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?
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.
I'm not sure why this keeps getting brought up. If the patient wants to stay in bed all day, she can. I don't have to agree with it in order to respect her as a person.
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?
This thread really was meant to address advance directives, but as surgery was also brought up, it turned also towards a discussion on medical care in general and accepting/refusing certain types of care. Again, not meant to create any theatrics, but it does promote debate regarding ethical issues as clearly not everyone is on the same page about what is right for everyone.
I will continue to repeat: We don't necessarily have to agree with each other's healthcare choices or that of our patients. Instead, we need to learn to respect each other and assist our patients in any way that meets their goal of care.
Unsure why it isn't clear that the goal of this thread is one thing and one thing only: Respect. That's all.
Just curious, then: What is your approach to caring for patients who refuse other life-saving treatments such as blood transfusions for religious reasons even when you do not feel it is in their best interest? These patients, too, have access to healthcare but are choosing not to pursue all options.
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 do we really need to know?
Unsure where I am being disrespectful. Yes, I am asking questions that are promoting a debate, but am by no means intending to be disrespectful. I apologize if that is what happening, but again, not sure where the lack of respect comes into play here. I will say that the only reason that my perspective on surgeries even came about was when someone asked if I would accept life-saving surgeries; prior to this, that was not even part of this discussion. With that said, if I have been rude, I apologize as that is not my intent.
This thread really was meant to address advance directives, but as surgery was also brought up, it turned also towards a discussion on medical care in general and accepting/refusing certain types of care. Again, not meant to create any theatrics, but it does promote debate regarding ethical issues as clearly not everyone is on the same page about what is right for everyone.
I think very few posters have a problem with advance directives. I know I don’t. I support your and everyone else’s right to decide for yourself. I’ll be 100% honest with you. It’s the repeated, thinly veiled allusions to self-harm that I find problematic. You don’t seem to respond to the posters who have tried to offer advice or encouragement. Which begs the question why you keep bringing it up. As I asked in my previous post, what is it you want from other posters?
1 hour ago, SilverBells said:
This thread really was meant to address advance directives, but as surgery was also brought up, it turned also towards a discussion on medical care in general and accepting/refusing certain types of care. I will continue to repeat: We don't necessarily have to agree with each other's healthcare choices or that of our patients. Instead, we need to learn to respect each other and assist our patients in any way that meets their goal of care.
Unsure why it isn't clear that the goal of this thread is one thing and one thing only: Respect. That's all.
Correct me if I’m wrong, but your only goal of care seems to be nocare whatsoever under any circumstance?
1 hour ago, SilverBells said:
Just curious, then: What is your approach to caring for patients who refuse other life-saving treatments such as blood transfusions for religious reasons even when you do not feel it is in their best interest? These patients, too, have access to healthcare but are choosing not to pursue all options.
That’s actually never happened to me and I work trauma surgeries. About 75-80% self-report as non-religious in my country and for the remaining 20%, it seems most religions will allow blood transfusions. So someone declining a blood transfusion is very rare. But if it were to happen and the adult patient was of sound mind, her or his wish would be respected. However if a patient with traumatic brain injury after an accident of some sort presented in my ER, screaming ”no blood”, they’d likely get a transfusion any way if one was needed. A child will always get a needed transfusion. An adult has the right to choose to die, but they aren’t allowed to make that decision for their children. That’s the law around here.
Im not taking anyone's advance directive personally. Clearly I am a big proponent of DNR education and respecting others rights.
However, an advance directive isn't necessarily a DNR.
Clearly, this person (a nurse in this thread) wants to be a full code, and claims to also be a DNR, but cant seem to understand that wanting to he resuscitated at death is contradictive to a DNR status, particularly when their "quality of life" is certainly not going to improve, because... drumroll, please.. they are dead. Their life is over. It has ended. Terminated. Finito. Done. There is no quality to be concerned with.
A person who really signs a DNR, understands these merits as its most basic CORE principle.
So my question is this: Does he or she really have a dnr, or is this person, perhaps, very confused about DNRs in general.
Again, I want to help people to understand how all this works.
I clearly know what the hell a DNR is, the semantics lesson wasn't necessary and condescending. You knew the gist of what I was saying. The fact you assume a sight full of nurses and medical professionals don't know what a DNR or advanced directives are is asinine. Spending all your time on this fake teaching expedition to damn near every post is comical but go off though.
Alas, there is much to be gained from this thread...education and a conversational debate on an important topic and respect for people of all viewpoints
Specializes in Pediatrics, Pediatric Float, PICU, NICU.
6 hours ago, SilverBells said:
I'm not sure why this keeps getting brought up. If the patient wants to stay in bed all day, she can. I don't have to agree with it in order to respect her as a person.
If you as the nurse manager and/or the medical providers had a concern that the person actively depressed and/or suicidal and wasn’t in their right mind because of their mental state, do you think the appropriate action would still be to let them do nothing which could be detrimental to their help?
If you as the nurse manager and/or the medical providers had a concern that the person actively depressed and/or suicidal and wasn’t in their right mind because of their mental state, do you think the appropriate action would still be to let them do nothing which could be detrimental to their help?
Well, no. But if the person is just unmotivated, you can educate and encourage all you want, but ultimately it is up to them. I’m not strongly advocating for letting patients stay in bed all day as it just promotes bowel concerns, the risk for pressure sores, and a host of other issues. However, if they are content and understand the risks/benefits after intervention, sometimes the patient has to accept responsibility for themselves. Which, by the way, is a statement that doesn’t come lightly from someone who is a fierce patient advocate, has strong concern for patients and pushes for the best care and outcomes possible
Alas, there is much to be gained from this thread...education and a conversational debate on an important topic and respect for people of all viewpoints
@Silverbells. I read that ENTIRE comment you made before deleting it and replacing it with a period. I read the ENTIRE thing. You lady/mister are a master manipulator. Why not share what was in that post you deleted.
This crap isn't funny. I don't even know how you live with this nonsense you put out into the world. I wouldn't want you anywhere near me or anyone I know or love. You mind is twisted. It seems you get satisfaction out of getting a rise out of others. You should not be in a position of critical decision making. You are unstable.
I wasn't going to comment further on this thread, but I saw you deleted the comment you made earlier, I was disgusted by yet more of your insincere and ridiculous behavior.
Maybe this is a personal attack. So be it. This individual is playing everyone and manipulating for his/her own entertainment. In no way is anything he/she says meant to start conversations about a topic.
TELL US WHAT YOU SAID IN THAT POST YOU DELETED.
Best thing to do with someone like SIlverbells is ignore. Block? Absolutely.
@Silverbells. I read that ENTIRE comment you made before deleting it and replacing it with a period. I read the ENTIRE thing. You lady/mister are a master manipulator. Why not share what was in that post you deleted.
This crap isn't funny. I don't even know how you live with this nonsense you put out into the world. I wouldn't want you anywhere near me or anyone I know or love. You mind is twisted. It seems you get satisfaction out of getting a rise out of others. You should not be in a position of critical decision making. You are unstable.
I wasn't going to comment further on this thread, but I saw you deleted the comment you made earlier, I was disgusted by yet more of your insincere and ridiculous behavior.
Maybe this is a personal attack. So be it. This individual is playing everyone and manipulating for his/her own entertainment. In no way is anything he/she says meant to start conversations about a topic.
TELL US WHAT YOU SAID IN THAT POST YOU DELETED.
Best thing to do with someone like SIlverbells is ignore. Block? Absolutely.
Sorry. I have no problems reiterating what I said. The post was meant as an apology for not acknowledging other viewpoints and that there are a wide range of reasons in which a DNR/DNI or refusing medical care would not be appropriate. I deleted it for the time being as it seemed to repeat itself over and over again and wasn’t worded correctly, or not in a way that would make sense. I have no issues admitting that I am wrong. Clearly, I’ve been wrong a lot lately, so wanting to take more time before posting. With that said, I’m sorry for your feelings and do apologize
SilverBells, BSN
1,108 Posts
I'm not sure why this keeps getting brought up. If the patient wants to stay in bed all day, she can. I don't have to agree with it in order to respect her as a person.