Feeling Guilty - page 2

by kwaziness

3,321 Views | 16 Comments

I work on a Telemetry floor (only 1 year of nursing experience) and I recently had a patient post Burr hole surgery for a subdural hematoma. She didn't recover well and was basically in a vegetative state, although she was awake.... Read More


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    I understand your feelings, but I don't share them. I view stopping the tube feedings and allowing natural death to be a kindness, in this situation. Does your employer offer an EAP (Employee Assistance Program)? You might find it helpful to talk to someone who can understand. Sometimes, friends and family just don't get it.
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    Quote from LYNDAA
    Might I suggest requesting a replacement nurse the next time you have such an encounter? Ethical dilemmas are never easy. You have to be at peace with yourself before you can fulfill those particular expectations. This is one of the reasons our Code of Ethics exist. You have the right to examine your own feelings about such things and make an informed decision for your well-being.

    I had a patient with Locked-In Syndrome who communicated with his eyes as his caregivers, we, spelled out every single word in every single sentence of what was left of his life. It was extremely time consuming but he was a home-health patient, of sorts, but not living at home. We took him on as a special case in a veteran's facility.

    After a year of living as he was, with a trach, foley, and peg tube, being transferred from one extended care facility to another simply because the facilities hadn't thoroughly assessed the magnitude of the care required, he made the decision to end his life by refusing his feedings. At that point, he was residing in a nursing home because even the VA felt his care was too expensive, even though he was a veteran. They were apparently looking at the 'big picture' as, other than those issues listed above, he was a healthy, 30-year-old, young man. Although I personally believe he would have lived for many years to come, being placed in a nursing home as a young man who still had his young wife, made for a grim outlook for him. After all, he was a soldier in the Army and was an avid hunter in his spare time. It was a very sad case for him as well as the life that it would have made for his wife.

    Eleven days after he began refusing the feedings, it was over.....his wishes were honored by respecting his right to refuse care. Otherwise, he had no quality of life to look forward to. Because he made that decision, dilemmas were minimal and his wife was with him every step of the way.
    I would do the same thing, if I could even imagine my life being that way. At least he had some control over his life. Poor thing. I'm glad he was able to still advocate for himself.
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    The feelings you have inside are because you are a human being, with feeling. Even though a nurse is a patient advocate, it is difficult in (our) heads to rationalize what needs to be done. As a nursing student, you probably began your journey wanting to be a great caregiver and advocate. I guess we all figure out at one point or another that someone's wishes don't always coincide with ours, and there are always contradictions in our heads. I attribute your feelings to my solider son who signed a paper that said he was "to protect and honor," yet when deployment time came, he had serious doubts about weather he was doing just that. Meanwhile, I would definitely want you taking care of my loved ones...you have guts and feelings. God Bless.
    i_love_patient_care likes this.
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    Yes, I have looked at the other posts and most everyone is right on. We all must make decisions and when we look back, it's hard to know what is best. But you just have to go with the best info you have at the time.
    Blessings
    i_love_patient_care likes this.
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    I have been in your situation many times. I have also seen patient's coded multiple times, every effort to save them only to prolong the patient suffering and inevitable death. I have watched a patient say, "let me go" to loved ones only to be coded yet again because the family could bear losing them. And same patient to be kept alive for months via machines.

    We call it respite care at my facility and I have found the process can be very peaceful. As a nurse I offer every comfort to the patient and family. I have cried with the family, hugged family members and I have been quiet and gotten out of the way so they could have privacy. I have opened the window and said a private prayer when the patient died alone. My daughter at nine said it so well to me when my own father passed, "dying is part of living". I see it as an honor to care for a patient at the end of their life. To offer respect, provide dignity to the process and support the family.

    I know I have made my wishes very clear to my family, if I can only live via machine, "LET ME GO!" do no prolong my suffering or yours, do not let me live without quality of life, do not let me live without dignity. I want to be remembered in life, full of life. Not the last X months in a hospital bed wasting away after numberous codes and hooked up to machines.

    But that is me, aways respect the wishes of the patient and hopefully they have made their wishes well know to family and family respects their wishes. Perhaps you should do some reading about end of life care, it might help you to look at it differently without the guilt. So long as you are providing the best care you can to the patient you have nothing to feel guilty about.
    nrsang97 likes this.
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    OP you aren't the only one to have this feeling. Just remember you did the right thing by following the pt and family wishes. Do you have other nurse friends you can talk to or the suggestion of EAP or pastoral care are good people you can talk to.

    I had a new grad one night tell me she turned down the morphine drip on a hospice pt. I asked her why she did that trying to understand her line of thinking. She said that she didn't want to hasten the pt death and would be no part of hastening someone's death. I explained to her she isn't going to hasten the death with morphine, death was coming weather she was there or not. She was there to make the pt comfortable. I went into the room and assessed the pt and told her the pt needed more morphine for symptom management and told her to turn it back up. She turned it back up, but told me that she still felt that it was hastening the pt death. I kept reassuring her that she was in no way hastening the pt death but making her comfortable until that inevitable moment came.
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    Yes, it's hard. Even though I'm totally on board with the hospice model of care, there is always a part of me that questions whether I could or should have done something more, whether there was something I missed that would have made a difference. And I've heard nurses with much more experience and education in hospice care express the same feelings.

    I think that it's inherently a hard decision for anyone ethical to make, even when it's the "right" choice.


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