The Patient I Failed - page 15
by nerdtonurse? | 375,510 Views | 321 Comments
She knew what she wanted. She'd watched her husband of 52 years die on a vent, and followed his wishes to remain a full code. But she knew that was not what she wanted for herself. So, she wrote a Living Will, had it... Read More
- 0Apr 28, '10 by NurseChaChaThis is beautifully written and well thought out, however, and I hate to be buzz kill here but there are a few discrepancies in this piece. I worked for 30 yrs in ICU/CCU and never saw anyone who was not "eligible" for DNR status. Secondly, I rarely saw a physician who would not follow a patient's living will, esp one that was so specific.
Most would not code a little lady like this anyway. But, I worked with some pretty incredible docs... Also the author mentioned putting a peg tube down the patient's throat. Peg tubes are placed thru the abd wall... These details almost killed it for me, however, I absolutely understand why this was written. I lived this many many times in the old days when docs were afraid to "not" do anything for fear of lawsuits.This was back when patients really didn't have the rights that are given to them now. I have seen family quarrels over what to do with mom or dad and it is really heart breaking.
- 0Apr 29, '10 by JoMark06Quote from NurseChaChaAlso the author mentioned putting a peg tube down the patient's throat. Peg tubes are placed thru the abd wall... These details almost killed it for me, however, I absolutely understand why this was written.
You must have misread the original piece. She did not say the PEG was placed down the pt's throat. Here is the specific paragraph you refer to:
"Her swallowing ability was lost in the storm in her brain that had left her with no voice, no sight, no movement. A scan showed she still had brain activity; she was aware of what was being done to her. Including the PEG tube sank down into her stomach, and the trach in her throat."
Just wanted to point that out since you say certain details killed the piece for you. I have seen DNR's rescinded at the request of the family when the patient, who had capacity before being vented, had asked the DNR be in place. I have seen patients who shouldn't be coded, coded time and again at the families wishes. I have seen a nurse request her husband be a full code when she knew, in her head, that her 80+ year old husband (who was frail, contracted and alert to self only from a CVA) would not survive a code. It happens more than you think.Last edit by JoMark06 on Apr 29, '10
- 2Apr 29, '10 by LonKiefferThis article is an excellent example of the Caregivers Dilemma (the basis of my program "Defending the Caregiver!" This Caregiver is exhibiting a classic example of COGNITIVE DISTORTION #10: PERSONALIZATION, where the Caregiver sees herself as the cause of some negative external event which in fact she was not primarily responsible for... this Caregiver failed no one! Instead, she executed her duties no matter how difficult and rather than feel proud of her actions she feels guilty for providing a service that few others could perform.Last edit by Silverdragon102 on Apr 29, '10 : Reason: TOS pm to member
- 0Apr 29, '10 by LonKiefferto GTMAHAR: You are correct in your comment regarding the role of the RN as being a patient-advocate, however, you are incorrect in one regard. This article is written from the perspective of a nurse, a Caregiver, taking care of this patient NOW! Well after the advanced directive decision was poorly executed previously. I understand your perspective but to voice it so succinctly only ads to the Caregivers Dilemma NOW.
This nurse has not failed anyone! Not only is this nursing PERSONALIZING the situation you are perhaps LABELING it; COGNITIVE DISTORTION #9LABELING AND MISLABELING: An extreme form of overgeneralization. Instead of describing the situation, you attach a negative label to yourself (FAILURE): "I'm a loser." When someone else's behavior rubs you the wrong way, you attach a negative label to him: "He's a goddam louse." Mislabeling involves language that is highly colored and emotionally loaded.
This article should be entitled... "The Patient I Took Care of Competently and with Passion tho Personally Difficult After Something Bad Happened Before I Ever Came into the Situation!"-- not very sexy but much more accurate! As a "Defender of Caregivers!" I feel compelled to point out that; this Nurse is dealing with a very emotionally difficult scenario she did not create; to attach a LABEL of FAILURE or NOT AN ADVOCATE makes it worse and more emotionally laden and is unfair to the Caregiver.Last edit by Silverdragon102 on Apr 29, '10 : Reason: TOS pm to member
- 0Apr 29, '10 by sharonazthank you for this powerful story. This is the kind of healthcare reform we need. We need to honor a person's wishes for death with dignity. This would save thousands of healthcare dollars and show respect for the dying. How many family members would insist on heroic actions if the fee came out of their pocket?