Coworkers Respecting Each Others' Advance Directives and Code Statuses

[SilverBells]

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? 

[Surfin USA]

9 hours ago, CABGpatch_RN said:

Then dear, you would get a 5150.

This is simply another gaslighting tactic created by the right to life crowd, who is willing to also imprison and put to death women who have abortions. DNR to them somehow equates to helping someone die. Im just sorry that in all your (and many others on here as well) years of being a medical provider, you still don't recognize that absence of breath and pulse is equal to DEATH and that death IS final. Im sorry if you force feed patients. Im sorry if you force patients to undergo treatments they don't want. 

A dead DNR is already dead. There is NO reason for all this crazymaking of those who have a DNR, just for knowing that it is a fact, that when they are dead they simply are dead, and wish to stay that way as nature intended, I.e. OK IM DEAD THERES NOTHING ELSE YOU NEED TO DO FOR ME  JUST RESPECT MY DEAD BODY NOW BY NOT DOING ANYTHING. 

Thats what DNR means. STOP bringing your ridiculous campaign to keep someone alive an extra day or two, into the picture. We arent crazy for understanding that here in the USA, only 10.6% of people who get BLS are discharged alive. 

If anything, if you want to change our minds, perhaps stop acting like NURSE RATCHET and work harder at improving your patients outcomes as a whole, rather than pointing your crooked finger at us, solely for recognizing that death is INDEED the *natural ending* of LIFE. 

[CrunchRN, ADN, RN]

I am sooooo confused now. Is SilverBells an alternate personality created by DaveyD?  Still interesting and fun, but please clarify.

[JadedCPN, BSN, RN]

15 minutes ago, Gillyboo said:

This is simply another gaslighting tactic created by the right to life crowd, who is willing to also imprison and put to death women who have abortions. DNR to them somehow equates to helping someone die. Im just sorry that in all your (and many others on here as well) years of being a medical provider, you still don't recognize that absence of breath and pulse is equal to DEATH and that death IS final. Im sorry if you force feed patients. Im sorry if you force patients to undergo treatments they don't want. 

A dead DNR is already dead. There is NO reason for all this crazymaking of those who have a DNR, just for knowing that it is a fact, that when they are dead they simply are dead, and wish to stay that way as nature intended, I.e. OK IM DEAD THERES NOTHING ELSE YOU NEED TO DO FOR ME  JUST RESPECT MY DEAD BODY NOW BY NOT DOING ANYTHING. 

Thats what DNR means. STOP bringing your ridiculous campaign to keep someone alive an extra day or two, into the picture. We arent crazy for understanding that here in the USA, only 10.6% of people who get BLS are discharged alive. 

If anything, if you want to change our minds, perhaps stop acting like NURSE RATCHET and work harder at improving your patients outcomes as a whole, rather than pointing your crooked finger at us, solely for recognizing that death is INDEED the *natural ending* of LIFE. 

Gillyboo if you follow the thread you’ll see that comment was in response to SilverBells essentially saying that they would decline ANY surgery in ANY scenario because they don’t see the purpose of them being alive and don’t believe they’re worth saving (a recurrent theme that SilverBells has posted throughout many threads). The 5150 also piggybacked on what I said which was basically there is a huge difference between being in the right mind to consent to a DNR which I fully support, and a healthy 20-something year old saying they would decline having an appendectomy because they are potentially in a bad mental space to make that decision.

[Davey Do]

1 hour ago, klone said:

Some of them are, Davey. You've been a little...unpleasant...in some threads recently.

Oh gee, klone, I'm so sorry you've found me to be "unpleasant".

[SilverBells, BSN]

3 hours ago, CrunchRN said:

I am sooooo confused now. Is SilverBells an alternate personality created by DaveyD?  Still interesting and fun, but please clarify.

Alas, only one and/or two individuals know the truth...?

On a serious note, I would be inclined to say that both Davey and SilverBells are strong advocates of respect

[FolksBtrippin, BSN, RN]

3 hours ago, Gillyboo said:

If you needed intubation, during surgery, great get intubated. Totally not the same thing as being resuscitated from death.. although, a person could indeed include a DNI along with their DNR. 

Just because a physician thinks its better to intubate you, doesnt mean its going to be allowed. It's actually something that physicians will kindly consider asking you, prior to surgery. It's LITERALLY ALL YOUR OWN CHOICE. 

And yes. If a DNR had a freak accident AND DIED from that accident, then do not resuscitate. 

The reasons for the death are not important. The persons choice of what medical care they want or don't want, IS. 

This entire thread is about RESPECTING another person's DNR. If they arent dead, take care of them. If they ARE dead, do the right thing as they ask, and let them die naturally, by NOT trying to resuscitate them. 

Its really not that difficult. 

Well...

my post was mostly a joke.

But I'll respond anyway and tell you that I respect your opinion.

It's an opinion.

My opinion is that there are certain circumstances where a simple DNR should not be honored. Like when an HCP has done something to cause the code to happen in the first place. You don't get to die on an operating table just because you don't want to be resuscitated. That's my opinion. You don't get to die choking on a chicken bone that I fed you. Decisions to "pull the plug" are different and can be made later. Not every situation really counts as a natural death.

And I am also telling you that there are plenty of times that DNRs are not followed for those reasons and others and that is not an opinion but a fact.

Lastly, I will say that if you are at end of life, you should create a POLST, which is a  detailed directive (not just a DNR) and a doctor or NP order and should always be honored under every circumstance. Because it actually considers the circumstances. 

 

[SilverBells, BSN]

2 hours ago, FolksBtrippin said:

Well...

my post was mostly a joke.

But I'll respond anyway and tell you that I respect your opinion.

It's an opinion.

My opinion is that there are certain circumstances where a simple DNR should not be honored. Like when an HCP has done something to cause the code to happen in the first place. You don't get to die on an operating table just because you don't want to be resuscitated. That's my opinion. You don't get to die choking on a chicken bone that I fed you. Decisions to "pull the plug" are different and can be made later. Not every situation really counts as a natural death.

And I am also telling you that there are plenty of times that DNRs are not followed for those reasons and others and that is not an opinion but a fact.

Lastly, I will say that if you are at end of life, you should create a POLST, which is a  detailed directive (not just a DNR) and a doctor or NP order and should always be honored under every circumstance. Because it actually considers the circumstances. 

 

Respectful post that acknowledges differences in opinion.  Thank you

[SilverBells, BSN]

It should also be mentioned that not wanting all medical care available does not necessarily indicate that "one needs help."  Consider patients of certain religions who refuse certain treatments; some of these refusals are potentially life-threatening, but yet are still respected with the acknowledgement that they understand the risks/benefits of refusal.  Some patients will decline hospital care as long as possible, and leave it up to "God's will."  Now, I'm not saying that everyone who refuses certain cares is religious, as it certainly does not play any role in my own refusals for certain treatments.   With that said, one should consider that there are many, many factors that influence someone declining treatment and think about how those factors can be respected before deciding they are "wrong." 

[SilverBells, BSN]

As nurses, we need to empower patients to make the choices that are right for them.  In order to do so, we need to learn to respect decisions that aren't necessarily what we would choose for ourselves. 

[amoLucia]

1 hour ago, SilverBells said:

As nurses, we need to empower patients to make the choices that are right for them.  In order to do so, we need to learn to respect decisions that aren't necessarily what we would choose for ourselves. 

Does this logic also apply to that pt who wants to stay in bed day after day??? Seems to be bothering you for the pt to do so.

[Lunah, MSN, RN]

1 hour ago, SilverBells said:

As nurses, we need to empower patients to make the choices that are right for them.  In order to do so, we need to learn to respect decisions that aren't necessarily what we would choose for ourselves. 

Yep, but I'm not your nurse, and you're not my patient. That is going to lead to differences in opinion and advocacy. ?

[macawake, MSN]

On 4/26/2021 at 7:39 PM, SilverBells said:

As for surgeries...it is unlikely that I would request/participate in any surgery of any kind, so I think we're safe there.  

 

On 4/26/2021 at 7:57 PM, londonflo said:

Do you mean if you developed appendicitis, gall bladder disease or something like that you would refuse surgery?

 

23 hours ago, SilverBells said:

Yes. No surgeries of any kind, for any reason. 

 

22 hours ago, JadedCPN said:

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.

 

22 hours 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?

 

21 hours ago, JadedCPN said:

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.

 

22 hours ago, SilverBells said:

Just think about this: I would be one of the easiest patients any physician would have because I want nothing done.  

No you wouldn’t be and I know you know that. Most physicians aren’t sociopaths. All the ones I know would be extremely bothered by seeing a thirty-year-old possibly die from something that’s easily treated in the 21st century. Dying from appendicitis would have counted as a natural death in the middle ages. Today, if you have access to healhcare, it’s a choice.

This is nothing at all like wanting to be DNR. Not seeking care for any type of easily fixed ailment or injury is a whole other thing. If I’m honest, I don’t believe half the stuff you write. You are constantly upping the ante. For dramatic effect? To elicit reactions?

You’ve mentioned respect several times. Others may disagree, but I don’t find what you’re doing at all respectful. If you don’t want a tetorifice booster after you step on a humongous rusty nail that was buried in the flower bed outside your place of work, then don’t get one. If you don’t want antibiotics to treat your UTI, as you think that pyelonephritis sounds enticing. By all means.. But why are you sharing all this? Do we need to know? What is it you want from other posters?