A Nurse's Living Will/Advanced Directives

  1. Since becoming a nurse (or nursing student), have you had any experiences that led to you changing or adding certain provisions to your living will/advanced directive form (if you have one, that is)? I'm talking about provisions like comfort measures/hydration/pain control, tube feedings, etc.
    •  
  2. 12 Comments

  3. by   NeuroICURN
    Quote from rnmi2004
    Since becoming a nurse (or nursing student), have you had any experiences that led to you changing or adding certain provisions to your living will/advanced directive form (if you have one, that is)? I'm talking about provisions like comfort measures/hydration/pain control, tube feedings, etc.
    I'm having DNR tattooed to my forehead and no chest compressions tattoed to my chest! :chuckle Under that will be "R3 or higher ONLY".

    Trust me....after becoming a nurse, there are lots of things I've changed! I have strict instructions (and I've also discussed it, at length, several times with lots of family members) about what I want done and what I don't.

    What it boils down to is this....if you can get three attending MDs to decide that I will have no MEANINGFUL recovery...then pull the darn plug!!!

    And I swear right now....if ANYONE signs to have me trached and pegged, then I will haunt you until the end of time!
  4. by   gwenith
    Me too!!! I have it written - keep me in a vegatative state and I WILL haunt you for the rest of your life!!!

    Definite DNR person here.
  5. by   VivaLasViejas
    DNR here too. If I can't take care of myself, enjoy food or sex or the fresh air, or if I have to be turned every 2 hrs around the clock so I don't develop decubiti, etc., I don't wanna play. :stone
  6. by   moia
    yup...me too..DNR all the way.
    I have told everybody if they leave me trached pegged and nursing homed without a brain in my head I will curse them forever.

    Funny that some of my non healthcare family just didn't get it and they said "oh I would want everything done"...they reconsidered when I told them exactly what "everything" actually means.

    I have seen "everything" and I still say if that is family "loving" I would rather they hated the patients guts.
  7. by   canoehead
    I told my family that if anyone ever approaches them about "pulling the plug" it was time to do it days ago, and to go ahead. No need to agonize-just do it.

    I've also made myself a DNR. That was after witnessing codes where the patient was semiconcious and aware while compressions were being performed, and as the ETT was inserted. If I get sick enough to arrest, let me go please.
  8. by   suzanne4
    As long as I stay in Thailand I should never have to face that problem.
    The emergency medical system is almost non-existent over here, and ambulances have trouble getting thru the traffic. So hopefully it will be too late to try anything. They do not have an Emergency Medicine training program over here. Perhaps that will be one of my next projects to work on.

    If I am stateside, all of my family as well as my friends know what I want done. Trach and peg-----no way.
  9. by   renerian
    I have a living will and DPOA health and financial. No feeding tubes ever.

    renerian
  10. by   Blackcat99
    I really need to get my paperwork in order. I want to be a DNR, no NG/tube feedings, no trach and no colostomy either.
  11. by   nursemary9
    I feel exavtly the same as almost everyone here; No tubes!!
    Nothing; DNR, absolutely no feeding tubes, trach's NOTHING!!

    I have spoken to my husband and every member of my family!!
    All are in agreement!! They all feel exactly the same as I.

    Before my husband had open heart, he did an advance directive;
  12. by   lisamc1RN
    Ok, please educate me. I'm not in nursing yet, so I don't know. Do people with trach's and feeding tubes usually not get better? Is there usually no hope of a full recovery once a person crosses that line? My mother is a nurse, and she told me the exact same things that you all are saying. I have not told her, but I am not sure I could let her starve to death. It disturbs me when she talks like that. How do you know when the point of no return is? Or am I missing the point?
  13. by   KaroSnowQueen
    DNR here. Living will, no trachs, no colostomy, no %*(#%@$ feeding tubes!! My living will specifically states that if I cannot get better and "drink a Coke and read a book under my own power" to pull the plug!
    I have preached, educated and browbeat my family that this "doing everything" business is NOT always the most loving precious thing people think it is!
    My 84 year old grandma feels the same way, she voiced this to my cousin that she was a DNR, had a living will, let her go in peace, etc. My cousin was upset, and said, "Oh no, Aunt K, I'll NEVER let that happen!" My grandma said, "You won't have a choice, KaroSQ will pull the plug when you're not there!"

    And to lisamc1, trachs are usually an irreversible thing, some people DO have them short term and have them closed, but usually they are just there. If you are able to leave the hospital/LTC setting and go home with them, you must usually be on O2, prone to infections, etc.
    Same way for feeding tubes, I think in 20 years of nursing, I have seen 2 people recover and get their tubes out, but usually it doesn't work that way.

    We, and your mom, have seen the multiple admissions and relapses people with these tubes have, and know that we do not want to go through this ourselves. In my own opinion, I would rather be gone, and would let my loved ones go than put them thru this.
    I had a private duty pt about 12 years ago, who was run over by a hit and run driver when he was 13. When I took care of him he was 19 or 20. Had a trach, catheter, totally paralyzed from the neck down, couldnt' even turn his head to see who came in the room. BUT was totally alert and with it, knew everything going on. He was at home, the family was totally stressed out and felt guilty that he had the accident, guilty that they got aggravated taking care of him, etc. The mom had sent him to the store the day he got hurt. They spoiled him rotten, I got reprimanded because he told me at 2 a.m. to go upstairs and wake up his 16 yr old sister and tell her to go downtown and get him some hamburgers. I refused to wake up a kid who had to get up and go to school the next day, and the mom called my boss and said yes I was to get the kid up, whatever he wanted he got!
    The mom told me he had been coded more than 10 times since the accident. I remember thinking at some point, if it were my child, I would have let them go. It was such a sad, sad, pitiful situation.
  14. by   nursemike
    I'm still really not sure about this DNR business. Past a point, absolutely, but we have discharged "comfort care" patients (well, one, for sure) and vents, feed tubes, etc. can be temporary. Our hospital has changed "DNR" to "No CPR", which sort of makes sense. At a meeting to discuss developing new protocols for No CPR, a doctor made a really interesting comment that if more people understood their chances with CPR, there would be a lot more No CPR orders.
    I suppose I really ought to make some decisions and get them in writing. At this point, my only advance directive is NPR. If I have to die, I want to do it with my virtue intact.

close