Note: This might seem like a strange topic, but seeing as how that is nothing new coming from the source, I'll go ahead anyway.
As nurses, we are trained to do everything we can to save someone until it's no longer feasible or unless doing so would go against a patient's wishes, such as performing CPR for a patient with a a DNR/DNI.
However, theoretically, anyone of us could "code" at anytime--and this includes at work.
For those who are full codes, this wouldn't create any ethical issues. You would simply perform CPR on your coworker as you would anyone else.
However, for those who have DNR/DNIs, issues could come up if coworkers are unaware such orders exist. How do we ensure that these coworkers have their wishes respected should the need come up?
For example, I am legally a Full Code but am wanting to pursue a DNR/DNI. Based on my age and no apparent health issues, I have a feeling most of my coworkers would automatically assume I am a Full Code should circumstances arise, however.
What is the best way to inform my coworkers that under no circumstances should anyone provide CPR to me?
For the rest of you, how do you ensure your coworkers' wishes for CPR or no CPR are ensured? Have you ever experienced such an ethical dilemma at work?
I don't think you really understand what a DNR/DNI is.
It doesn't mean that you won't be resuscitated or incubated under any circumstances. If you were at end of life you could have a POLST, which is a different thing.
A DNR doesn't apply if for example: you went under anesthesia to get your tubes tied and then you had a weird reaction and they had to intubate you. The people doing your tubal ligation don't have to be responsible for your death just because you'd like to be a DNR. You have rights and so does your surgeon.
Or in a freak accident. Let's say you slipped in some powerful poop on your unit, cracked your head on the vending machine that was devoid of sodas due to coworkers hoarding them and then a great horned people eating eagle swooped in through the open window on your unit and attacked you. The smarter nurse manager than you can't just be like... oh... girlfriend's a DNR. Just let the eagle eat her. Or wait... you can shoo the eagle out but no compressions for Bellsy.
No, no, no.
That scenario is great ??
As for surgeries...it is unlikely that I would request/participate in any surgery of any kind, so I think we're safe there.
How sad for you! If you ever have that moment in time when a surgery would have impreved your qual of life or forestalled further complications, you most prob will seriously rue the day you made that orig decision.
How sad for you! If you ever have that moment in time when a surgery would have impreved your qual of life or forestalled further complications, you most prob will seriously rue the day you made that orig decision.
Take it from someone who knows ....
I figure there's probably other ways to manage quality of life than surgery, and I'm not someone who is interested in prolonging their life with each and every measure possible. I'd also decline IV antibiotics, feeding tubes, etc so even if there are complications, there's probably not much to be done.
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
Just now, SilverBells said:
I figure there's probably other ways to manage quality of life than surgery, and I'm not someone who is interested in prolonging their life with each and every measure possible. I'd also decline IV antibiotics, feeding tubes, etc so even if there are complications, there's probably not much to be done.
I can't believe I'm even indulging this, but maybe for some random who is stumbling upon this site with good intentions instead of just pot stirring and theatrics; There's a difference between declining surgeries and IV antibiotics etc in a terminal situation (declining a tumor resection for example), and declining a standard surgery like appendectomy or declining IV antibiotics for a simple pneumonia or cellulitis in an otherwise healthy person. One scenario comes across as a reasonable and logical personal choice, whereas the other does not.
I can't believe I'm even indulging this, but maybe for some random who is stumbling upon this site with good intentions instead of just pot stirring and theatrics; There's a difference between declining surgeries and IV antibiotics etc in a terminal situation (declining a tumor resection for example), and declining a standard surgery like appendectomy or declining IV antibiotics for a simple pneumonia or cellulitis in an otherwise healthy person. One scenario comes across as a reasonable and logical personal choice, whereas the other does not.
Not intending to create any theatrics. I am just wondering why a healthy person would have fewer rights to decline healthcare than someone older or sicker? I figure as long as both people are aware of the consequences, each should be able to make their own decisions.
Just think about this: I would be one of the easiest patients any physician would have because I want nothing done.
Also, this does present a very realistic, possible dilemma:
Is it right to assume that all young, healthy people want all healthcare interventions?
Before you answer, is it right to assume that all 98-year old's with many comorbidities wish to be a DNR/DNI? I would think not. I have seen many people in their mid to upper 90's with 20+ diagnoses still request that anything and everything be done for them. As nurses, we may realize that some interventions would be limited in their efficacy in certain patients, but we also understand it's not our decision to decide who does and does not receive care.
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
4 minutes ago, SilverBells said:
Not intending to create any theatrics. I am just wondering why a healthy person would have fewer rights to decline healthcare than someone older or sicker? I figure as long as both people are aware of the consequences, each should be able to make their own decisions.
Just think about this: I would be one of the easiest patients any physician would have because I want nothing done.
Because again one of them represents a logical, reasonable, rational person in their right might making a choice, and the other scenario is something we would likely see in a patient with suicidal ideation who is not in their right mind and being unreasonable. Death by appendicitis in a time when there's no reason anyone should be dying from an untreated appendicitis, that's not reasonable and just about any medical provider would question that an individual refusing it is in their right state of mind.
If you were experiencing excruciating abd pain and risking peritonitis and other issues, WHERE WOULD YOU BE GOING FOR HELP???? You're 'front line' for covid. What about that care & tx,vesp if outcomes are unknown?
Like if you'd refuse acceptable standards of care at the hosp, will you just be suffering AT HOME until the inevitable???? And who do you think will providing any assist for care as you're just laying in your bed and waiting to die??? You say you're NOT close with family; no BF or kids. What's left - some other institutional setting? PVT pay? That $450,000 home sounds more & more remote.
I don't think you've thought this all out rationally considering all long-term sequellae. So for all your supp rational 'wishes', there's somethings not easy to plan for. Noble 'wishes' are all just that - noble 'wishes' when things come down to the nitty-gritty.
Because again one of them represents a logical, reasonable, rational person in their right might making a choice, and the other scenario is something we would likely see in a patient with suicidal ideation who is not in their right mind and being unreasonable
Okay, For a real life example: I developed a volulus with subsequent bowel obstruction..Worked the full day and didn't develop symptoms until evening. The next day I had a bowel resection with out a colostomy etc. I have enjoyed 15 more years because of this .. pleasure with my antiques business, outings with friends, read 1000 books, worked on my hobbies and home. Why would I have thrown this all away to avoid an abdominal incision, FMLA time and such a better quality of life! (Prior to this I had a redundant colon and after the surgery my life was improved.)
If you decline something like a life saving surgery - not a life alterating surgery you know that your decision making competence will be evaluated.
SilverBells, BSN
1,108 Posts
That scenario is great ??
As for surgeries...it is unlikely that I would request/participate in any surgery of any kind, so I think we're safe there.