My best friend in nursing school was ordered to terminally sedate a stroke patient. - page 5

He was comatose and given little chance of recovery (but was breathing on his own). His family wanted nothing to do with the guy because they said he was a child molestor. A medical review board at... Read More

  1. by   happystudent
    Just wanted to add my 2cents....

    I respectfully disagree c/ those who feel that this was an inappropriate pt to be assigned to a student. I ve been assigned to pts that were on the verge of coding, or extreme hypertension and I was pushing lopressor and vasotec c/ supervision from my instructor. I think situations like this enhances our learning experience and makes (me) reflect on my own abilities and ethics. To shelter one from "unusual situations" denies that person the opportunity to learn how to work in certian situations.

    Now, I could see if the "student" was uncomfortable, but I DEFINATELY feel that students should be exposed to as much as possible in the little time we have. Don't shelter us............please.........

    As for the instuctor, maybe she/he should of clarified what was really happening and followed up in post conference........
  2. by   CCU NRS
    Quote from happystudent
    Just wanted to add my 2cents....

    I respectfully disagree c/ those who feel that this was an inappropriate pt to be assigned to a student. I ve been assigned to pts that were on the verge of coding, or extreme hypertension and I was pushing lopressor and vasotec c/ supervision from my instructor. I think situations like this enhances our learning experience and makes (me) reflect on my own abilities and ethics. To shelter one from "unusual situations" denies that person the opportunity to learn how to work in certian situations.

    Now, I could see if the "student" was uncomfortable, but I DEFINATELY feel that students should be exposed to as much as possible in the little time we have. Don't shelter us............please.........

    As for the instuctor, maybe she/he should of clarified what was really happening and followed up in post conference........
    I feel that the instructor has put a student into a potentially culpable situation and put the entire case in even greater jepordy by having a student perform in a very questionable manner, for one thing the order did not even seem to bew clear from the way I read the OP something about "Here's what bothers me. My friend was ordered to give 2mg/hr IV. (as needed), but told that he would need the medication every hour." as needed would indicate nursing judgement but then someone was telling this person that it was needed every hour, I think this instructor did a disservice to the student by #1 involving him/her in the situation and #2 telling him/her that this is how things are done #3 Not allowing room for nursing judgement and a correct assessment to decide if Pain medication is actually appropriate or needed. I let students in y facility do anything they are capapble and have been trained to do but this instructor IMO was just providing added probelems to an already sticky situation.
  3. by   happystudent
    Quote from CCU NRS
    I feel that the instructor has put a student into a potentially culpable situation and put the entire case in even greater jepordy by having a student perform in a very questionable manner, for one thing the order did not even seem to bew clear from the way I read the OP something about "Here's what bothers me. .
    I agree with u ccu nrs. The whole situation sounds fishy, but MY point is that as students, we should have the opportunity to be involved is cases such as the OP. Pallitive (sp?) care is something that isn't freely discussed and it should be! This is a perfect real life situation and the fact that some of the posters felt that a student should not have been assigned seems unfair to me. Yes, the orders were questionable and the instuctors actions were questionable but this makes for an interesting ethics debate and heightens awareness on this issue.
  4. by   Love767
    I think my instructor was saying that it was euthanasia, and that it was common. I wonder if this really reflects reality or is just her impression of the way things are. The reason that I mentioned that the patient was an alleged child molester is because that is the reason the family gave for not being involved. Because the family wouldn't sign a DNR the ethics commitee had to be called upon to make the decision.

    It seems as if most people do not believe that this was appropriate. To me there is a big difference between giving pain medications that may kill somone, but which are needed to control pain, and giving them in such a way as to hasten death. In any case our instructor ended up pushing the meds rather than the student, and the patient did pass away the next day on a different nurses watch.

    Out of 100 terminal patients (or ones diagnosed to be so) how many do you think are "assisted"? Obviously, this will vary greatly by facility and location. It would be shocking to me if the number were greater than two or three, but I really don't know.
  5. by   sbic56
    Love 767
    Interesting question, but as you have learned, a hard one to be able to know the answer to because euthanasia is not only illegal, but a very political subject as well. My personal solution to the delemma would be to give the best care I know how and let my conscience be my guide. Don't do what you can't justify in court later or anything that will keep you awake at night.
  6. by   KMSRN
    It is euthanasia if the Pt dies one minute before they would have with out intervention and a Morphine drip of 2mg hr continuous will eventually build up to a dose that is not safe.[/QUOTE]

    I agree with the first part about a patient dying ahead of the natural time. I disagree about the 2 mg/hr eventually building up. Many people have been on considerably higher continuous doses for extended periods of time.
  7. by   CCU NRS
    Quote from CCU NRS
    It is euthanasia if the Pt dies one minute before they would have with out intervention and a Morphine drip of 2mg hr continuous will eventually build up to a dose that is not safe.
    Quote from KMSRN
    I agree with the first part about a patient dying ahead of the natural time. I disagree about the 2 mg/hr eventually building up. Many people have been on considerably higher continuous doses for extended periods of time.

    Yes but were they people that were conscious and having pain or people that were comatose with respiratory difficulty without mechanical ventilation? OP stated that the PT did die the next day.
    Last edit by CCU NRS on Apr 13, '04
  8. by   KMSRN
    Quote from CCU NRS
    Yes but were they people that were conscious and having pain or people that were comatose with respiratory difficulty without mechanical ventilation? OP stated that the PT did die the next day.
    That doesn't mean it was the morphine that killed him. But it is hard to tell without individual assessment.
  9. by   CCU NRS
    Quote from KMSRN
    That doesn't mean it was the morphine that killed him. But it is hard to tell without individual assessment.
    I concur but the situation is really a serious case for speculation and nursing students should be able to learn in a setting that is conducive to positive ideas and discussion of serious matters should be considered without a student being placed in a postition that could cause legal ramifications not to mention moral delimma that is really best suited to yeas of experience. I am not saying students should no see and discuss cases such as these, they should but a student should not be put in a position to perform this task IMO!
  10. by   BabyRN2Be
    OK, I've read this entire thread. I think my suspicions are dead on in this one. Like someone said earlier, except for a few changes, this was taken almost entirely from Echo Heron's book. From a person who didn't have a shot at life, an instructor who was essentially forcing a student in a situation in which she was not ready, to the 10mg bolus dose of morphine.

    That's my number one problem.

    2. The OP originally said it was her "best friend" who pushed the morphine. It
    then changed to the "instructor" who actually pushed the MS (much like
    Echo Heron's book).
    3. The OP hasn't said what year student her best friend was.
    4. Wasn't sure if morphine had a trade name or not.
    5. Never mind the legalities of student's being able to push MS.
    6. 10mg bolus MS plus 2mg every hour probably isn't going to kill someone
    the next day, we don't know how narc sensitive this guy was in the first
    place.
    7. The OP really hasn't been back to defend the whole story with further
    details!

    I'm really not one to rush to judgment, but I tell ya, this whole story reeks to high heaven.

    But I'll be glad to hear more if the OP has any more details which don't already add to the aroma of the original post.

    This is just my opinion. I've read the Echo Heron books too many times.
    Gotta love her and I hope she comes out with more!
  11. by   Love767
    BabyRN2Be, let me address your concerns:

    1. Who is Echo Herron and why does it matter? This happened, but even if it didn't it wouldn't change the validity of the issue for discussion.

    2. My "best friend" (and I am a he by the way) was ordered to push the drug because it was her patient (we choose are own patients in this rotation which is cardio our third semester of clinicals) and we pass all meds for our patients while we are there, unless we haven't been checked off on the mode of administration. Our instructor, ultimately pushed the drug when she found out the situation because she felt my friend shouldn't have to do so. This sparked a conversation amongst several of the students in our group (and the instructor) concerning the situation.

    3. We are in our third clinical semester of a BSN program that runs five semester, not that it matters.

    4. I said I wasn't sure what the trade name of the particular drug was no where did I say that morphine didn't have a trade name. I looked it up in my Davis guide and it didn't make a distinction between brand names for IV morphine, maybe it matters but I still don't know what the trade name was in this case.

    5. We are able to push all drugs so long as we have been checked off on the method of delivery. Usually the instructor will try to be present if it is an IV or IM.

    6. Can't say if the dose killed the patient, but he did die the next day. I also don't know if the dose was later elevated, or if additonal boluses were given.

    7. If you scroll up the thread a few inches you will see that I explained a couple of points. Why, should I have to defend a post about an experience at school? Going back to point number one even if I was making up something out of some book (which I didn't!) it wouldn't change the validity of the issue for discussion.
    Last edit by Love767 on Apr 13, '04
  12. by   BabyRN2Be
    Love767,

    I do apologize for the tone in my post. I guess I was a bit cynical when I read your post yesterday because it sounded like it was really out of Echo Heron's book called "Intensive Care: The Story of a Nurse." The details were almost identical to a storyline from the book when she was asked to do basically the same thing.

    If you get the chance to read the book, which I highly recommend, you might see why I have some concerns. Some people get on these boards after reading something shocking like that, something that seems dichotomous in the field of nursing and wonder if anything like euthanasia happens in hospitals. It's the Internet, people troll to get a response. *shrugs*

    However, I do say that I was a bit harsh and I do apologize.
  13. by   babinurse@msn.com
    This thread bares alot of discussion, there are pros and cons to the subject as is the case in all ethical situations. I'm sure there was discussion at the hospital where this occurred. The student might not have been privy to all of it. But, along with ethical discussions comes professionalism. Please be careful about calling someone a moron. None of us deserve that kind of disrespect. We need to build up each other and our profession, not tear it down. I understand there are strong feelings involved in issues such as this, but if you weren't there, and don't know all the facts, then you didn't walk a mile in that instructors shoes.
    As for me? Well, I'm working on my Masters and on certificates in clinical and bioethics and also in clinical ministry. I'm hoping to carve out a position as a consultant to nurses, patients, families that are in situations like this and to help in the decision making process thats best for everyone. Babinurse

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