Behavioural Changes: The Importance of “Knowing the Person”

This story is shared with us by our colleague Andrea Leatherdale – RN, BScN, Practical Nursing Program Coordinator at Centennial College. In this story, the nurse observes changes in behaviour of one of the residents. The nurse is not able to shake off the concern that something significant is about to happen. The story illustrates the nurses listening skills and her attempts to alert others to the changes. 

A woman in her late 80s with advanced dementia and COPD with limited communication.  She was usually kept engaged in hand activities, like folding laundry and dressing dolls.  The usual practice on the unit was for nursing staff to play music during morning medication rounds and engage residents with singing and dancing.  Usually this woman wouldn’t engage, even though her family said she loved music.

This woman’s COPD was typically mild, but one morning she developed a new respiratory congestion, that was relieved with inhalation medications.   At the time that the morning congestion started, she started to sing spontaneously.  She was singing “Wake me up before you go-go, I’m not planning on going solo”.  She sang this phrase over and over again.

The nurses were surprised at this sudden change. The resident did not normally engage verbally. The nurses wondered what caused this change in behaviour, they discussed it as a team and reported it to the doctor and asked the doctor to assess the woman’s chest congestion. The doctor said that since the chest congestion cleared with the morning inhalation treatments, it was not a concern.

When her family heard their mother singing, they were excited that their mother was more alert and active. They attributed this as a positive change to the way the staff was interacting with her.

The nurse assigned to care for her, who was most familiar with her, still felt that there was something else happening. She talked with the doctor again. The doctor still said since the woman was eating and drinking normally and her temperature was normal, no further investigation was needed.

The resident sang this song every morning for 5 days.  On the fifth day, she had a sudden increase in congestion. She was sent to hospital.  She died 2 days later in hospital from pneumonia secondary to COPD. Her daughter was with her at time of death. Other family members were not there. The family was concerned that she had not died in place, in her home, at the facility.


We’d love to hear about your experiences and thoughts on this story. Please leave your comments below.


Journaling for Self-Care

It is a wonderful thing to care for loved ones, family, and friends…

As Tia Walker says,

“To care for those who once cared for us is one of the highest honors.”

“The Inspired Caregiver: Finding Joy While Caring for Those You Love”,


And it is a wonderful thing to be a caregiver by profession.

But caregiving is also challenging. It is just plain hard at times.

Caregiving can be hard on our health, emotional strength and resilience, and our relationships.

Journaling is one tool, one method of self care that can help the writer reflect, gain insight, get clear, solve a few problems, learn, improve, gain strength, and move forward.  It is also a good tool for curling up and hiding away on occasion.  Journaling can stimulate creativity, and help us find new paths, new ways of doing things.

There are many ways to journal, and different people have different tips on journaling.

A few tips that I find stimulate and inspire my writing and learning:

  • Take some time daily
  • Create a special place, a creative corner….
  • Put pen(cil) to the paper
  • Move your pen and write
  • Write for 20 minutes
  • Don’t worry about what you are writing
  • Don’t worry about grammar or spelling, just write
  • Consider keeping your writing private, you do not have to share it

For more information about journaling, to get some ideas, ask a journaling expert some questions, get inspired, you might like to visit CreateWriteNow website 

Warm regards,

Kath Murray

PS We have a new journal coming out in the next few weeks with some great quotes specifically on Self Care to stimulate and inspire… stay tuned!


On being a hospice palliative care nurse AND a daughter…

Last month I wrote about my mom dying.  Mary Hughes (nurse leader extraordinaire) from PEI wrote to say that she wanted to hear my thoughts on being a daughter and a Hospice Palliative Care (HPC) nurse.. how was it easier? in what ways was it harder?

I have reflected on this over the past few months.. here are my thoughts of the moment. I am interested in hearing your thoughts, and insights. Please either respond to the blog or write me an email directly.

My reflections:

In what way was care easier because I was a HPC nurse and a daughter?

As a HPC nurse, I know that death happens. I am not surprised that someone can get sick, be diagnosed and die within a short period of time.

I know about symptom management and use of medication and other comfort measures. I know it is helpful to take medications to prevent pain rather than chase it when it has escalated. I know that breakthrough doses can be taken if the pain is not controlled, and that dosages can be increased to provide pain management.

I know about decreasing appetite, and I know that the dying do not die because they eat less, but that they eat less because they are dying.

In knowing these things, I provided care, I tried to anticipate changes, I requested medications, route changes, and equipment in advance.

“Knowing” the basics of hospice palliative care surely made the pathway familiar and made it easier to care.

As a nurse I knew that hospital beds could fit more than one person.  On a few occasions, we climbed in and napped along side mom.

In what ways was caring for my mom more difficult because I was HPC nurse?

As a palliative response nurse, my work for more than a decade was in responding to people who were dying and who were in crisis of some kind, either symptom management, or psychosocial. Knowing that crisis can and do occur, I wanted to prevent even the possibility of discomfort. This was difficult when I wanted to balance her symptom management with the concern of siblings who might have been concerned that her decreased level of consciousness was related to medications.  On the one hand I wanted her to be comfortable, and on the other hand I felt the incredible sorrow of realizing that she was no longer able to respond.  I felt the tug between protecting her and the desire or hope that we could help her be as alert as possible.

Working with loved ones who had other ways of doing things was difficult at times.  It was challenging.  We had to be committed to the shared goal of pain management, and be flexible on the plan of care to achieve that goal.

A most difficult challenge for me was when my mom developed a few skin wounds.  I felt I could have prevented this had I been more adamant about regular turns.

What was unique, but not positive or negative about being a HPC nurse and daughter?

Entering into the caregiving experience, I was aware of how difficult it is to “be family”, to sit and to wait with the dying. I came to understand this on an even deeper level.

I thought of the term “difficult family”. I did not want to “be difficult”.  I did not want to experience contention, nor did I want to inflict contention on the health care team. I thought more than a few times of my prefered term “difficult situations” and just how very challenging family caregiving is.

As the HPC nurse/daughter, I wanted to respect the requests and suggestions of my siblings with regards to care for our mom. I wanted to respect the different styles of grieving and communicating.  If they were clear about how they wanted something done, I wanted to try and be helpful.  (And though I wanted to do this, I was not always successful!)

Mostly, I wanted to prevent my siblings from suffering.  I hoped that I could provide care and act in a way that would make it easier for them.  Again, I was successful in this, as it is painful to have a mom die.

The struggles to balance, juggle and respect the opinions and needs of family members was perhaps the most difficult.  In retrospect, a few months later… I think that we worked pretty well as a team. As siblings we had gathered from around the world, with such different personalities and experiences. Throughout her last months we provided our mom with great support.  She died pain-free (her first priority) at home, at the far end of a rather isolated island,with all of us present.

Being a HPC nurse and a daughter, had its challenges I am sure, but overall, I would not have traded that expertise for anything!