end of life, please??

[RN-ing, BSN, MSN, NP]

On our unit, we have had a few patients die on a ventilator because family members are willing to make them a no code, but not willing to make them end-of-life, despite weeks of physicians and nurses emphasizing the graveness of the situation and poor prognosis. Reason being--"they can't live with the guilt". I have had to watch two of these patients, blue with oxygen saturations in the 70's, guppy-breathing for hours and hours, slowly brady down and die in the last few months, and its GETTING TO ME.

I understand how emotionally stressful these situations are to family members, so I just want to know....

In these situations, do you urge family members to make the leap to end-of-life? How do you comfort them and how do you personally cope with the emotional stress?

[MunoRN, RN]

We are as honest and consistent with our information as possible. When that fails we move on to declaring medical futility. Families actually handle a finding of medical futility pretty well most of the time, I think in some situations it helps to take the responsibility and associated guilt of withdrawing care off the family's plate.

[RN-ing, BSN, MSN, NP]

How does declaring medical futility differ from end-of-life?

[EMSnut45, BSN, RN, EMT-P]

I have struggled with the same feelings, nursbrooklyn. The physicians that I work with will use the futility term also with families who are struggling with making a decision. They usually phrase it as "mom isn't going to get better no matter what we do. Right now they are suffering. We need to change gears now and focus on making mom comfortable. We are going to start some medication to make her comfortable, and won't torture her with more tests. Once your family gives us the ok, we are going to remove her breathing tube."We take the decision and guilt out of their hands.

[Ted]

First. . . I can totally relate to your feeling of helplessness in such situations. Heck, I just simply don't like watching people die. I don't think I'll ever get used to it, or to the pain the family feels when their loved one leaves them behind.

Our hospital has "Comfort Measures Only" and, when the physicians check all of the happy little boxes on his or her computer screen (we've recently gone near 100% computer for everything. . . which is a topic all by itself!!!), the patient is cared for with "comfort only" measures (apologies for the redundancy). And, I believe, that our facility does a very nice job supporting the patient and the patient's family through this obviously difficult time. With all of that said, not all of our hospitalists does a thorough job (quite frankly) explaining to the patient's family the idea behind the concepts of "graveness" or "poor prognosis" or "futility". One of the hospitalists does. She seems savoy enough to explain to the family, without forcing their decision, the process behind dying and what prolongs the inevitable. She's wonderfully respectful but she's explicit.

Still. . . there are families that just don't want to put their loved on on "Comfort Measures Only" (although that seems rare now-a-days). It breaks my heart to see the slooooooooow and prolooooonged journey for the patient. I guess I just continue to focus on giving the patient as much comfort as possible (in addition to the IV fluids and the G-tube feedings, etc.), and continue to support the family. In the meanwhile. . . WE need to vent our sorrow and our frustration, or it WILL get to us. It has to me in the past. I'm in a better place with regards to watching the process (sometimes the slooooow process) of dying. But I don't think I'll ever get used to it.

Good thread. . . sad subject. . .

[EMSnut45, BSN, RN, EMT-P]

Check out this thread that was just started. It is tackling the same "ethics" issues that you are having difficulty with.

https://allnurses.com/general-nursing-discussion/when-care-equals-676484.html

[RN-ing, BSN, MSN, NP]

Thanks for all the comments --- good links, especially in the other thread posted by EMSnut45!