DNRCC in the CCU

Yes, you did a great job. Unfortunately some individuals, nurses and doctors included are themselves uncomfortable with death and dying. I have learned a long time ago, that in order for one to help another through death and dying they must be comfortable with not only their own mortality, but with the subject on a whole. It is disheartening to see the patients suffer so. Where I work, there are a few of us that will see to approaching the topic when needed.

I am very thankful that the unit I currently work in is very proactive about talking with family concerning code status. We have numerous doctors who are afraid to approach the subject, and it's typically left to the nurses. Good for you for taking a stand for the pt!

Unfortunately, you as a nurse can "approach" the topic all you like, only to have the physician undo all of your work.

I had a family all ready to accept the inevitable death of thier loved one. only to have the physician come in, and actually ask them if this patient would have expressed his wish in his "real" life.The family then stated that this was not "the real" him; although 5 minutes before they had told me that

his unceasing begging to "let me die" should be honored.

Don't get sick without a medical power of attorney and a living will. Your family will cave in the face of a persuasive doctor who does'nt want to get sued.

i never tell families what they should do when they ask. but... If they ask me, "If it was your dad , what would you do? " Well, then I look at the situation objectivly AND subjectivly, AND empathectically as best as possible. I am very honest, but i am clear to state that it is a personal opinion,and not a medical opinion. I always tell my families that i am not there to sway them. I know that sometimes they need relief form the guilt. If they have chosen comfort measures, & the patient then dies,.... i tell them what heros they are (&I believe it). But if they ask my opinion before the decision..... This job sucks. Ethics committes , and palliative care committees, can help alot.

As I stated in my earlier post, as long as the patient has left no directives as to final measures, it is up to you as the nurse to illuminate the family as to the current situation.YOU CANNOT MAKE A PROGNOSIS, ONLY SPELL OUT WHAT THE SIGNS AND SYMPTOMS INDICATE.

The doctor will often be adverse to making a decision, due to malpractice concerns. Right? No. Cowardly, yes.

We all agree that a person should not suffer due to other's unwillingness to take a position.

But, I as a nurse do not have the power to say "There is nothing more we can do".

I can only strongly indicate it, and work to get the family and the doctor onto the same ground.

It's the hardest work I do.

Cate

Had another situation this week where it seemed I was the only nurse comfortable enough to talk to a family about what was really happening with their loved one. He was in the process of dying, BUN and Cr through the roof, Na levels high, lethargic, embolic stoke post cath, Ef of 8%, you get the picture. I was told "don't you dare talk to the family about his code status, They have made up their minds and he is a full code." Long story short: the cardiologist and I talked to the family, obtained their consent for a DNRCC order and the patient died peacefully and comfortably 2 hours later with all family members grieving appropriately at his bedside. Why am I the olny one who can deal with death that is inevitable in the CCU? We can't and shouldn't try to "save" everyone! Any suggestions or input? I feel the staff needs a huge dose of education in the dying process and somehow the ability to feel comfortable with death; I realize the later may be something that can't be taught!

:monkeydance: You know statistically that approx. 1 in 5 patients admitted to the ICU will die. That's about 20 %, a relatively high number. You would think that because of that, we would take a more proactive stance in the death/dying situations. I am a traveler who has been at facilities, and when I ask the MD about palliative care, they look at you as if you are an alien in disuguise. Nurses are the same way. Birth is just as real as death. Don't forget that everyone must passs at sometimes. We should be helpding families/patients with the process.

What does CC mean in DNRCC?

The original poster did the right thing. I am lucky because at my facility the intensivest and the nurse practitioner(sp?) are both proactive when talking honestly with the family about death and dying. I had a pt this past month who was young and had a crani for bleed then went into DIC and eventually ICP went up to 70 while receiving mannitol to bring ICP down. We did all we could to get the ICP down. Mannitol IVP, Versed, Fentanyl, Propofol, and Thiopental, and 23% NaCl. Went to stat CT and pt had more damage. The intensivest and NP talked to family right away and arrangements made for terminal wean and donation after cardiac death. Pt organs not donated, but was terminally weaned the next day and pt passed peacefully with myself, RT, my preceptor, and her sister at bedside.

Sometimes people need to thing about the QUALITY of life not about how long a person lives.

What does CC mean in DNRCC?

I would love to know what the CC means as well....

Yes, you did a great job. Unfortunately some individuals, nurses and doctors included are themselves uncomfortable with death and dying. I have learned a long time ago, that in order for one to help another through death and dying they must be comfortable with not only their own mortality, but with the subject on a whole. It is disheartening to see the patients suffer so. Where I work, there are a few of us that will see to approaching the topic when needed.

Death and dying is a part of our job and the patients deserve better than they're getting. If people are "uncomfortable" about discussing these issues with the patients, then some education is in order to de-sensitize the staff and help them figure out how their own attitudes are interfereing. Its a slow-go topic. We can only move forward when we're ready, but when we are ready, resources should be available for the staff. I have read on some of these threads that some nursing majors are required to become a CNA first. As big as the gulf is between CNA and RN, I've been converted to seeing this as a good idea - weeds out the ones who realize early on that they cannot deal with dying and the other icky issues of nursing.