When do we take care of ourselves? and our own medical decisions?

  1. When do we take care of ourselves? and our own medical decisions?
    I provide inservices for the staff at my facility. A few times each year the topic is ADVANCE DIRECTIVES.
    I am wondering how many of us that see first hand where you can end up with out one actually have one?
    We have a patient on the unit right now and all 3 children are fighting over if the patient should be taken off the ventilator or not! The patient had a massive stroke a few years ago and has been in a total vegetative state ever since.
    The time to make our decisions and actually commit our decisions to a written format is before we are in a state where we can't express them. There are so many cases that I see over the years where it seems so simple if there were an advance directive to state what the patient wants and refuses.

    Just food for thought! Anyone care to answer?

    Cali
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  2. 8 Comments

  3. by   live4today
    I have cared for patients who DID have an Advance Directive.....yet when it came down to using it FOR the patient ACCORDING to the patient's wishes.....FAMILY still fought like cats and dogs.....refused certain things to be done.....and so forth.

    BOTTOM LINE is THE LIVING RELATIVES will STILL have the LAST SAY! UNFORTUNATELY!
  4. by   bagladyrn
    I have advance directives, have talked to my parents about this, know their wishes, they have advance directives, informed my son of my intentions, and also have done the same with regards to organ donation.
  5. by   MollyMo
    My mother has her directives on file with her attorney. Each of her children has a copy. I am the first decision maker for her health in terms of DNR, etc. What she needs to do is make it clear to the others that my decision is the final one and that it will be based on her wishes. I'm the only health professional in my family. But I'm also the youngest child and I foresee many battles if this isn't made crystal clear now while she is still living and of sound mind.
  6. by   sjoe
    Just goes to show that we need not only advance directives, but a Durable Power Of Attorney for Health Care appointed who will take over control of health care interventions when it is time to do so. Someone tough who knows the medical score and who has a letter from us about just exactly what we do and do not want. (Mine is a nurse--actually sshe was my first nurse preceptor.) I've had all this stuff for over 25 years now, long before I was a nurse, after once seeing what goes on in hospitals. Once was enough!
    I highly recommend it, having seen repeatedly that Living Wills, etc. are routinely (about 50% of the time) ignored by hospitals, as has been pointed out on this thread already. NOLO Press has a good book on this, with forms, etc. to be found at Amazon.com or any large bookstore. You DON"T need an attorney, just the required number of witnesses.
    Last edit by sjoe on Sep 12, '02
  7. by   CaliNurse
    In the state of California once it is in writting and it was constructed appropriately it is as good as gold. I even know some of my coworkers that put in an extra statement of - "Anyone who goes against my wishes is out of my will". I was suprised when I first heard that but now I understand why they add it in there.

    When people construct them they need to give everyone concerned a copy. The doctors, hospitals, & any other health care providers. You can in California even register your advance directive with the state. Last I heard it was a $12.00 fee. I think if you went to the efforts to register it that they would know that you are certain about your wishes.

    There is a new form here in California (sorry I don't know the legal system of other states), there is only one form now. I like that. I know some people that have paid attorneys big money for a living will and a durable power of attorney. Now it is just one form, one document with 2 parts. It addresses everything from what your wishes are, who you would like to speak for you if anyone, what type of treatment you want to refuse, accept, pain relief, organ donation, & burial arrangements.
    It even has a portion to state if you want your agent to start speaking for you now or when you loose the ability to direct your own health care. Personnally I don't know who would give their power to another person to make decisions for them while they still can but I guess it may fits some situations out there.

    When we did the inservice at work I was amazed how many of the staff, some non-nursing as well, stated that "I don't ever want to be left like that". One of our units is a LTC subacute vent/trach unit. Some of the patients have been there for 14 years. The only mechanical assistance is a feeding tube and a trach. Some of them don't even require oxygen.

    My advice to all of them is to formulate an advance health care directive and make plenty of copies. We have copies in the glove box of each car, in my night stand, with relatives, doctor, hospital, and yes there are also wallets cards. I have not registered our copies with the state yet but I will soon.

    Is anyone out there from another state? Do you have to follow different state laws? I couldn't find anything on the internet addressing the lastest changes in the legal system (march 2002).

    Thanks for your responses -

    Cali
    Last edit by CaliNurse on Sep 11, '02
  8. by   CaliNurse
    Sjoe, thank you for your response. I also should mention that you can also get forms from the case manager or social worker at any hospital. They are required by law to provide this to anyone who is interested (If the hospital accepts Medicare or Medical). They are free that way. You don't even need an attorney to do this. You can complete the form, have 2 witnesses sign it or have it notarized. It is that simple. Good for you sjoe, I was late in my nursing knowledge when I addresses it. It actually took an illness in the family for me to think about it.

    Cali
  9. by   sjoe
    CaliNurse--good points. I believe the State form to which you refer is simply called "Declaration," but I didn't find it worth doing, since these other forms more than covered the same issues.

    Two questions, though: 1) I hadn't heard of registering these documents with the State, but even if one did so and was, say hit by a car in Utah, in a coma, etc. it would probably take far too long to get anything from the State, if anyone even took the time to try. It couldn't hurt, but it may not help, in short.

    2) It is my understanding that, even in California, even if all this paperwork is completed, only about 50% of the time is it complied with, absent a forceful agent named as DPOAHC. Particularly when a loud relative is demanding that "everything be done."

    Incidentally, an informal survey of this demand in one hospital where I worked indicated that the farther away from the patient the relative lived and the less contact the relative had with the patient, the MORE likely that relative would be to demand that "everything be done" to keep them alive.

    This was NOT a formal study, admittedly, but it might be interesting to take a look at this in a formal way. Any research nurses out there looking for a project?

    PS. Within the DOPAHC you can also add the following paragraph: "If any friend or relative or other person or health care facility representative opposes the decisions of my appointed agent, I direct my physicians and the courts to disregard all such demands and to follow only the directives of my agent."
    Last edit by sjoe on Sep 12, '02
  10. by   kahann
    I also have an Advanced Directive and appointed a DPOA for Health Care as well as a back up DPOA just in case. All are aware of my wishes. When I recently changed physicians due to a change in insurance, my new physician asked why someone so young felt they needed an Advanced Directive. I had my drawn up previous to having surgery done simply because you never know what can happen. He still was surprised. Made me wonder what Docs are taught in med school about counseling patients on Advanced Directives!

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