No code

[moonshadeau, ADN, BSN, MSN, RN, APN, NP, CNS]

After working several months on a quite intense at times telemetry floor. I have heard several nurses say "That person really should be a no code, because of their illness or being in varying degrees of heart block will do them in anyway and their won't be anything we can do". I was just wondering. Isn't it still the patient's choice to decide whether or not they want to be resucitated and not the nurse or doctor pressuring the family into it for convienence purposes. I realize that some people really should be a no code for obvious reasons, but if a person who's only problem is what the monitor is showing and they are asymptomatic then why automatically say "they need to have a code order written". Maybe this is coming from someone who has never run a code before (knock on wood) but when I hear people saying things like this I find it quite discouraging. As if the patient hasn't lost enough control just by being in the hospital. What do other people think or am I just naive?

[JillR]

I have hears and probably made this comment a time or two. That does not mean that the patient is being pressured into anything. We all say things to each other that we would not say to the patient. I wouldn't come to the conclusion that anyone is being pressured into anything unless you hear someone say "I told the pt he/she should be a no code"

Nurses and Doctors are not in a position to tell anyone what code status they should be, but we are in a position to educate the pts about thier choices and make sure those choices are known.

I highly doubt that any of the people who are verbalizing these thoughts actually say this to the pts.

I think you are making a bid deal out of nothing.

[RNPAULIE]

I think that patients or their families should be able to make an INFORMED decision about code status, and all too often the extent of illness or poor prognosis is not clearly discussed by the physician. So when the patient starts to deteriorate all the nurses are saying is lets not do something they may not want have done to them if they really knew how ill they were. It gets to be a sticky situation if the nurse tries to discuss code status and the patient doesn't have a clear understanding of their prognosis. I think physicians need to be a little more forthright in their explanations of prognosis, what exactly a code entails etc.... Too often it is thrown in nursings lap at the last minute before the code cart is pulled out.

[canoehead, BSN, RN]

The public doesn't realize that only 10% of coded patients live. And that doesn't guarantee any quality of life, or that they won't code again tomorrow and die. They also don't realize that some coded patients are concious enough to feel pain, some push our hands away ( I assume from that that they have some cognition). All the coded patients on ER are out cold and about 70% live and recover fully.

In my hospital we have docs- one in particular- that will ask repeatedly about code status if pt is a DNR, and does not do so for patients that are full code. So the pt naturally thinks "my doc thinks I made the wrong decision". And then each pt becomes a science project with every tube known to man. I would welcome some more DNR's, but I think it should be discussed long before the pt hits the hospital. Like years before, when they are healthy.

And if anyone resuscitates me to a vegetable state I will gladly haunt them and their hospital for eternity.