxer. Jessica recounted the "helpless" situation to Twitter, saying four patients died of the devastating illness in a single shift. "Tonight I helplessly held the hand of and stroked the hair of a beautiful 14-year-old girl as she exited his world," she wrote on Twitter. "She was looking forward to starting high school and eventually becoming a veterinarian. It was so senseless! <blockquote class="twitter-tweet"> parents had not forbidden us from intubating her. A free vaccination would have prevented it all! This little girl was robbed of her whole life and of fulfilling all of her dreams. She had been with us 9 days and was able to communicate well until taking a turn for the worse — Jessica M. MSN, FNP-C (@Jessicam6946) <a href="https://twitter.com/Jessicam6946/status/1426569588825858051?ref_src=twsrc%5Etfw">August 14, 2021</a></blockquote> Jessica said her parents refused for their daughter to have a tube placed down her throat to assist with her breathing. "I truly believe she could have been saved if her parents had not forbidden us from intubating her," Jessica explained. "A free vaccination would have prevented it all! This little girl was robbed of her whole life and of fulfilling all of her dreams." <img style="width: 500px; height: 281.25px;" src="https://oversixtydev.blob.core.windows.net/media/7819915/hospital.jpg" alt="" data-udi="umb://media/dd37337f6dc8477c8ddcd468397ecb21" /> Image: Shutterstock The teenage patient had been in hospital for nine days, prior to her death. Jessica went on to share a number of deaths she believed were preventable had the patient received COVID vaccinations. She said medical staff lost a 25-year-old mother who was 15 weeks pregnant, just two hours after the death of the young teen. "She had refused the vaccines because of the lies about them causing infertility and harming her baby," Jessica explained. The nurse went on to claim that anti-vax rhetoric was what was causing the deaths of otherwise healthy people. "Liars killed her, her baby, and robbed a two-year-old little boy of his mommy and sibling. Not to mention robbing a husband of his wife and child." The nurse said it was the first time since March that the hospital unit had lost more than three patients in one night. A 45-year-old was the oldest to die that evening. <blockquote class="twitter-tweet"> mommy and sibling. Not to mention robbing a husband of his wife and child. Those were 2 of 4 deaths we had tonight with the oldest being 45 years old! It was the 1st time since late March we have lost more than 3 covid patients in a single shift. Then we find out this morning — Jessica M. MSN, FNP-C (@Jessicam6946) <a href="https://twitter.com/Jessicam6946/status/1426569591942172673?ref_src=twsrc%5Etfw">August 14, 2021</a></blockquote> The vaccination rate across Australia shows that at least 50.2 per cent of people have had their first dose. So far, 28.2 per cent are fully vaccinated. Health Minister Greg Hunt has said rising rates reflected the "huge" turnouts for vaccinations. "It is being sustained, so over a 10-day period now, we have had more than 2.4 million doses delivered," he said.

Caring

Red Cross nurse accused of switching vaccines for salt solution

Northern German authorities are contacting thousands of people and informing them to get another COVID-19 jab after an investigation uncovered that a Red Cross nurse may have injected them with a saline solution. The nurse has been suspected of injecting salt solution into people's arms instead of a real dose at a vaccination centre in Friesland, a district near the North Sea Coast. "I am totally shocked by this episode," Sven Ambrosy, a local councillor, said on Facebook. Local authorities are in the process of contacting over 8,600 residents who may have been affected. <img style="width: 500px; height:281.25px;" src="https://oversixtydev.blob.core.windows.net/media/7836313/vaccine.jpg" alt="" data-udi="umb://media/1e3453d989304150b35c9bbfb0e97893" /> Image: Shutterstock Saline solution is harmless, however many people who got vaccinated in Germany in March and April are elderly people at high risk of catching the deadly viral disease. Sadly, the time frame that a majority of elderly people received the jab, coincides with when the nurse is suspected to have switched the vaccines. Police investigator Peter Beer, told German media that there is "a reasonable suspicion of danger". The nurse, who remains anonymous for now, made it clear on social media that she was sceptical of vaccines in social media posts, police investigators said.

Body

A frontline nurse’s gripping story

When Melbourne was plunged into rounds of lockdowns during the first months of the global coronavirus pandemic, two friends answered the call to join the frontline as nurses. After spending years as a family violence educator and sexual health nurse, Simone Sheridan put her hand up to retrain and work as an ICU nurse. Over countless phone conversations with her friend Alisa Wild, Simone shared the exhaustion, confusion, tears and surprising moments as she faced the greatest health crisis her city had ever seen. Then Alisa wrote it all down to form the newly-released book, The Care Factor. A celebration of friendship and nursing in the time of social distancing, The Care Factor has been praised for its ‘behind the scenes’ view into nursing and health care during the COVID-19 pandemic. Here, we present an excerpt from their gripping tale. Chapter 1 ‘Like preparing for a war’ The Crisis Respondent It’s 20 March and I’m in a doom spiral, fear- scrolling and heartbroken. There are twenty-eight new cases of Covid-19 in Victoria. Yesterday 2700 passengers disembarked from the Ruby Princess cruise ship into Sydney. It’s time to keep my three- year-old home from childcare. I’ve been working from home for years, setting up and packing up my laptop from the kitchen table each day. I think of this house as mine alone. Those hours when Jono is at work and Jack’s at childcare, the stretching peace of tea and silence and room for my brain to work; they are what keep me sane. I’m about to give them up. I’m supposed to be writing a children’s book but I can’t focus. I’m afraid. Instead, I call my friend in Sydney whose grandmother is dying in aged care. Limits on visitors seem to shrink each day. She’s from a big Greek family and everything feels wrong about her Yiayia being alone for a second. There should be cousins and great-grandchildren and love all around her for these final days. My friend manages to get permission for her children to come in for a ten-minute visit to say goodbye. With her own full-time work, the domestic load, and the children in her face, she sounds like she doesn’t have time to grieve. I call my single friend who is just back from an overseas work trip. She’s in quarantine at home alone – facing lockdown as soon as her quarantine time ends. She’s been sharing articles about skin- hunger and loneliness. I bite back my envy of her space, my longing to be alone. And I listen to her sadness. I call my friend who is helping to care for her bedridden father. He has a slow, debilitating terminal illness. Someone needs to wake with him several times a night to help with toileting because his bladder is shot. My friend is living several nights a week at their house, trying to share the load, dressing in cobbled-together homemade PPE when she does the shopping. I call my friend who’s living on Centrelink with two kids and training to be a nurse. I check that she’s got the tech she needs for remote learning. I call my friend whose work as a touring theatre performer stopped overnight to find out how she’s planning to manage financially. I call my friend who’s a high school teacher. He is spending the entire school holidays planning how to deliver distance learning. I feel like they are all superheroes. I feel like I am part of a great network of carers who are holding up the world and I hope my phone calls lighten the burden. I realise that the phrase, ‘Love makes the world go around’ isn’t actually about the nice feeling I have in my chest sometimes. It’s talking about the hard, endless, soft, sleepless, exhausting labour of caring for our people. That labour just got a whole lot harder. I call Simone. I make my first recorded call to talk about how she’s feeling as the lockdowns roll in. Wu Han, Seoul, California, New Zealand … and now us. I’ve been listening to ICU nurses in New York talking about their days. The danger. The deaths. The lack of PPE. I want to know exactly what’s happening here in the hospitals near me. I asked her how she came to decide. ‘I guess I felt: I’m up for this. I’ve got ICU experience. I’m fit and healthy and I’ve got good support. So, I’m going to give it a go. For me, there wasn’t a question. Sure, there’s a part of me that would love to just bury my head in the sand but…’ But people need her help. At the first ICU orientation session, the message Sim heard was, ‘We need you. Please come and do whatever you can. If you only come in for two hours to relieve tea breaks, at least that’s something.’ She is part of a huge cohort of nurses returning to ICU from other places – education, project management, retirement or maternity leave. Sim will be stepping back a little from her other role: training health professionals to recognise and respond to signs of family violence in their patients. ‘The thing is,’ she tells me, ‘all the face-to-face training I was doing has ceased. We can’t have people in a room together. No-one’s got time. It’s not the priority right now.’ She’s obviously conflicted about this. ‘We know from data around bushfires and other crises that we’re going to end up with an escalation in family violence incidents. Isolation at home will just make it …’ She breaks off. ‘It’s really hard for a lot of people. Really fucking hard.’ She explains that, on top of increasing incidences, the family violence services have to find ways to operate with social distancing. ‘Social workers are having to figure out what they can do online, from their homes. The refuges are asking questions like, can they take people who’ve been in hospital, or might they be a risk to other people in the refuge?’ I feel the issues expand in front of me. Of people living in crisis accommodation, of children in state care, of prisoners. How are we, as a society, going to keep people safe? ‘So, I’m hearing all this info about family violence and my emails are full of it and my job is to make sure hospital staff have an eye open for it. But you can imagine the barrage of information going through hospitals at the moment. People are trying to filter what they need to know from pages of writing. They just don’t have time for it. I wrote one email about the increases in family violence we’re expecting. I probably went over it 20 million times trying to make it as succinct and easy to read as I could.’ Her frustration levels are high. This is not surprising, when all she can do is send emails people might not read. ‘I don’t have the ability to talk to people about all the details. All I can do is flag it and make sure they know where to look for resources.’ She’ll keep working at that for now. But she’s also getting ready for something very different. She had her first training in ICU yesterday. ‘It was, quite hilariously, the most welcoming experience I’ve ever had there.’ She pauses to explain. ‘Background: ICUs can be snobbish places in the sense that you have to meet certain criteria to work there. They’re very strict about it. If you haven’t worked there for a while, they will only take you back under specific conditions – so you can receive support and training.’ It makes sense to me. This is about life and death. You need to get it right. ‘But we just don’t have the ability to run ICUs with the number of staff this pandemic will require. Things are changing fast and we need to think outside the box. Suddenly it feels like ICU is rolling out the red carpet. They’re just having to say, “We want you. We want all of you.”’ It’s been five years since Sim worked regularly in an ICU and when she did it was at a smaller, more specialised unit. She’s never worked in a big trauma ICU like at the Royal Melbourne Hospital. I ask her how she’s feeling about it. ‘I’m incredibly nervous. You can imagine that there are a lot of machines. And there are a lot of things to remember. There’s a lot of immediate recall of what to do at each point that really isn’t fresh for me.’ Her voice rises. ‘And there was a woman in my group yesterday who hasn’t worked in ICU for eighteen years!’ On the recording of our conversation, you can hear me gasp, ‘Eighteen years! The tech must have really changed for people like her.’ Sim equivocates. ‘Yeah, but interestingly, a lot of the principles haven’t. Bodies are still the same. Blood pressures are still controlled in the same way. The tech has changed for sure, but some of it’s become more intuitive.’ She laughs. ‘You know, like how using an iPhone is actually easier than using an old Nokia.’ Sim explains the way ICUs are run. If a patient is on a ventilator, they have a nurse dedicated solely to them, who does not leave the bedside. The machines control how many breaths they take, the volume of air with each breath and the concentration of oxygen they receive. Medications are delivered by pumps to control blood pressure and heart rate. The nurse is always there, monitoring the machines and adapting settings and dosages in response to changes in the patient’s vital signs. ‘I stupidly started the day by reading stories from nurses living the nightmare that is ICU in London right now.’ Her voice rises with incredulity. ‘I read they only have one ICU nurse to six patients.’ I can feel the tension rolling down the phone. Royal Melbourne usually has thirty-two ICU beds and they’re looking to open ninety-nine in preparation for the pandemic. ‘So, if we are going to ninety-nine beds, then we need to triple the number of staff, and there’s just not that many ICU nurses. Even with all of us coming back from retirement and out of projects, there’s a gap. So, they’re also training up a cohort of nurses who haven’t worked in ICU before; they’re calling them Fast Track nurses.’ She says they’re not just training. They’re also ‘untraining’. ‘They always talk about danger to self. Don’t go in if there’s a danger to you. But nurses are inherently bad at that. If someone suddenly pulls out a breathing tube or is bleeding everywhere, we tend to go straightin. We should wear gloves, of course, but in that moment, we often just do what we can to save that person’s life – then deal with ourselves later.’ They’ve been training in how to put on Covid PPE. They have to pay attention to exactly how they handle the mask and breathe strongly to test if they have a seal. The mask is tight-fitting and takes time to get it on. It takes time to get it right. ‘If I look into a room and someone’s arresting, I can’t rush in and save that person’s life. I have to diligently put my mask on and focus on myself first. It’s actually going to be really hard.’ But Sim’s trainer told them, ‘Look, the thing is, how many other people won’t make it if we lose one ICU nurse for fourteen days? Even if you’re not sick, you’ll have to isolate and that has an impact on how many people we could actually save.’ ‘Yeah, that was just huge.’ She laughs her disbelief. She explains that the ‘pods’ of the intensive care unit will be divided to stop the spread of infection. ‘Initially, they’ll put Covid patients into the isolation rooms, but there are only eight. Once the isolation rooms are full, then they’ll go into Pod A and B which can be locked into Pandemic Mode. And then, of course, there will still be all the patients in ICU who don’t have Covid – so they’ll be in the other pods. ‘And then just … we don’t know what will happen. But that’s the initial plan.’ I’m worried about older nurses coming out of retirement, back onto the wards and being put in the way of infection. I’m worried about the fresh new mothers who had months of maternity leave planned and are suddenly, instead, stepping back into a risk- filled workplace. I’m afraid of our hospital system being overwhelmed. My sister lives in London and works for the National Health Service. Just days ago, she was telling me about clearing entire mental health hospitals to make way for palliative care wards. Wards for the Covid patients over sixty who they won’t be ventilating. Who will quite probably die. I’m scared for my parents who are far away in New South Wales. Sim’s parents are even further, in Western Australia. But we don’t talk about our families. It’s easier to focus on the details of the organisation and planning underway. It feels both compelling and reassuring. ‘They’re trying to work out an estimate as to when we expect to see patients at the hospital. When we expect to be flooded. And the interesting thing is, they don’t think it will peak for us until late April.’ The hospital was planning to roll out a new system of electronic medical records in April but they’ve slammed the brakes on that. They don’t want to be training hundreds of staff how to operate a whole different record-keeping system in the middle of a global pandemic. They’ll do it in July, when hopefully the peak will be over. ‘We’re going into a period now of potentially four weeks of not much happening from a hospital perspective. So, we have this amazing benefit of time to prepare in a way that Italy didn’t. And the UK didn’t. Those countries were flooded with ICU needs before they had time to think what was happening. ‘Whereas we don’t have any patients with Covid at the moment at Royal Melbourne, so we’re in total preparation mode. Teams are being formed. People are being brought on. Recruitment is happening.’ Sim pauses and slows. ‘It’s weird. It’s like preparing for a war, but the war’s not here yet.’ This is an extract from <a href="https://www.hardiegrant.com/au/publishing/bookfinder/book/the-care-factor-by-ailsa-wild/9781743797273">The Care Factor</a>, the story of one incredible nurse who chose to join the frontline combating an unprecedented global health crisis (Hardie Grant Publishing Australia), out now.

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Hospice nurse reveals people's last words before they die

Hospice nurse shares what happens to the body after death

Hospice nurse shares the four physical stages of dying

Hospice nurse reveals the key to a peaceful death

Hospice nurse reveals six unexplainable "death bed phenomena"

Hospice nurse explains why we shouldn't be afraid to die

Life behind bars for serial killer nurse

Hospice nurse shares the specific things people see before they die

Should we move our loved one with dementia into a nursing home? 6 things to consider when making this tough decision

Hospice nurse explains the “very comforting” thing that happens just before death

Moral injury: what happens when exhausted health workers can no longer provide the care they want for their patients

Terminally ill nurse caught in desperate waiting game

Nurse who lost both legs to Russian landmine gets married in hospital

Ukrainian nurses care for surrogacy babies underground

Trainee nurse sprints into action to save toddler

Conflicts between nursing home residents are often chalked up to dementia – the real problem is inadequate care and neglect

Hospice nurse reveals the three words many people say before they die

“Liars killed her and her baby”: Desperate nurse’s anguished accusation

Red Cross nurse accused of switching vaccines for salt solution

A frontline nurse’s gripping story

News

Shop

Catalogues

Travel

Health

Lifestyle

Finance

Entertainment

Property

Information

Keep up to date

Search

Hospice nurse reveals people's last words before they die

Hospice nurse shares what happens to the body after death

Hospice nurse shares the four physical stages of dying

Hospice nurse reveals the key to a peaceful death

Hospice nurse reveals six unexplainable "death bed phenomena"

Hospice nurse explains why we shouldn't be afraid to die

Life behind bars ﻿for serial killer nurse

Hospice nurse shares the specific things people see before they die

Should we move our loved one with dementia into a nursing home? 6 things to consider when making this tough decision

Hospice nurse explains the “very comforting” thing that happens just before death

Moral injury: what happens when exhausted health workers can no longer provide the care they want for their patients

Terminally ill nurse caught in desperate waiting game

Nurse who lost both legs to Russian landmine gets married in hospital

Ukrainian nurses care for surrogacy babies underground

Trainee nurse sprints into action to save toddler

Conflicts between nursing home residents are often chalked up to dementia – the real problem is inadequate care and neglect

Hospice nurse reveals the three words many people say before they die

“Liars killed her and her baby”: Desperate nurse’s anguished accusation

Red Cross nurse accused of switching vaccines for salt solution

A frontline nurse’s gripping story

Life behind bars for serial killer nurse