The Slow Code - page 7
by TheCommuter 25,831 Views | 148 Comments Senior Moderator
I have been a nurse for only seven years; however, certain events and situations will remain embedded in my memory for the rest of my life. One of these events took place during my first year of nursing practice when I was... Read More
- 4Dec 7, '12 by PMFB-RNQuote from Esme12Ya totaly don't blame you. It was an improper and terrable thing for that nurse to say. WHen I speak to patients about DNR status I frame it as "what do you want us to do after you die?" So long as a patient is alive the DNR isn't in effect and should not be taken into account when providing care.I have always HATED this attitude DNR does NOT mean do not treat. I had a personal experience with this recently with my brother in law and being transferred to ICU when hospitalized when the ICU nurses had the unmitigated gall to talk to my sister about her husband "taking up an ICU bed". Just because we didn't want him coded doesn't mean we didn't want treatment to stop the immediate threat or that he should suffer because a DNR in ICU takes up valuable space. My BIL was YOUNG....I was so angry it made me want to spit nails.
- 3Dec 7, '12 by akulahawkRNQuote from PMFB-RNThe DNR is in effect until it is rescinded... I look at it as a very specific restriction on what therapies I may not use. Unfortunately, the do not treat attitude is all too common, especially if the patient is elderly.Ya totaly don't blame you. It was an improper and terrable thing for that nurse to say. WHen I speak to patients about DNR status I frame it as "what do you want us to do after you die?" So long as a patient is alive the DNR isn't in effect and should not be taken into account when providing care.
- 1Dec 7, '12 by joanna73 GuideI know of the "slow code", as I work LTC. I have never participated in one myself, but we have discussed this at work. I would rather honour the wishes of the patient/family. Their code status is documented, and 95 percent of our residents are DNR anyway. The family/ patient should always be given their options and consent to the treatment plan. At times, we have recommended that a resident's code status be changed to DNR, as reviving that person would ultimately cause more suffering, and this has happened.
- 0Dec 7, '12 by PMFB-RNThe DNR is in effect until it is rescinded...
Ilook at it as a very specific restriction on what therapies I may not use.
*** What therapies are resricted when a patient is DNR? None I am aware of, with the possible exception of intubation, (depending on if you are in a DNR vs DNR/DNI faciliety) until after they die.
Unfortunately, the do not treat attitude is all too common, especially if the patient is elderly.
- 2Dec 7, '12 by TheCommuter Senior ModeratorQuote from PMFB-RNI agree with this. CPR is carried out on clinically dead people only. We resuscitate the clinically dead, not the living, breathing, pulsating patient.The DNR order is irrelevent until the person dies. We don't code people who are alive, at least I don't.
- 1Dec 7, '12 by somenurseQuote from redhead_NURSE98!The problem I have with these is that I've seen physicians just see these documents and say "oh they're DNR." Um NO. Therefore I will not be filling one out for quite awhile.
above quote is referring to a living will.
Your last sentence there, leads me to believe, that you yourself view living wills, as being equated to a self- full code order,(? not sure, but, seems like that is what you meant??)
Some ppl also think a living will = self DNR order.
which is a sad misperception, but a common one. A few times on this thread, i've tried to point out,
that a living will can state ANYTHING!!
You can have a complete algorithm, with all various scenarios,
and state what you want done in each of those kind of scenes.
~A sudden, unanticipated cardiac arrest in some recovery room? Oh yeah, code me!
~I am verifiably brain dead on a vent for 3 days, don't code me, remove the vent, remove the tube feed.
~I want everything done, no matter what, even if brain dead, code me, code me, code me.
I don't know the specifics of the case you were involved in,
but, possibly, the person's living will stated they would want to be changed to a DNR in the event ______blahblahblah_______.
Or, perhaps, the patient and doc had some conversation, and the pt's verbal instruction to the doc trumped his earlier living will.
no idea. But IF IF IF the doc DID make pt a DNR, and pt's living will stated he wanted "code me, no matter what"
the family can have the DNR rescinded and have pt made a full code again, based on the pt's living will. (that might not be the wisest, most compassionate thing to do, but, with a living will, that IS an option)
I am kind of disappointed, how many NURSES on this thread
are stating remarks that seem to indicate they view themselves as too young,
or it's too early in their life,
to get involved with a having a living will for themselves......
AGAIN, ALL TOGETHER NOW---------------A LIVING WILL
IS NOT NOT NOT A DNR ORDER.
NOR IS IT A REQUEST FOR FULL CODES, either.
EVERYONE'S LIVING WILL CAN BE DIFFERENT from anyone else's living will.
Each of us,
might have different criteria for what WE want done.
A LIVING WILL
WHAT *YOU* WOULD WANT DONE
IN VARIOUS SCENARIOS.
In your living will-----------
YOU CAN REQUEST FULL CODE NO MATTER WHAT.
YOU CAN REQUEST FULL CODE UNLESS_______(whatever you want here)_________. (you do NOT NOT NOT have to wait til you are 80 years old to write this out, kids!!)
YOU CAN REQUEST TERMINATION OF TUBE FEEDS, VENTS, ETC, in the event you are certifiably brain dead, or whatever criteria you want.
You can request tube feeds and vents be left in place for eons, and full codes daily til the full codes fail, even if you are certifiably brain dead.
whatever YOU want done, is what living wills are about.
Verbally telling your next of kin IS helpful, and great idea,
but THAT might not necessarily always be enough. Remember Terry Schiavo.
You ppl who think you are "too young" to get a living will,
might be inadvertently causing future stress to your next of kin by not having one. Car accidents happen.
Also, get living wills on all your loved ones, too.
Like i said earlier, i also enlisted my most assertive pal to be my "medical power of attorney" in the event i can no longer speak for myself. She knows my wishes,
and would go to bat for me. She's also perfect, because she is both a lawyer, and a nurse and my best pal, and very assertive yet would be so compassionate to my family, she knows them all very well, too.
My family would, indeed, waffle, and leave me on the vent, i know they would, bless their hearts. They would.
so i chose my pal. My family has been told of my medical POA, and of my wishes, so they wont' be shocked when Bev pulls the plug on me, ha ha.
By taking even half an hour,
most ppl CAN avoid causing their families extra suffering, and can prevent their own selves from being that tragic brain-dead victim being kept "alive" with vents, tube feeds, etc.
My living will allows 3 days brain dead, just to give my family time to 'get it', cuz, i know how they are.
lol.Last edit by somenurse on Dec 7, '12
- 0Dec 7, '12 by somenurseTo avoid further derail,
on what living wills actually ARE,
i have started new thread on living wills:
- 0Dec 7, '12 by amoLuciaI usually don't follow these types of threads too deeply as I freq find them disturbing and I have very strong personal opinions on the subject. It was because of this mindset that I had my own complement of paperwork drawn up some 20+ years ago.
I'll be reading this thread to get a better perspective of others' point of view. And I learn from the info provided by others better versed and knowledgeable than I.
I plan also to find my paperwork and review it ASAP.