Dnr In Icu

[gizelda196]

Hi.

I just had another one of those knock down drag out fights with the manager.

Our unit has its issues. (see my other post) We have just lost 12 nurses with a total of over 200 hundred years of critical care experience.We have no contract .blah blah blah.

Hence we have some just here "for the paycheck"staff. WE have now travel nurses( a few are really great) We have some perdiems. We have a few reg staff.

So let me get to the point of my post. Some times in our unit we have a rare family in a very hard situation that need to make some very hard choices.Sometimes you get a pt that was someone very special and had allot of love and support and a big family. The patient I received in report was a 50ish male myeloma for 4 years in a metastasis process. He was at work Friday. This was a guy who lived every day despite chemo and Rtx.Well Friday noc he had a GI bleed. He was a walk in to E.R with family in tow. Full CODE ,ICU admit.a&ox3 pleasant. family around. All intentions of going home. Well after multiple units of blood.ffp fluids blah blah blah. Things were not getting better. The gi bleed turned to a cecal mass large and pt was not an or candidate.Over the weekend staff went into support mode .assisting the family Pt on Sunday told wife I want to be a DNR. PT was started on mso4. hospice was consulted and by Monday he was on his path. Hospice came in on tues. .Well here is were I come in. I guess over the weekend the family had to boundaries. It was hard for the RN over the weekend Because she had a heart and this really was one of those families you just will never forget.She also had the pleasure of knowing the patient.(a&o on admission)

and was a part of the families journey.Well I came into rumors that the family was doing this and the family was doing that And the nurse let them have 3 icu rooms blah blah blah.So night nurse(Traveler) says well I put a stop to that .They are all sleeping on the pt floor! So I was sick. I figured I would assist this family. I dug up some recliners.opened up the adjoining room (shared bathroomwith pt room) woke the children up and consolidated the family into one room.Hospice came in had a 3 hour meeting with that family in that room.Then all said a prayer. family priest came up and the family had last rights and a prayer about an hour later.It was a large group but they all jammed in the room and assisted one another in the process. .Well the manager was beside herself. she wanted this family out of the unit. out of the room and transferred to another floor.I refused.this family was tucked away in 2 rooms on the other side of the unit away from other patients,.They had a rough weekend and death was interment.So blow out number one. Hospice backed me during this convo.Only nurse to do so.So we came to an agreement that pt would be transferred to rehab unit in am. We were making the plans, and tcu was going to clear an area. SO if nothing had changed in condition pt would be going there wed am. We were fine with that because the hospice nurse and I knew that it was soon.So later in the shift the manager with a chip on her shoulder came on the unit. looked at the family . walked into the adjoining room and announced they had to 3 o'clock to remove there belongings blah blah. well I was angry. So I told my manager the next time you wish to address any patient of mine you need to come to me first. well she was angry so we had a blow out.I went back the unit.Told the family hang tight.SOOOOOOOOO get this. Someone from administration is the patient niece. She visits. finds out form the family that they have to clear out and she goes to my boss and says. my family is going thru a tough time they would really appreciate the use of the rooms.and my boss says ohhh sure no problem if there is any thing else I can do. WEEEEEEEEEEELLLLLLLL. I lost all respect for this manager at that moment(I had very little any hoot)The pt died at 3pm.The whole entire family was in that room with him they told him they loved him it was okay and so on they were all there It was a very touching moment for me to be apart of.

My question is What do you do in these cases. We have plenty of dnr we transfer out to the floors for dying care. but once in a while we get that family that your heart just breaks.And it was such a tough and very quick journey to go threw with the family.The bonds and trust between staff and family were in place and moving him and bending was not the right choice at this moment. How would you have done it. And what is your policy on DNRs in the unit. Let me just add. we are a tiny community hospital struggling. we had 6 patients 4 nurses and 9 empty beds. I had a slot open and one other nuse had a slot open. And we have no staff any hoot so that would have been the max load any hoot.and we never have a code bed!!!!!(another issue)

[Chad_KY_SRNA]

In my LTC facility when the patients go south over the course of a day or two, the residents roomate is moved into another room and the empty bed is used by the family. We bring in chairs and dietary brings in a coffee pot. Nursing staff just needs a path so that they can get in to check vitals. We have had as many as 12 squeeze into a room of a dying person.

[TennRN2004]

If nurses aren't considerate and compassionate to families at such a terrible time, then who will be? You showed yourself to be an excellent nurse gizela, because you put your pts needs above all else. I know in my hospital we have set visiting hours, but extending those hours is always at the discretion of the nurse. A nurse with a good heart empathizes with families and you did exactly that. Your manager should be ashamed. If that were her father/mother/close family member how would the situation have been different? It would bother me also about the change in attitude whenever the mgr finds out the niece works in administration. We should treat all patients and families with proper respect no matter who they are or who they know.

Side note- in our facility is always stressed to families dnr does not equal do not treat. I know in this case the pt had no chance of recovery, but if we have a dnr we do all we can to support the pt through the acute process. There is just no invasive attempts if a code does happen to pull the pt through.

[Hellllllo Nurse, BSN, RN]

I was a hospice nurse in an INPATIENT ACUTE hospice facility. Sounds like this would have been a great option for the pt and family.

Unfortunately, most hospices provide only homecare, and care in others' facilities. They do not provide 24 hrs a day RN care, and do not have inpt facilities.

I think that many more hospices should have inpt facilites.

I had a hospice pt very similar to the pt described by the OP:

Pt in his 40s, malignant melanoma w/ mets. Very large, wonderful family.

His entire family was with him, when he died a gentle, peaceful death.

His death was just about as "good" a death as I have seen.

I have often thought that it would be a great idea for ICUs to have an ajoining hospice unit.

ICU staff and hospice staff could have transitional pt focus meetings to facilitate the transfer of pt and family from ICU to hospice.

The pt's bed could simply be rolled through a set of double doors to the hospice unit, where the focus would be completely different. Docs could be educated in hospice and palliative care, so that the pt could retai9n their same doc when they transfered to hospice.

I've fantasized about the possibility of ICUs w/ ajoining hospice units for a long time.