The soul crushing part about nursing - page 4

by OnlybyHisgraceRN

6,958 Views | 35 Comments

There are many things I love about nursing, however there are some things that are really soul crushing. Like, having a 90 year old patient, who is a full code, trached, has a peg, multiple pressure sores, infections, renal... Read More


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    I would hope that I would be the first to excuse myself from the code team in the instances where I were morally objected. Especially if my team were floundering in what they believe to be a full code.

    *** I do not excuse myself. I remain present to advocate for my patient and provide whatever appropiate care I can. I realize in reading over my messages on this topic I may have given the impression that this is a daily or weekly occurance. In realiety I have been in this situation 3 or 4 times in the years I have had this job and in my previous job as an ICU/ER nurse.

    My thought process in needing some sort of facility support was based on how one would explain why it is that they chose not to be a key person in a code when in fact patient is a full code. And should you use this law to protect you, it is based on hear-say?

    *** I will do what I believe to be in the best interest of my patient and their expressed wishes reguardless of the concequences to my job or lisence. I hope that neither are at risk. In realiety nothing has ever been said to me. In each case it was recognized that coding those particular patients wasn't the right thing to do and the code team seemed relieved that somebody said something. I have also been told (by our hospital's risk manager) that, in therory, the code team could be charged with battery for coding a patient aginst their wishes.

    On the same token, if you know that the patient has said to you over and over again code me, do everything, I want to be coded and they are made a DNR when they are no longer capable of decision making, are you equally as diligent in coding them?

    *** That issue doesn't come up since a code would not be called on them and I would not be present. Hypotheticaly I may or may not code them. Let's say your patient is asking you for narcotic pain meds. Your assessment, and the patients comments lead you to belive your patient has unrelived pain. In such a case I assume you, and any RN, would do what they could to get pain control for your patient. Either providing ordered PRNs, or if nothing is ordered calling the provider and obtaining an order, maybe even going over the providers head if they choose not to address your patient's pain. You would advocate for your patient in that situation. Any of us would. Now lets say the exact situation except your assessment makes you question if the patient is really in pain and on the way out of the room you clearly hear the neurologicaly intact patient tell his visitors that he isn't in pain but just wants some narcs. Would you still be a strong advocate for obtaining pain meds for that patient? Probaly not. At the very least I assume it would cause you to re-assess his pain with his comments in mind.
    We (health care providers) do not provide whatever care a patient asks for just cause they ask for it. Nobody would amputate a perfectly health limb just cause a patient requests it. On the other hand it isn't unusual to have a patient refuse the amputation of a diseased limb, even if it means they will die. Their wishes to refuse care are respected. I don't see how a code is different. In the case where I knew nothing about the patient and just arrived on the scene I would fo course code them if they were a full code.
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    I worked in Oncology, so I have seen the scenario described by the OP played out many times, sadly. On our Oncology floor, it was often up to us nurses to talk to the family. We would have our "You have to love them enough to let them go" talk, sometimes. There are worse things than death. But, you have to be very honest with the family. Often, they are waiting for a cue from the doctors and nurses to make those painful decisions. In a sense, we can help relieve that guilt and uncertainty they feel. We want so badly for them to make the decision on their own, but they look to us for guidance.
    SHGR, ~*Stargazer*~, and PMFB-RN like this.
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    It's not our call.The family makes the decision.
    Our job is to offer education and support to make their choice. If the choice remains denial...so be it.

    Beating yourself up..when you don't agree with their decision is USELESS.
    Comfort the patient and the family.. to the best of your ability .. nurses cannot and should not judge the family wishes.
    applewhitern, jadelpn, aknottedyarn, and 1 other like this.
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    I agree with JMBnurse. I think sometimes family members need "permission" to let go. I think that for some, there is a tremendous amount of guilt that comes with thinking you didn't do everything possible for your loved one, and they just need to know that they have, and that it's okay to let go.
    sherdk and JMBnurse like this.
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    This is why it's SO important to convey to everyone you know, friends, family, and YOURSELF, to have a health care proxy, living revocable trust, just something legally in writing letting healthcare facilities know your wishes regarding your healthcare in the event you cannot express them yourself at the time. If more people took care of this on their own, we wouldn't have to worry or see it on the scale that we do.
    redhead_NURSE98!, sherdk, jadelpn, and 1 other like this.
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    good for you! we have home nursing laws for pediatrics where the nurses have to call ems and do everything regardless of a dnr. however if the parents or guardians are there and in charge they can take over and change the situation. This doesn't always happen though.


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