Patient Left Unrestrained, #Patient Injured. #Nurses Judgement Call, #nursing #malpractice #nursefriendly #epatient #negligence

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Summary: The decision to use or not use restraints must be made with caution and good judgement. Their intended purpose must be to protect either the patient or others who may be injured by the patient including the staff caring for the client. The ultimate determination of necessity is left with the physician. Often, the moment to moment necessity is determined by the nurse. In this case a nurse did not feel restraining the patient was necessary. When an injury occurred, the patient sued.

The patient was involved in a motor vehicle accident. A head injury was suffered leaving him in a state of confusion and prone to agitation.

"Each year, an estimated 2 million people sustain a head injury. About 500,000 to 750,000 head injuries each year are severe enough to require hospitalization. Head injury is most common among males between the ages of 15-24, but can strike, unexpectedly, at any age. Many head injuries are mild, and symptoms usually disappear over time with proper attention. Others are more severe and may result in permanent disability." 2

Following the head injury, the patient was visibly confused and frequently became agitated. During the course of his admission, an order for "soft" wrist restraints was obtained and implemented to protect the patient from injury related to mental status (personality) changes.

"Personality Changes-Apathy and decreased motivation. Emotional lability, irritability, depression. Disinhibition which may result in temper flare-ups, aggression, cursing, lowered frustration tolerance, and inappropriate sexual behavior."2

On the day of the incident, the nurse on duty had assessed the patient. In her professional opinion restraints were not needed.

"What Is Restraint?

"Restraint" is physical force, mechanical devices, chemicals, seclusion, or any other means which unreasonably limit freedom of movement. hospital staff may use four types of restraint to restrict patients who are acting, or threatening to act, in a violent way towards themselves or others.

Physical restraint--holding a patient for over five minutes in order to prevent freedom of movement.

Mechanical restraint--using a device, such as 4-point or full sheet restraint, to restrict a patient's movement (excludes devices prescribed for medical purposes).

Chemical restraint--medicating a patient against her will for the purpose of restraint rather than treatment.

Seclusion--placing a patient alone in a room so that she cannot see or speak with patients or staff and the patient cannot leave or believes she cannot leave."3

She based this decision on her observation of the patient's mental, physical state and level of consciousness. It is common procedure and protocol in facilities for patient's to be released from restraints when the danger of violence is felt to have passed.

"How Long May Restraint Continue?

When an emergency no longer exists, the patient should be released. Thus, staff should release a patient who, upon examination, appears calm. The total time which a patient may be restrained is limited:"3

Later in the shift, the same nurse was helping the patient get up. In the course of this maneuver, the patient fell and claimed that an injury was sustained.

A lawsuit would be filed against the facility alleging negligence on the part of the nurse. The patient contended that the removal of the restraints breached standards of care.

In the initial trial, the jury was instructed to view the nurse's role as an "error in judgement." Based on this and on testimony on the proper use of restraints, standards of care, the court found for the facility.

The patient appealed.

Questions to be answered:

1. Was the nurse in error to remove the restraints from a patient when she felt they were no longer needed.

2. Did the removal of the restraints directly contribute to the "injury" that the patient claimed to sustain?

3. Were the standards of care governing restraint use adequately maintained?

The plaintiff's arguments sought to convince the jury that poor judgement was exercised by the nurse. It was contended that removal of the restraints and ambulation of the patient put him in harm's way.

With the patient assessed to be calm, the purpose of the restraints, "to prevent the patient from harming himself or others," had been achieved.

The purpose of the restraints had not been to "keep the patient from falling out of bed." The removal of the restraints then, could not be deemed as negligent. There was no duty of care breached in allowing the calm patient to remain unrestrained.

The order was in place to ambulate the patient when stable. In the nurse's opinion, the patient was ready. Another nurse may not have agreed with her actions. The patient under a different nurse's care might have been kept in restraints. A nurse could have "held off" on the order to ambulate.

There was no causative relationship between removing the restraints and the patient's fall. In carrying out orders for ambulation, the nurse was providing proper nursing care.

It's not difficult to picture a lone nurse with an unsteady patient losing control and having the patient slip away. Would this be a breach of duty owed to the patient?

One could argue that the nurse had no business trying to move a patient by herself. One might also observe the staffing patterns at the time and realize the nurse was doing "the best she could."

The decision to remove the restraints was clearly a nursing decision. Often the decision to use them in the first place lies with the nurse too.

This illustrates the leeway and discretion given nurses when carrying out physician's orders. It also shows the typical catch 22 situation some nurses may find themselves in regarding restraint use.

"Historically, conventional wisdom supported using physical restraints, including bed side rails, to "protect and safeguard" residents. Ironically, little documented evidence exists that restraints prevent falls and risk of injury from falls. Clinical studies demonstrate that restraints, conversely, in some instances, precipitate or exacerbate fall risk."4

Both nurses in the above situation would be acting within their scope of practice. Each would be adhering to standards of care.

For the plaintiff to have a case, it would need to proven that either the removal of the restraints or the ambulation of the patient was premature.

This was clearly not the case. The actions of the nurse were in good faith and exercised reasonable concern for the well being of the patient. The fact that the patient suffered a fall is unfortunate, and reasonably unforseeable.

It can be compared to the actions of a physician when dealing with an acute patient. Depending on which course of treatment that physician chooses, the patient might or might not have a favorable outcome.

In either case, as long as the physician exercises reasonable judgement based on established principles of practice, a finding of negligence is unlikely.

It has been well established that Medicine is not an exact science. Outcomes are not guaranteed when prescribing courses of treatment.

They are the result of standard medical practices and individual patient responses. These responses are not always predictable. Basically, the caregiver can only hope for the best.

The same principle applies to Nursing care. Regardless of how accurate assessments are and how diligently orders are carried out, patients may or may not experience favorable outcomes.

When outcomes are unfavorable, it is the constitutional right of the patient or patient's estate to sue anyone felt to be involved.

The court reviewed the facts of the case and a nursing expert's testimony on restraint use. The appeals court agreed that standards of care had been maintained.

There exists today intense pressure from family members, governmental agencies and regulatory agencies to limit restraint use to "only when absolutely necessary." As soon as they are put in use, the plan of care must include provisions for their removal.

Link Sections:

Head Injuries:
http://www.nursefriendly.com/nursing/directpatientcare/head.injuries.htm

Ethics:
http://www.nursefriendly.com/nursing/directpatientcare/ethics.htm

Mechanical & Physical Restraints:
http://www.nursefriendly.com/nursing/directpatientcare/mechanical.physical.re...

Medical Legal Consulting Nurse Entrepreneurs
http://www.nursefriendly.com/nursing/ymedlegal.htm

Sources:

1. RRNL 2 (July 1997)

2. Family Caregivers Alliance Clearinghouse. Revised November 1996. Fact Sheet: Head Injury. Retrieved May 30, 1999 from the World Wide Web: http://www.caregiver.org/factsheets/head_injury.html

3. Mental Health Legal Advisors Committee. No date given. Your Rights in Hospitals Regarding Restraining and Seclusion. Retrieved May 30, 1999 from the World Wide Web: http://www.psychiatry.com/mhlac/basicrights/restraintandseclusion.html

4. Braun, Julie A. & Quish, Clare J. 11/10/98. Illinois Institute for Continuing Legal Education. Physical Restraints And Fall-Related Injuries. Retrieved May 30, 1999 from the World Wide Web: http://www.iicle.com/articles/braun11_10_98b.html

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Extravasation Follows Chemotherapy Administration, Potential Complication or Nursing Negligence

Extravasation Follows Chemotherapy Administration, Potential Complication or Nursing Negligence

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Extravasation Follows Chemotherapy Administration. Potential Complication or Nursing Negligence
Iacano v. St. Peter’s Medical Center, 334 N. j. Super. 547 – NJ (2000)

Summary: Intravenous therapy has inherent risks and potential complications. When you introduce chemotherapeutic drugs and known vesicants, those risks increase dramatically. In this case, a known risk, extravasation, occurred following administration. The question arises, could the nurses have acted sooner to prevent the extravasation and resulting tissue damage.

The patient was an Oncology patient being treated as an outpatient for non-Hodgkin’s lymphoma, a cancer of the lymphatic system. On a regular basis (every third Friday), she would come in for her treatments. Her Chemotherapeutic regimen consisted of four different drugs, three of them given intravenously. The IV drugs were Cytotoxan, Oncovin, and Adriamycin.

Oncovin and Adriamycin are known vesicants (chemicals which can cause tissue damage and destruction if they leak into surrounding tissues) and typically administered via “IV Push” meaning they are injected directly into the bloodstream through an IV access device. It is critical that the patient be monitored for signs/symptoms of adverse reactions or complications during and after this type of administration.

“Extravasation of chemotherapeutic vesicant agents can result in significant tissue damage, alteration in limb function, and pain. Quality of life for long-term survivors can be severely impacted by negative sequelae from vesicant extravasation. Currently, there is no known preventive therapy. Early detection and intervention are paramount to halt tissue damage and reduce the chance of permanent disability or disfigurement.”²

On this day, the patient was accompanied by a friend who witnessed her treatment. She would attest to the patient’s account of administration of the medications and complaints of discomfort soon afterwards. She would state that the nurses on duty had been informed of this discomfort not once but twice but did nothing. Reports of a red, swollen and puffy hand appearance were allegedly made to the nurse with no action taken.

The patient was initially given Cytotoxan (not a vesicant) through a peripheral IV line in her right hand. Shortly after the infusion began, the patient would begin her complaints of discomfort in that hand.

The patient would state that even after describing her hand discomfort, the nurse injected the vesicant medications into the right hand IV site.

The nurse would later state that she got “good blood return” from the site and did not recall any complaints of pain by the patient. No nurse’s notes were available to collaborate her testimony.

Soon after administration of the vesicants, there were further complaints of pain, and new complaints of “burning.” An extravasation was then reported to the physician. Orders were obtained to discontinue the IV in that hand and treat the extravasation with cold compresses. Apparently, it was not until the patient reported a “burning” sensation that the nurse took notice and took action on the patient’s concerns.

“What is Extravasation? The leakage of intravenous drugs from the vein into the surrounding tissue.(1) Extravasation injury usually refers to the damage caused by leakage of solutions from the vein to the surrounding tissue spaces during intravenous administration. Once an extravasation has occurred, damage can continue for months and involve nerves, tendons and joints. If treatment is delayed, surgical debridement, skin grafting, and even amputation may be the unfortunate consequences.”³

(Please visit http://www.extravasation.org.uk/Definition.htm for a photo example of the type of injury involved in this case (center photo))

It is important to note that despite the patient’s complaints of pain, and witness reports, despite the documented report of an extravasation and resulting physician orders to deal with it, despite the restarting of the IV to continue therapy, no mention of these events was available in the nursing portion of the chart when it was reviewed after the fact.

The patient would need an Orthopedic consult to deal with the extensive damage caused by the extravasation. Debridement and tissue repair would leave permanent scarring and irreversible damage.

The patient sued the Nursing staff on duty that day for negligence. The courts returned an award of 1.5 Million dollars. This would later be ruled excessive and reduced to 0.5 Million dollars.

The defense appealed for a new trial based on the excessive award initially granted.

Questions to be answered.

1. Who was responsible for monitoring the patient for potential complications, and was this monitoring carried out within acceptable standards of care?

2. Special precautions/monitoring must be in place when administering vesicant medications. Were the nurses negligent in their duty to monitor for complications of chemotherapy?

3. Was the patient in fact having pain and discomfort well before the administration of the vesicants? If so, was the nurse in error, to administer the medication despite the patients concerns and complaints?

4. Was there appropriate documentation to support either the nurses or the patient’s account of the situation.

5. Could the extravasation and resulting tissue damage have been prevented?

6. Did the jury in the initial trial award an excessive amount based on flawed information in the initial trial.

The two nurses on duty were clearly responsible for monitoring this patient (and all the other patients in the office as well). It is recognized that the greatest responsibility would fall on the nurse who was administering the vesicant-type medications. Before administering any medication into an IV site, it must be assessed for signs/symptoms of irritation, patency and proper placement.

It would seem incredible, that a patient’s complaints of first discomfort, pain, and then burning would not be investigated by the nurses on duty. These are obvious signs/symptoms of potential vesicant complications. Due to the lack of documentation, this is what we must assume happened.

Of the two nurses on duty, at least one of them would have been made aware and had the responsibility to notify both the other nurse and the physician when appropriate. In light of the fact that an extravasation did occur and resulted in tissue damage, a case for negligence in the monitoring of this patient is established.

It can be argued that the “prudent nurse” when made aware of a patient’s discomfort, would have either slowed or stopped the intravenous infusion and checked the site before proceeding. With the patient’s companion echoing complaints of both pain and a “puffy, red” appearance, that IV site should have been discontinued immediately.

It is unfortunate that no nurses notes were available to give the nurses’ side of the story. It can only be assumed that there was in fact a problem with the site (based on the later reported extravasation and tissue injury).

"Each state has enacted a nurse practice act that authorizes an individual to practice as a registered nurse if the applicant meets specific criteria. Laws or administrative rules in each state further outline documentation issues, such as handling of records, falsification of records and confidentiality.6 Regardless of your work setting or nursing specialty, you must document care based upon the requirements of your state’s nurse practice act. For information on your state’s nurse practice act, contact the National Council of State Boards of Nursing at www.ncsbn.org.”⁴

There is an inherent duty which a nurse (like a physician) owes to a patient which is to do no harm, and protect them from foreseeable complications. In this case, when the nurse injected the vesicants into an IV site that had already been reported as “causing discomfort,” that duty was clearly not adhered to. Her testimony later that she had “good blood return” from the site was clearly an inadequate assessment.

The presence or absent of “blood return” is not a reliable indicator of an intravenous line’s proper placement or appropriate location.

Again, it would seem incredible that a nurse would inject vesicants, chemicals known to damage tissue and cause significant complications, into an already problematic intravenous site. Due to the lack of documentation in the medical record, we must assume this is what took place based on the end results.

If in fact the patient was complaining of discomfort from the site, then the vesicants should never have been injected. It is dictated by standards of care that, the existing site be discontinued and treatment initiated if warranted by nursing judgment or physician’s orders, another intravenous site be initiated and the medications placed in an alternate location. If no other location was available, or accessible a call would need to be placed to the physician for further orders.

Summary: In the end, the appeals court would find that even though the initial award was excessive, it was not based on an error or misinterpretation of fact. The request for a new trial was denied and the $500,000 award for the negligence on the part of the nurses was upheld.

Related Link Sections:

Clinical Charting and Documentation, Nurses Notes:
http://www.nursefriendly.com/nursing/directpatientcare/clinical.documentation.nurses.notes.htm

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Cancer, Oncology, Malignancy, Tumors (over a thousand sites):
http://www.nursefriendly.com/cancer/

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Direct Patient Care Links :
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Extravasation, Vesicant Infiltrations, Complications of Intraveous (IV) Therapy:
http://www.nursefriendly.com/extravasation

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Informed Consent
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/informed.consent.medical.legal.htm

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Intravenous Therapy, Nursing IV Team
http://www.intravenousnursing.com

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Nurse Practice Acts, Legal and Medical Links
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/nurse.practice.acts.htm

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Nursing Professional Malpractice & Liability Insurance
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Starting An IV Line, Intravenous Therapy, Infusion Resources:
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Torts Law & Personal Injury, Legal Resources
http://www.legalnursingconsultant.org/legal.nurse.consultants.lnc/law/torts.htm

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Related Nursing Malpractice Cases:

August 1, 1999: Nursing Duty To Patient, "Does Not Guarantee" Safety Or
Quality Of Care.
Summary: When a nurse accepts report and responsibility for the care of a patient a duty to the patient is also accepted. This duty is to provide a reasonable standard of care as defined by the Nurse Practice Act of the individual state and the facility Policy & Procedures. In this case, a post-op abdominal aneurysm repair patient was injured after falling from his bed to the floor. When a lawsuit was filed the court initially mistook expert testimony to imply the role of the nurse includes a guarantee of safety.
Downey v. Mobile Infirmary Med. Ctr. - 662 So. 2d 1152 (1995).
http://www.nursefriendly.com/nursing/clinical.cases/080899.htm

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August 8, 1999: Pregnant Prison Inmate Complains of Miscarriage, Corrections Nurse On Duty Ignores Symptoms?
Ferris v. County of Kennebec, 44 5. Supp.2d 62 –ME (1999)
Summary: Nursing assessment skills are one of our most valuable assets. They allow us to effectively evaluate our patients and communicate significant findings to physicians and other members of the healthcare team. In this case, a pregnant woman with a previous history of miscarriage complained of vaginal bleeding and abdominal discomfort. The assessment performed by the nurse fell negligently short of the required standard of care.
http://www.nursefriendly.com/nursing/clinical.cases/080899.htm

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September 12, 1999: Sleep Apnea Monitor Turned off or Ignored By Nursing Staff, Patient's Coding Goes Unnoticed.
Monitors and Monitored patients present special challenges to practicing nurses. Like a call bell, when alarms on a monitor are activated, they can signal benign or life-threatening events. In this case, a patient's monitors did not alarm as expected. The patient was in distress and would be found without respirations and pulseless by the nurse on duty.
Odom v. State Dept. of Health and Hosp., 322 So. 2d 91 -LA (1999)
http://www.nursefriendly.com/nursing/clinical.cases/091299.htm

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October 3, 1999: Grand Mal Seizure Follows Cervical Myelogram, Anticipated Risk or Nursing Negligence?
Cascio v. St. Joseph Hosp., 734 So.2d 1099 - FL (1999)
Summary: With a proper Informed Consent obtained, it is accepted that a patient is aware of potential risks & complications prior to a procedure. In this case, following a cervical myelogram, a patient developed seizures and suffered an injury. The physician would blame the nursing staff for causing an "increased risk" by not following procedures.
http://www.nursefriendly.com/nursing/clinical.cases/100399.htm

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References:

1. 41 NLRR 6 (November 2000)

2. Kassney, Elizabeth. (6/1/2004). Evaluation and Treatment of Chemotherapy Extravasation Injuries. National Extravasation Information Service. http://www.extravasation.org.uk/Eval.htm (21 January, 2004)

3. Stanley, A. (6/1/2004). What is Extravasation. National Extravasation Information Service. http://www.extravasation.org.uk/Definition.htm (21 January, 2004)

4. Habel, Maureen. (1/13/03). Document It Right. Would your charting stand up to scrutiny? Nurseweek.com. http://www.nurseweek.com/ce/ce670a.asp (21 January 2004)

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Please choose from the following:

• Malpractice Cases By Date Posted (Twenty Nine Cases Total)

• Malpractice Cases by Department: Emergency Department, Operating Room, Surgical

• By Type of Facility: Hospital

• By Topic:
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  • Informed Consent,
  • Nurse Abuse,
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  • Organ Donation,
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  • Restraints,
  • Sepsis,
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Nothing Is More Important Than Relationships, Inspirational Poems, Touching Stories

Nothing Is More Important Than Relationships, Inspirational Poems, Touching Stories

To Receive our inspirational stories as we post them subscribe to our mailing list by sending a blank e-mail to inspirationalstories-subscribe@topica.com

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I sat next to the bed of old man, a friend for over twenty years, and held his hand. Hal was dying. We both knew these next few days would be his last.

We spent time reminiscing about his long and fruitful career as a church pastor. We talked about old friends. We chatted about his family. And I listened as he offered sage wisdom and advice to a member of a "younger generation."

At a lull in the conversation, Hal seemed to carefully consider what he was about to say next. Then he squeezed my hand, gazed intently into my eyes and whispered, just loud enough for me to hear, "Nothing is more important than relationships."

I knew that this was somehow near the pinnacle of his life's learnings. As he considered all of his experiences -- personal, professional, spiritual and family, this one ultimate observation surfaced above the rest: "Nothing is more important than relationships."

"Don't get overly caught up in your career," he seemed to be saying to me. "Likewise, don't use people in order to achieve your goals, then throw them away. No project, no program, no task should be pursued at the expense of friends and family. Remember," I heard him saying, as clearly as if he were speaking the words, "that in the end, only your relationships will truly matter. Tend them well."

Writer Og Mandino puts it this way: "Beginning today," he said, "treat everyone you meet as if he or she were going to be dead by midnight. Extend to them all the care, kindness, and understanding you can muster, and do so with no thought of any reward. Your life will never be the same again."

At the end of a long life, my friend Hal would have agreed.

Author unknown

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Nothing Is More Important Than Relationships, #Inspirational Poems, Touching #Stories, #inspire #inspiration #poems

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I sat next to the bed of old man, a friend for over twenty years, and held his hand. Hal was dying. We both knew these next few days would be his last.

We spent time reminiscing about his long and fruitful career as a church pastor. We talked about old friends. We chatted about his family. And I listened as he offered sage wisdom and advice to a member of a "younger generation."

At a lull in the conversation, Hal seemed to carefully consider what he was about to say next. Then he squeezed my hand, gazed intently into my eyes and whispered, just loud enough for me to hear, "Nothing is more important than relationships."

I knew that this was somehow near the pinnacle of his life's learnings. As he considered all of his experiences -- personal, professional, spiritual and family, this one ultimate observation surfaced above the rest: "Nothing is more important than relationships."

"Don't get overly caught up in your career," he seemed to be saying to me. "Likewise, don't use people in order to achieve your goals, then throw them away. No project, no program, no task should be pursued at the expense of friends and family. Remember," I heard him saying, as clearly as if he were speaking the words, "that in the end, only your relationships will truly matter. Tend them well."

Writer Og Mandino puts it this way: "Beginning today," he said, "treat everyone you meet as if he or she were going to be dead by midnight. Extend to them all the care, kindness, and understanding you can muster, and do so with no thought of any reward. Your life will never be the same again."

At the end of a long life, my friend Hal would have agreed.

Author unknown

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InspirationalNursing.com:"InspirationalNursing.com. Touching Poems, and Inspiring stories that touch the heart and occasionally bring a tear to your eye. Affection, Ambition, Angels In Our Lives, Animals, Babies, Bereavement, Caring, Caring, Children, Christian Stories, Christmas, Computers & The Internet, Death, Dependability, Determination, Dying, Easter, Emergency Medical Services (EMS), End of Life, Etc., Friendship, God's Creatures, Grief, Holiday Thoughts, Honesty, Hospice Poems, etc."
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Death, Dying, End of Life, Hospice, Inspirational Poems, Touching Stories

Death, Dying, End of Life, Hospice, Inspirational Poems, Touching Stories

To Receive our inspirational stories as we post them subscribe to our mailing list by sending a blank e-mail to inspirationalstories-subscribe@topica.com

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Faith Friends by Nancy Haygood, Hospice Poems, Stories of Death and Dignity:"I don't want to say goodbye
Don't want you to see me cry
But in the end, that sweet by and by
We will meet again."
http://www.inspirationalnursing.com/faith

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Tribute to a Hospice Nurse by E.V. Stankowski, RN, Inspirational Poems, Touching Stories:"When it comes to death and dying
There's a special gift you share
One that Angels all admire
One that goes beyond just care

http://www.inspirationalnursing.com/hn

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A Trip To The Supermarket, Inspiration Poems, Touching Stories:"I walked into the grocery store not particularly interested in buying groceries. I wasn't hungry. The pain of losing my husband of 37 years was still too raw. And this grocery store held so many sweet memories."
http://www.nursefriendly.com/nursing/inspiration/a.trip.to.the.supermarket.htm

Inspirational Categories: Affection, Caring, Friendship, Angels In Our Lives, Watching Over Us, Bereavement, Grief, Loss, Sorrow, Death, Dying, End of Life, Hospice Poems, Love, Marriage, Matrimony, Loving Partners

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Always Say I Love You, Inspirational Poems, Touching Stories:"Brittney loved basketball Friends and parties too And when it came to painting That's all she wanted to do."
http://www.nursefriendly.com/nursing/inspiration/always_say_i_love_you.htm

Inspirational Categories: Affection, Caring, Friendship, Babies, Children, Infants, Kids, Bereavement, Grief, Loss, Sorrow, Death, Dying, End of Life, Hospice Poems, Living Life To The Fullest, Love, Caring, Self Esteem, Self Worth, Parents & Parenting

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Angels of Mercy, Inspirational Poems, Touching Stories:"Sorry if we woke you in the middle of the night But someone in your neighborhood is fighting for his life. Sorry if we block the road and make you turn around, But there's been a bad wreck with dying children on the ground."
http://www.4nursing.com/inspirational-poems-touching-stories-angels-of-mercy.html

Inspirational Categories: Death, Dying, End of Life, Hospice Poems, Emergency Medical Services (EMS)

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Beatitudes For Aging, Inspirational Poems, Touching Stories:"Blessed are they who understand My faltering steps and palsied hand. Blessed are they who know my ears today must strain to catch the words they say."
http://www.nursefriendly.com/nursing/inspiration/beatitudes.for.aging.htm

Inspirational Categories: Affection, Caring, Friendship, Angels In Our Lives, Watching Over Us, Parents & Parenting Death, Dying, End of Life, Hospice Poems, Living Life To The Fullest, Love, Caring, Self Esteem, Self Worth

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Butterfly Courage, by David L. Kuzminski:"Walking down a path through some woods in Georgia in 1977, I saw a water puddle ahead on the path. I angled my direction to go around it on the part of the path that wasn't covered by water and mud. As I reached the puddle, I was suddenly attacked!"
http://www.inspirationalnursing.com/courage

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Death Is Nothing At All, Poems About Death & Dying, Loss:"Death is nothing at all...
I have only slipped away to the next room...
I am I and you are you...
Whatever we were to each, that we are still."
http://www.inspirationalnursing.com/nothing

Inspirational Categories: Bereavement, Grief, Loss, Sorrow, Death, Dying, End of Life, Hospice Poems, Living Life To The Fullest

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Do Not Stand At My Grave, Inspirational Poems About Death & Dying:"Do not stand at my grave and weep, I am not there, I do not sleep. I am a thousand winds that blow; I am the diamond glints on the snow."
http://www.inspirationalnursing.com/grave

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Earthbound Angel, Inspirational Poems, Touching Stories:"Occasionally, we are graced with the presence of an earth bound Angel. They are unable to stay with us for long, but while they do, they bring unprecedented joy and happiness to all they touch."
http://www.inspirationalnursing.com/earthbound

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Gone From My Sight, Inspirational Poems, Touching Stories:"I am standing upon the seashore. A ship at my side spreads her white sails to the morning breeze and starts for the blue ocean."
http://www.inspirationalnursing.com/sight

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Hummingbird Man, The by Nancy Haygood, Hospice Poems, Stories of Death and Dignity:"He shows me tomatoes – red cherries, neatly hoed,
He naps in the sun, soaks up heat, sky aglow.
"Meet my new pup," proudly, "she's for squirreling."
His pain burns deep, he hides it, buried, gnawing."
http://www.inspirationalnursing.com/hummingbird

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I Found Jesus There, Inspirational Poems, Touching Stories:"The surgeon sat beside the boy's bed; the boy's parents sat across from him. "Tomorrow morning," the surgeon began, "I'll open up your heart..." "You'll find Jesus there," the boy interrupted."
http://www.inspirationalnursing.com/there

Inspirational Categories: Affection, Caring, Friendship, Babies, Children, Infants, Kids, Death, Dying, End of Life, Hospice Poems, Parents & Parenting, Religious Poems, Christian Stories

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If It Should Be, Animal Poems, Pet Stories:"If it be I grow frail and weak, And pain should wake me from my sleep, then you must do what must be done, for this last battle can't be won."
http://www.inspirationalnursing.com/be

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If Roses Grew In Heaven, Inspirational Poems, Touching Stories:"If roses grow in Heaven, Lord please pick a bunch for me, Place them in my daughters arms and tell her they're from me."
http://www.inspirationalnursing.com/roses

Inspirational Categories: Babies, Children, Infants, Kids, Bereavement, Grief, Loss, Sorrow, Death, Dying, End of Life, Hospice Poems, Motherhood, Mothering, Moms, Parents & Parenting, Prayers, Requests, Praying, Religious Poems, Christian Stories

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If There Were No Tomorrow..., Inspirational Poems, Touching Stories:"I would tell you today
That you are the one that fills my life,
Whose smile I cannot wait to see,
Whose arms I long to have wrapped around me,
Whose lips I live to kiss,
Softly, passionately, in every way."
http://www.inspirationalnursing.com/were

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Inheritance, Inspirational Poems, Touching Stories:"There is a lovely story told about a famous art collector who learned that his son had been killed in the war, killed saving the life of another soldier. Some time past and the soldier who survived and who himself was an amateur painter, gave the art collector a simple portrait he'd sketched of his son. It was nothing like a masterpiece but it became very special to the man in his loneliness."
http://www.inspirationalnursing.com/inheritance

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Life Still Has A Meaning, Inspirational Poems, Touching Stories:"If there is a future there is time for mending- Time to see your troubles coming to an ending."
http://www.inspirationalnursing.com/meaning

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Men Do Cry, Inspirational Poems, Touching Stories:"I heard quite often "men don't cry" though no one ever told me why So when I fell and skinned a knee, no one came by to comfort me."
http://www.inspirationalnursing.com/men

Inspirational Categories: Babies, Children, Infants, Kids, Bereavement, Grief, Loss, Sorrow, Death, Dying, End of Life, Hospice Poems, Parents & Parenting

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My Brother Has Fallen, Inspirational Poems, Touching Stories:"My Brother has fallen; no, I don't know his name. Have not the same parents still family all the same. He lives in this town, I live in another, It doesn't really matter 'cause this man is my Brother."
http://www.inspirationalnursing.com/fallen

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My First Christmas In Heaven, Inspirational Poems, Touching Stories:"I see the countless Christmas Trees around the world below, with tiny lights, like heaven's stars, reflecting on the snow. The sight is so spectacular, please wipe away that tear, for I am spending Christmas with Jesus Christ this year."
http://www.inspirationalnursing.com/my

Inspirational Categories: Angels In Our Lives, Watching Over Us, Babies, Children, Infants, Kids, Bereavement, Grief, Loss, Sorrow, Death, Dying, End of Life, Hospice Poems, Holiday Thoughts, Christmas, Easter, Thanksgiving, Etc., Living Life To The Fullest, Love, Caring, Self Esteem, Self Worth, Religious Poems, Christian Stories

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Nothing Is More Important Than Relationships:"I sat next to the bed of old man, a friend for over twenty years, and held his hand. Hal was dying. We both knew these next few days would be his last. We spent time reminiscing about his long and fruitful career as a church pastor. We talked about old friends. We chatted about his family. And I listened as he offered sage wisdom and advice to a member of a "younger generation."
http://www.inspirationalnursing.com/relationships

Categories: Affection, Caring, Friendship, Bereavement, Grief, Sadness, Sorrow, Death, Dying, End of Life, Hospice Poems, Living Life To The Fullest, Love, Caring, Self Esteem, Self Worth, Religious Poems, Christian Stories

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Old Man and His Dog,The, Inspirational Poems, Touching Stories:"An old man and his dog were walking along a country road, enjoying the scenery, when it suddenly occurred to the man that he had died. He remembered dying, and realized, too, that the dog had been dead for many years. He wondered where the road would lead them, and continued onward."
http://www.4nursing.com/inspiration-the-old-man-and-his-dog.html

Categories: Affection, Caring, Friendship Animals, Pets, Death, Dying, End of Life, Hospice Poems, Love, Caring, Self Esteem, Self Worth, Religious Poems, Tales of Faith, Christian Stories

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Remember Me, Inspirational Poems, Touching Stories:"To the sorrowful, I will never return To the angry, I was cheated But, to the happy, I am at peace And to the faithful, I have never left."
http://www.inspirationalnursing.com/me

Inspirational Categories: Bereavement, Grief, Loss, Sorrow, Death, Dying, End of Life, Hospice Poems, Religious Poems, Christian Stories

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Sarah's Tears by Tony Collins, LVN:"Late one December night on the cancer ward the halls were quiet and solemn, the patients were asleep and most of the visitors were gone. The nurses were gathered about the nurse's station preparing for shift change. Sarah, one of the nurses, was especially tired, having worked seven straight 12 hour days. The kids had needs, her husband had been laid off, and the house payment was due."
http://www.inspirationalnursing.com/inspire.inspirational.inspiration.sarahs.tears.htm

Inspirational Categories:

Affection, Caring, Friendship, Ambition, Determination, Persistence, Resiliency, Bereavement, Grief, Loss, Sorrow, Death, Dying, End of Life, Hospice Poems, Dependability, Honesty, Reliability, Virtues, Living Life To The Fullest, Love, Caring, Self Esteem, Self Worth, Religious Poems, Christian Stories

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The Hummingbird Man by Nancy Haygood, Hospice Poems, Stories of Death and Dignity:"He shows me tomatoes – red cherries, neatly hoed,
He naps in the sun, soaks up heat, sky aglow.
"Meet my new pup," proudly, "she's for squirreling."
His pain burns deep, he hides it, buried, gnawing."
http://www.inspirationalnursing.com/hummingbird

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To The One Left Behind, Bereavement Poems, Stories of Grief:"Here my body lies But I am gone I'm sorry I left you behind I ask you to carry on."
http://www.inspirationalnursing.com/behind

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Too True, Too Often, Inspirational Poems, Touching Stories:"Too often we don't realize
we have until it is gone
Too often we wait too late to say
"I'm sorry - I was wrong."

http://www.inspirationalnursing.com/often

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Why? Inspirational Poems, Touching Stories:"Perhaps one day we'll understand Why God decided to take your hand And lead you into Heaven above surrounded by his tender love."
http://www.nursefriendly.com/why

Inspirational Categories: Bereavement, Grief, Loss, Sorrow, Death, Dying, End of Life, Hospice Poems, Parents & Parenting, Religious Poems, Christian Stories

See also:

Poetry, Blessings, Toasts, Quotes, Prayers and Words of Comfort, About.com: Death & Dying:"Sometimes, it seems that all you need is the right quote, poem or inspirational message at the right moment to help provide perspective, insight and aid in surviving a loss or crisis. When coping with a death, a significant loss or crisis, it can help to read the words from others who have "been there," coped and survived. This section contains comforting poems and quotes that may be helpful when writing eulogies or obituaries, or used in memorial services, blessing helpful in the healing process, quotes about death and dying and famous last words."
http://dying.about.com/

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For Health Information you can use, Follow, Connect, Like us on (Most Invites Accepted): http://www.nursefriendly.com/social/:

Twitter! http://www.nursefriendly.com/twitter

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Posterous.com, http://nursefriendly.posterous.com

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