Blue about Code Blue - page 2

by barbaralynn 7,859 Views | 42 Comments

I am a new nurse working on the Oncology floor. The stages of cancer we treat vary from newly diagnosed to metastatic. Some of my patients have good prognoses while others have only weeks or possibly days to live. Recently I... Read More


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    One of my nursing instructors says it really depends on how you ask the patient... "Do you want to be resuscitated?" vs "Do you want to be allowed a natural death?" She stressed that CPR was meant for the 'healthy-dead' and wasn't intended to be used on the old, frail, and very sick.

    I'm a new grad and just experienced my first code last week so I've been reviewing my notes from school on this topic. The patient was revived. I didn't know him at all though. When I arrived all of the major tasks were already being performed but no one was recording, so I took that on. I did a pretty good job and the nursing supervisor used my notes to fill out the report.
    1feistymama likes this.
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    I would say most issues with code status root from lack of education. For a lot of patients and families the only CPR they know is what they see on TV. Ultimately the best we can do is make sure they are informed as much as possible and give them support while making a very difficult decision. I don't personally agree with coding a 90 something year old so that best case scenario she can be on a ventilator with broken ribs and pneumos, but we give the options therefore we have to respect the decisions.

    On another note I am doing a project on family presence during codes. There's research to support that it is beneficial to give families the option to stay with their loved one instead of whisking them to the waiting room after the patient arrests. It's obviously not for everyone, but it might have been nice for the wife (with the careful support of a dedicated staff member) to sit at the foot of the bed and rub their feet or something in his last moments. Often times its easier to come to terms with the outcome when the family sees how hard the staff is working and how horrible the coding process is. Just some food for thought!
    CrazierThanYou and sapphire18 like this.
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    This is a death defying society.

    Everyone is supposed to live forever and be in perfect health.
    i♥words, NurseDirtyBird, KelRN215, and 5 others like this.
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    Quote from Mulan
    This is a death defying society.

    Everyone is supposed to live forever and be in perfect health.
    This is what my teacher says.
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    Quote from Clovery
    One of my nursing instructors says it really depends on how you ask the patient... "Do you want to be resuscitated?" vs "Do you want to be allowed a natural death?" She stressed that CPR was meant for the 'healthy-dead' and wasn't intended to be used on the old, frail, and very sick.

    I'm a new grad and just experienced my first code last week so I've been reviewing my notes from school on this topic. The patient was revived. I didn't know him at all though. When I arrived all of the major tasks were already being performed but no one was recording, so I took that on. I did a pretty good job and the nursing supervisor used my notes to fill out the report.
    I disagree with your nursing instructor's question to the patient "Do you want to be resuscitated," versus "Do you want to be allowed a natural death?" I am going by your literal wording of your instructor's comments in my response here. Does your instructor explain the difference to the patient? As a nurse I understand the question. If you asked my family members I believe they would be confused. The question is not straightforward. People have a right to choose to receive CPR/ACLS if they wish, regardless of their age or medical condition. Your instructor has the right to his/her belief that CPR is meant for the 'healthy-dead' and wasn't intended to be used on the old, frail and very sick, but he/she does not have the right to impose his/her beliefs on other people (patients and family), who may have different values and beliefs, and who have a right to make their own choice.

    I am beginning to feel some people (people in general, not your instructor in particular) are seeing the old, whether sick or healthy, who choose life-sustaining measures, as a burden, and are subtly indicating to them that they should not choose life-sustaining measures. I find this reprehensible. Provide sufficient information regarding the choices available, respect the patient/family's choice, and carry out their wishes.
    Last edit by Susie2310 on May 5, '13
    sapphire18 likes this.
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    As a full time rapid response RN I go to many codes, occasionaly am the one running tthe code. Your experince is typical. They are frusterating in the extream, rarely helpful, usually brutual and crule. Our society simply does not handel end of life isses very well. Add to that cowardly physicians and other staff who don't have the guts to be strait up and honest with the family and patient.
    It is VERY rare to have a sucessful code, meaning a patient leavers the hospital to have some semblance of a qualiety life. Occasionaly we get a cardiac arrest code on a young patient (<70) and we can get them back. Despite going to maybe 50 codes in the last 2 years I can't think of any patient over 70 who we got back to do more than die a slow lingering death in ICU. One of our aggresive residents even coded a 96 year old patient who died for no apperent reason. I put a stop to the code as soon as I arrived. On several occasions I have refused to code certain patients. On even more occasions we have run "show" or "slow" codes.
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    My mother thought that DNR meant the person wouldn't be treated.

    There needs to be more education about what DNR means so people can make informed choices.
    NurseDirtyBird, KelRN215, Patchouli, and 1 other like this.
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    Quote from chrisrn24
    My mother thought that DNR meant the person wouldn't be treated.

    There needs to be more education about what DNR means so people can make informed choices.
    *** Right. I often describe it to patients as "What do you want us to do after you die?" to make clear that care won't change while they are alive.
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    Quote from chrisrn24
    My mother thought that DNR meant the person wouldn't be treated.

    There needs to be more education about what DNR means so people can make informed choices.
    Agreed. People just don't understand. I wish people would think about these things before they're in the hospital and scared. I asked an OLD 66 yr old (multiple cancers, bypasses, still smoking, falls, social issues, etc) woman if she had a health care proxy and explained it to her. She told me no but her boys know what she wants. I tried to explain that we need a name in writing and offer to get her the form, explaining the whole thing and that it is simple...and she refused. So she essentially told me her sons should be her hcps, but her lack of understanding (and refusal to be truly educated) is going to lead to us following our protocols because we've got nothing on paper. :-(. And this was just for HCP info- cant imagine trying to bring up MOLST.
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    There does need to be much more education on what DNR means. What comfort care is. However, we are often not party to private conversations in families. Some patients are really clear on their desire to "have everything done". And although we may not agree, it is an absolute right.
    This is why it is so important to have these conversations with one's health care advocate/proxy. Someone who will be one's voice. Who will in fact do what you want, as opposed to what they or even any of us want.
    It is complicated, personal, and needs frank education most importantly at the begining of a terminal diagnosis. (and in fact when one fills out a health care proxy).
    Should be mandatory education for patients.


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