[DDRN4me]

Kudos for thinking "outside the box" however, i would caution against saying anything to the family in this instance.... families under that amount of stress tend to say things to the doc and other nurses like " the student said that you should be giving him ambien, and that would wake him up..why arent you?" even when that is the last thing that you would have said!
leaving a copy of the research for the primary nurse at the nurses station or for the doc is a better way of getting your message across.

[castens]

Originally Posted by canoehead

Alternatively, when family mentions the remotest possibility of a miracle you could reply, "yes, we hear lots of the miracle stories- look at the patients that were revived with Ambien- one in a billion chance..." They may choose to leave it alone, or they may research it on their own.

Whoa! Just be careful how you do this... and I would NOT advise a nursing student to do this. There is a very realistic possibility - I've seen it happen too many times myself - that the family might behave like Jim Carry in "Dumb and Dumber"

"Do you think there's a one in a thousand chance you could love me?

"I'd say more like one in a million."

"So you're telling me there's a chance!"

One in a billion is still a chance - and it's that chance that a lot of families pick up on... especially when they're trying to decide on continuing support. Also keep in mind that the one in a billion chance, if it exists, probably wouldn't materialize for YEARS.

A more realistic course of action is to understand for yourself (by inquiry, or reading the chart) what the physician's take on this is. Have there been blood flow studies, EEGs, MRIs? What is the medical prognosis - which is not the same as "a chance"? If in fact this is determined to be a permenant vegitative state, I would discuss the patient's wishes with the family. Would "Steve" want to live this way permanently? At this point, the patient's wishes are the only thing that the family, physicans, and nurses as patient advocates should consider.

Having said all that...

1. Good job in doing your research! Evidence-based practice is what I wish 90% of my staff looked at!

2. Miracles do happen, I've seen numerous myself. But even as a devout Christian, when I'm dealing with tragic patient cases, I make my rule: Believe in miracles, hope for miracles, but don't count on miracles.

3. There ARE fates worse than death.

4. Everybody dies sometime, the only differences are how soon and how well. It may be that at this point, the best death is all that can be done.

By the way... if Steve's family (or other document) indicates that Steve would want to be kept alive by all heroic measures possible, the staff will have to accept that as well - and sometimes that can be harder for nurses than withdrawing support.

[castens]

I would also like to ammend my previous post. I definitely don't think that a nursing student should be discussing end-of-life issues like continuing/withdrawing support with a family - at least not without their instructor/preceptor heavily guiding the conversation.

Important convesations to sit in on, yes... not yet ready to participate.