Palliative Patients Who Are Full Codes

[sabrina_RPN]

Let me first begin by saying that I believe that everyone has the right to choose what they want to be done for end-of-life care. And as a health care provider I respect these choices, no matter what I think.

I have been thinking a lot about ethical situations at work, and I have come across one that seems to strike a different chord with nurses and physicians alike. It seems to me that lately at work (medical floor), a lot of our palliative patients with a prognosis of less that 3 months are full codes. Because of this, a lot of nurses have different opinions about what is going to happen when the patient actually codes. Such as, doing a "slow code", ie: no one reacts as if there is an emergency, allowing the patient to pass on. Others think that calling rapid response with any significant change in the patient would effectively take the code situation "off our hands". And other nurses think that it should be treated like any other code. (I tend to agree with the latter)

Nurses, students, anyone at all... I am simply looking for some insight, opinions, experiences to develop my own learning through you.

Thanks in advance,

Sabrina

[leslie :-D]

Thank you for all of your comments. I can tell you that if a patient codes, I will be doing everything that they want done, and nothing that they don't want. I very much appreciate all of your input.

Thanks,

Sabrina

yep, you really have to.

the sad thing is, many of these pt wishes are ignored, and codes are fulfilled r/t family wishes and/or dr's ego or fear.

admittedly, i've known many hospice pts who defer to the family's wishes, even when it goes against their own.

often, it's because they're too weak/tired to fight it.

sad...really sad.

leslie

[Fiona59]

I loathe those "subjective" codes. No intubation, "do what you can but don't send to ICU" (yes, we've actually had family say that). I've seen family who haven't talked to the patient in years try and tell us not to use certain meds that the docs and wife have no issue with.

Palliative units that I've experienced usually only accept those with a 90 day life expectancy. So go figure. You're a DNR.