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?
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.
Well, to be fair, I probably wouldn't be seeking emergency treatment. It would not be a good use of ER resources to evaluate a person who will just refuse all treatments anyway. With that said, I do live with family although not a husband or children. There's a chance that they might rush me to the ER anyway, but hopefully they would understand that the answer is no. And, if my hypothetical condition were to worsen at home...well, what can you do, you know?
I would think staying at home would be rational on my part knowing that hospitals/ERs are crowded and it would not be wise for them to spend time on someone who will refuse everything anyway.
I agree that the $450,000 home is getting further away, but I don't necessarily that was ever realistic anyway.
Regardless, as a nurse, I always try to respect my patients' wishes, even if I'm not necessarily in agreement. Hopefully, others would do the same for me. I still believe a young person's wishes should be respected as much as an older person's.
One scenario comes across as a reasonable and logical personal choice, whereas the other does not.
And this is exactly when, as a nurse, I would get psych and eventually ethics involved. It IS one thing to make end of life decisions that probably not will improve their quality of life when terminal and another thing completely to assist one in their own demise when it's only because they don't want anything to be done and they are otherwise healthy (but perhaps not psychologically healthy).
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
7 minutes ago, SilverBells said:
Regardless, as a nurse, I always try to respect my patients' wishes, even if I'm not necessarily in agreement. Hopefully, others would do the same for me. I still believe a young person's wishes should be respected as much as an older person's.
Hopefully if you had concerns about the mental capacity and competency of a patient to safely make those decisions, you would intervene as well. Surely you experience this in your setting. It isn't about age, old or young.
Silverbells - I fervently hope you see that this post has devolved from 'coworkers' to family, friends, PROVIDERS, and poss unknown strangers.
All people who have the best intentions to look out for your well-bring even as you've atypical opinions otherwise.
I've noticed. These threads always seem to take twists/turns and/or get slightly off topic. Regardless, the intention is the same--promoting respect for each other's healthcare wishes. As nurses, we should understand that each person's desires and needs may be different from those of another. Simply because one chooses a different form of healing or healthcare does not make it wrong, so respect is crucial
Hopefully if you had concerns about the mental capacity and competency of a patient to safely make those decisions, you would intervene as well. Surely you experience this in your setting. It isn't about age, old or young.
Oh, for sure. This isn't that uncommon at my facility, really. There's been several times that I've had to get family involved for various reasons. On the other hand, sometimes approaching family isn't always the best option either, so provider intervention is needed (I.e. family requesting excessively "aggressive" healthcare interventions for 100+ year olds with terminal illness, or families/patients refusing any interventions while the patient continues to decline and remain a Full Code).
And this is exactly when, as a nurse, I would get psych and eventually ethics involved. It IS one thing to make end of life decisions that probably not will improve their quality of life when terminal and another thing completely to assist one in their own demise when it's only because they don't want anything to be done and they are otherwise healthy (but perhaps not psychologically healthy).
I would say in this case if it were me, I would also decline psych intervention and request not to be referred to the Ethics committee, for this would be time consuming and unnecessary. As a nurse, I am aware of the consequences of not receiving certain treatments. I would have a full understanding of what I would be refusing. Age and overall health should not necessarily be cause for concern if a person has informed consent of refused treatments. I believe that instead of coercing one into certain treatments, consequences should be reviewed and confirmed, with a Risk/Benefit form signed by both patient and provider should the provider require this. At my facility, we use Risk/Benefit forms all the time when a patient chooses to elect treatments that are not recommended or refuse treatments that are. This allows us, as healthcare providers, to express our concerns while providing respect to the patient's wishes.
I would say in this case if it were me, I would also decline psych intervention and request not to be referred to the Ethics committee, for this would be time consuming and unnecessary.
But first, I would receive unwanted abdominal surgery.
Seems like a violation of patient rights. At my facility, patients have the right all the time to refuse any treatment they do not want. I would think these rights should be extended to all people. If someone understands the Risks and Benefits, I would believe they should be able to make their own decisions.
From what I gather, it seems as if only very old people or very sick people have the right to refuse certain health care treatments. Why is this? When, in nursing school, did we learn that younger people have no rights regarding care? Maybe I’m wrong, but I always thought we were taught to respect everyone’s wishes. I believe it would do us all well to remember that not everyone has the same goals of care. Each person is an individual, and this should be respected
Silverbells - just KNOW this. If ever I were to meet you in person and I knew WHO you were from these posts, you'd better believe that I would start resusc efforts regardless....
Yeah, I respect your 'personal wishes'. But NOWHERE have I read ANYWHERE that YOU respect OUR own personal ethics, professionalism and our own consciences. YOU. YOU. YOU. I need to be able to put my head down on my pillow at night by knowing that I did act in your best interests. Even if you don't see/recognize it.
You either are trolling us all, or you truly do have grievous psych issues that you pooh-pooh re seeking help. Part of the psych - please get help.
Not trying to disrespect anyone or disturb their consciences. Rather, I am urging people to consider that different people have different wants and needs. Simply because a person doesn’t want what most people would ask for does not mean their wishes are wrong. Some 98 year olds want all treatment possible. Some younger people would rather decline certain treatments. I am not sure what is strange or unusual about people of different ages desiring different approaches to care.
Think about this: We might not agree with a patient spending all day in bed as it promotes bowel problems and the risks for pressure wounds. But unless that patient is motivated to get out of bed, there’s not a whole lot we can do. We might not agree with this, but unfortunately we have to respect that a patient is choosing to be non compliant
SilverBells, BSN
1,108 Posts
Well, to be fair, I probably wouldn't be seeking emergency treatment. It would not be a good use of ER resources to evaluate a person who will just refuse all treatments anyway. With that said, I do live with family although not a husband or children. There's a chance that they might rush me to the ER anyway, but hopefully they would understand that the answer is no. And, if my hypothetical condition were to worsen at home...well, what can you do, you know?
I would think staying at home would be rational on my part knowing that hospitals/ERs are crowded and it would not be wise for them to spend time on someone who will refuse everything anyway.
I agree that the $450,000 home is getting further away, but I don't necessarily that was ever realistic anyway.
Regardless, as a nurse, I always try to respect my patients' wishes, even if I'm not necessarily in agreement. Hopefully, others would do the same for me. I still believe a young person's wishes should be respected as much as an older person's.