Blue about Code Blue

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I am a new nurse working on the Oncology floor. The stages of cancer we treat vary from newly diagnosed to metastatic. Some of my patients have good prognoses while others have only weeks or possibly days to live. Recently I experienced my first Code Blue. The patient, in his mid-eighties, had been in an altered state for 2 weeks or so: disoriented, incoherent, and inclined to curse at nurses over and over. Although he was not my patient, hearing his unmistakable behavior from the teaming station and hallway, I sensed a detachment from reality. One day, while charting, we suddenly heard a soft and anxious voice of a family member coming from the patient's room, pleading for help. The experienced nurses around me jumped to their feet and into action while I followed, my heart beginning to race. A few minutes later several professionals had crowded into the room. I tired to participate and be helpful but seeing the patient's open and lifeless eyes, feared he was unlikely to make it. Indeed, after an honest attempt the code was called and time of death noted.

Several feelings and thoughts have gone through me since witnessing and my first Code Blue, however there is one thought I am grappling with and want to share with you:

This patient had lived a long life, and being terminally ill was going to die soon. Yet he was not DNR. Because of this, the natural last breaths of his life and still moments afterward were replaced with a violent (for lack of a better word) physical act. His wife trembled as my clinical manager led her away from the scene. I thought about when my parents will die and know neither they nor I will want this if, one day, found in a similar situation. I thought about how important it can be to chose DNR. I realize however it is not for everyone and each situation is personal, individual and even complicated.

For you nurses who have witnessed many codes, how often have you seen a similar circumstance as the one I've described? More importantly, is DNR discussed and rediscussed with patients as they progress in their illnesses and into older age? Are issues such as likeliness of being revived, invasiveness of the code itself, and its effect on family members (witnessing the code or being whisked away from their loved one) discussed openly and honestly with the patient and family, so that they may make an informed decision? Anyone's feelings and opinions on this sensitive topic is welcome and appreciated. I am also curious about the thoughts of more experienced nurses.

Thank you!!!!

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Specializes in Family Nurse Practitioner.

Every day as I too work oncology. Some patients are coded several times because family can't accept or do not want them to be a DNR and they are no longer able to make decisions. I absolutely believe the patient should be able to die peacefully with dignity. I am actually in school to become a NP now. I would like to work in hospice or palliative care. There is a huge need.

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Specializes in Cardiology.
I am a new nurse working on the Oncology floor. The stages of cancer we treat vary from newly diagnosed to metastatic. Some of my patients have good prognoses while others have only weeks or possibly days to live. Recently I experienced my first Code Blue. The patient, in his mid-eighties, had been in an altered state for 2 weeks or so: disoriented, incoherent, and inclined to curse at nurses over and over. Although he was not my patient, hearing his unmistakable behavior from the teaming station and hallway, I sensed a detachment from reality. One day, while charting, we suddenly heard a soft and anxious voice of a family member coming from the patient's room, pleading for help. The experienced nurses around me jumped to their feet and into action while I followed, my heart beginning to race. A few minutes later several professionals had crowded into the room. I tired to participate and be helpful but seeing the patient's open and lifeless eyes, feared he was unlikely to make it. Indeed, after an honest attempt the code was called and time of death noted.

Several feelings and thoughts have gone through me since witnessing and my first Code Blue, however there is one thought I am grappling with and want to share with you:

This patient had lived a long life, and being terminally ill was going to die soon. Yet he was not DNR. Because of this, the natural last breaths of his life and still moments afterward were replaced with a violent (for lack of a better word) physical act. His wife trembled as my clinical manager led her away from the scene. I thought about when my parents will die and know neither they nor I will want this if, one day, found in a similar situation. I thought about how important it can be to chose DNR. I realize however it is not for everyone and each situation is personal, individual and even complicated.

For you nurses who have witnessed many codes, how often have you seen a similar circumstance as the one I've described? More importantly, is DNR discussed and rediscussed with patients as they progress in their illnesses and into older age? Are issues such as likeliness of being revived, invasiveness of the code itself, and its effect on family members (witnessing the code or being whisked away from their loved one) discussed openly and honestly with the patient and family, so that they may make an informed decision? Anyone's feelings and opinions on this sensitive topic is welcome and appreciated. I am also curious about the thoughts of more experienced nurses.

Thank you!!!!

I don't think it is discussed well enough at all. I have seen plenty of codes. We generally bring them back long enough to stabilize them and get them off my cardiac unit and to the ICU/CCU. I've never heard of one of ours surviving more than a few days after that but maybe that is enough time for a loved one to get to the hospital and say goodbye, so I can't pass judgement.

I had a woman a month ago or so who was a DNR. She was about 80 and had some problems but nothing that concerned me imminently. When I went to put the DNR bracelet on her, she seemed hesitant/upset. I cut the bracelet off her because she felt she had no choice but DNR. I explained briefly advanced directives vs HCP, then asked the MD to come speak with her. He didn't want to. They never want to, and they seem to feel anyone over 70 should be a DNR.

I personally only want to be coded in the hospital and while my child is still a child. I've also discussed this with my parents and am clear on their wishes (I'm the HCP.). Do I think pts really understand? Nope. And sometimes the family only gets it when they actually see it.

For most people, I don't think any amount of explaining a code will make them understand how physically horrible a code is. People often don't want hospice even if they are DNR and dying. They have a narrow perspective on the whole thing and most people just aren't prepared to be done with living and don't want to think about it or feel they are hurrying themselves along.

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Specializes in ICU.

Well, codes aren't horrible for the patients, they don't feel a thing. If they want everything done, then it should be. It all depends on the individual circumstance and why they code in the first place. If you run 10 codes and only one patient survives and walks out of the hospital under their own power ... was it worth it all? You bet. One story a friend tells is of a patient coded during a long hospital to hospital transfer and EMS did CPR for 100 miles. That patient actually did walk out of there pretty much 100% intact (certainly wasn't 80 years old though). The stories are endless for both pro and con DNR.

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Coding someone who is above 80 or cancer filled is a terrible experience for me but it happens once a month. What people also fail to think about is how the person will be if we do get them back... How long were they down? Were they receiving adequate CPR? Will this patient be trached and pegged a month from now? If the patient survives and leaves their mortality rate for the next year increases 60 percent, will they be back? I will personally be dnr when i hit 70 bc its all downhill from there if i code but people need to be more educated.

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Specializes in ICU.

I've seen trached patients smile and laugh.

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Specializes in Trauma, Critical Care.

Medical staff and patients, and patients and their loved ones need to have clear ideas of the pt's end of life wishes whether the patient is coding or is just unable to make decisions on their own. I give kudos to all families/patients that know what they want, either way, from the start and aren't afraid to do it. If patients haven't talked about those kinda decisions with anyone before its too late, then that's just tragic.

Had a wife once say, "we didn't put our dog with cancer down, I'm not going to do the same to him.". I disagree that making someone a DNR is "putting them down" but at least she knew what he would've wanted."

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Specializes in NICU, ICU, PICU, Academia.

I'm going to take a slightly different tack here. I've had 35+ years in nursing, and seen a lot- from gero-psych to NICU and everything in between.

It seems to me that we live in a society in which 'no' is not an acceptable answer. As in "No, there is nothing more that can be done for you/ your loved one besides comfort measures". And in healthcare some (not all, but some) equate 'death' with 'failure'.

Just an observation

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Specializes in Neuro ICU and Med Surg.
I've seen trached patients smile and laugh.

So have I but the poster previous to you was stating more along the lines of being trached and pegged after prolonged CPR and being left with no quality of life. Most of us wouldn't want something like that.

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Specializes in ICU.

It's still the decision of the individua. If someone in their 90's want's me to start CPR if their heart stops, then okay, I got no problem with that. You only get one shot at life, once you're dead, that's it.

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One of my nursing instructors says it really depends on how you ask the patient... "Do you want to be resuscitated?" vs "Do you want to be allowed a natural death?" She stressed that CPR was meant for the 'healthy-dead' and wasn't intended to be used on the old, frail, and very sick.

I'm a new grad and just experienced my first code last week so I've been reviewing my notes from school on this topic. The patient was revived. I didn't know him at all though. When I arrived all of the major tasks were already being performed but no one was recording, so I took that on. I did a pretty good job and the nursing supervisor used my notes to fill out the report.

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I would say most issues with code status root from lack of education. For a lot of patients and families the only CPR they know is what they see on TV. Ultimately the best we can do is make sure they are informed as much as possible and give them support while making a very difficult decision. I don't personally agree with coding a 90 something year old so that best case scenario she can be on a ventilator with broken ribs and pneumos, but we give the options therefore we have to respect the decisions.

On another note I am doing a project on family presence during codes. There's research to support that it is beneficial to give families the option to stay with their loved one instead of whisking them to the waiting room after the patient arrests. It's obviously not for everyone, but it might have been nice for the wife (with the careful support of a dedicated staff member) to sit at the foot of the bed and rub their feet or something in his last moments. Often times its easier to come to terms with the outcome when the family sees how hard the staff is working and how horrible the coding process is. Just some food for thought!

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