When care equals Torture - page 3
I thought this article did a good job of describing what many of us in healthcare deal with on a regular basis. "At a certain stage of life, aggressive medical treatment can become sanctioned... Read More
Mar 8, '12Your note wouldn't mean anything without a doctor's order. It's horrible that people can do everything they know to do, and still be full codes....
Mar 20, '12as a side note, it looks like i've already been relegated to the relative wasteland of "nursing news". is it just me or have threads been moved out of the general nursing discussion really quick lately. it would be nice to be allowed a spot in the general nursing discussion for more than just a few hours before it gets essentially filed away.
i think it is part of the present day theme of emails and short texts and any topic that lasts longer than an hour seems "old news."
Mar 25, '12Thank God someone is able to articulate these things in such a precise manner. When I complain about this, the feedback I get is, "maybe it's a time for you to find a new job, you're burned out."
Really? Well, yes, maybe I am burned out from working with the family members who are frantically trying to induce more active care for their 90 yr+ family member. I work with mostly geriatric patients, and if I had a dime for every family member who told me that, "you are not doing enough," I would not have to work anymore.
I think we have an obligation to protect patients from the scenario described in the above columns. I don't think it should be the choice of the family!! Call me radical, they don't know what they are choosing, they don't have to deliver the consequences.
If the family makes the choice to prolong the dying process, then let them deliver the torturous care that they want for the patient.
Mar 25, '12Quote from aznurse1Yes, I hear that exact response as well. It only makes me feel worse. The people who respond with that are not the ones who provide the bedside care to these patients. It's the support staff (chaplain, case manager, social worker, etc.) and my family. I wonder what their feelings would be if they had to provide the "torture" to these patients.When I complain about this, the feedback I get is, "maybe it's a time for you to find a new job, you're burned out."
I recently cared for an elderly patient who had not eaten (per the family) for three months due to low appetite, nausea, vomiting, and abdominal pain. The patient was so malnurished that they had 4+ pitting edema and weeping all over. Pretty much every organ system was failing, and the CT scan showed abcesses vs mets throughout the abdominal cavity. Anyone with any medical knowledge knows that a healthy person would have difficulty recovering from a large abdominal surgery let alone multi-system organ failure. But this patient was going to have to overcome these with baseline extreme malnurishment and overall low reserve. Did the docs ever speak of this with the family? Of course not! They wisked the patient off to surgery and the patient continues to do poorly. It would have been totally appropriate to have sat down with the family prior to surgery and explained the situation, ask what their ultimate goals were, and explain that their loved one was most likely not ever going to fully recover from this if they even made it out of the ICU. These kind of talks just don't happen often enough.
Ok... I feel better now that I have vented!
Mar 25, '12I have been a nurse 38 years in many different settings. I have seen this dilemma many times. After many years working with physicians and hospital administrators and chaplains other nurses, and the community at a large country trauma center we developed an ethics committee and encouraged a residency training team in palliative medical care be funded at our medical center. This has worked very well to discuss patient, family, doctor, nurse social worker and community concurs about care appropriate to give our patients.
An ethics committee recommendation is made and documented in the patient's chart with the notation that these recommendations are ethical not legal recommendations. The patient's attending physician makes decisions about care for the patient with patient and family input after the ethics committee's analysis which includes the family.
The ethic committee's work in the hospital made a path for the hiring of a palliative care physician for consults to support the patient's physician problem solve with the patient/family appropriate interventions. This systematic approach including all of the disciplines of care in the hospital was profoundly satisfying as we all saw that the patient got the best outcomes from this approach per the patient's/family report.
Mar 25, '12Ethics committee!?!? Yeah, that's a joke at the hospital that I work at. We have brought cases to them, and they only side with the family and have stated that they will never state anything against what the family wishes.
It all comes down to $$$. If the ethics committee makes a recommendation against what the family wants, the family will not return to our hospital.
Mar 25, '12I tried to get an ethics committee consult once. Got the run around until it was too late to do anything anyway. Supposedly it's better now (as we ramped things up trying to get Magnet again.) I'll believe it when I see it...