First pt code... is this normal?

highlandlass1592, BSN, RN · Jan 17, 2010

It's absolutely normal and quite human. As nurses, we are in a special positions when it comes to patients. We strike a bond with them that no other profession really does. We are usually the ones who spend the most time with our patients. There is nothing wrong with reflection..it is a normal part of the grieving process. But don't allow your grieving to eat you up. Sometimes, patients die for no reason that we are privileged to know. As a surgeon I greatly respect says, we can't save them all. You do the best you can while you are there....and then learn to take care of yourself when you go home. You may feel comfortable seeking out a chaplain or social worker at work for a "debrief", to talk about your feelings and concerns. It truly does help. If those types of people aren't available, speaking with coworkers can also help...don't bottle up your feelings regarding the experience. It will only eat at you. Good luck to you.

ONCRN84 · Jan 17, 2010

Thank you for your response. I have a few years of nursing experience, but I'm new in the ICU so this was the first coding pt I was responsible for. There's more background on the pt but I don't really want to put it out there. I think what got to me most was after he was tubed he came to (amazing what some oxygenation does huh), looked at me and started crying and shaking his head. It just broke my heart.

I'm going to e-mail one of our hospital educators that I trust and see if we can talk for a few. I feel like I need to debrief.

Emergency RN · Jan 17, 2010

It is good that you're here talking about it because it obviously is affecting you emotionally. In many ways, nursing in the ICU, where there is high likelihood of death, has been compared by some to combat zone emotions. There is a degree of survivor guilt, coupled with self doubt as to whether something not done or missed contributed needlessly to the negative outcome. In short, the feelings can come awfully close to post traumatic stress disorder.

You're right on the money in your personal assessment that you need to debrief. Grief counseling is not only for a decedent's loved ones or family; they're there for us professionals too. There is no shame in seeking their assistance.

I thank you for your post, and good luck.

Tweety, BSN, RN · Jan 17, 2010

When a stable alert and oriented person crashes and/or codes, you can't help but replay it. It can be a learning experience as long as you don't beat yourself up. I've been to dozens of codes and I still do it. Debriefing is very important.

mamamerlee, LPN · Jan 17, 2010

You will replay most codes or dramatic changes in status in your mind. This is normal. Some things will happen without any warning.

You are a good nurse, be proud of that.

Best wishes.

ONCRN84 · Jan 17, 2010

Thanks everyone for the comments and support. I know there will be more codes and it's just a matter of learning how to process the emotions that follow. I worked inpatient oncology/hospice as a new grad for 2 years and I still remember some of the patient deaths I experienced. I learned how to handle those emotions so I'm sure I'll learn how to deal with these.

PostOpPrincess, BSN, RN · Jan 17, 2010

MI?

Pulm embolus?

Dissecting aneurysm?

Just curious.

I agree with the PP above about PTSD. I suffered from it, and when faced with situations such as those above get reminded.

I have managed to compartmentalize as a coping skill and know that as long as I've done everything properly, there is no looking back.

You learn to move forward...seems cold like that, but, how else do you continue to be a nurse if you don't?

Jokerhill · Jan 17, 2010

If you did not think about it you would be abnormal or worse uncaring. I analyze everyone of them sometimes a bit to much and I have been on many, most with positive outcomes thankfully. I think it makes me a better nurse to analyze them further, I look hard to see how I could have done things better. I talk to others as well about what went on and what I learned. I don't beat myself up though as I can only do as much as I know at that time and what I learn I figure will help the next time that I am called in to duty. The reality that we all have to live with though is that, no matter what we do if the patient is meant to live God will make it so, and if God has other plans no matter what we do God is going to get his way. And, I truly believe God does not make mistakes. We give ourselves to way to much credit when things go well and to much blame when it does not work out how we wish it did. You sound like a caring nurse and those are the best in my book.

ONCRN84 · Jan 18, 2010

MI?
Pulm embolus?
Dissecting aneurysm?
Just curious.

We don't really know at this point. I was in 20 minutes prior and he had no complaints. He was doing his usual cough, vitals were the same (on levo). He was joking around with me, as he had been all night. O2 sats mid 90s. Urine output at been marginal all night (renal failure). The PA was in discussing code status 30-40 minutes prior. I came in and he was dusky, tachy, and talking. Called my charge, ordered stat ABGs, but before we got them he became unresponsive. He was going to be made a no code later, but wanted to wait til his sister got there. His renal panal was unchanged from the day before, his CBC showed he was dry (3rd spacing all day. MD aware), but his ABGs showed acidosis. PH 7. He had made statements throughout the day regarding death. When I did my 4am assessment I commented that he still sounded congested, but no worse than earlier. He said "I know. Sweetie I'm dying." (that was when I called about the code talk again and the PA came to talk to him). I think it gets to me because he just wanted to wait for his sister, then he was going to be a no code. He didn't want interventions, but it wasn't going to become an official order until the afternoon. When he looked at me it was like "What the hell did you do to me?" Part of me wonders if he had denied something important because he gave up and was ready to go.

When the day shift MD got there he wasn't fully sedated yet and she talked to him for a while. He was answering yes and no appropriately and was expressing he wanted to be extubated and understood he'd die. They withdrew the pressors and extubated around 830.

mustlovepoodles, RN · Jan 18, 2010

Last night I had a pt code early in the morning. This pt had been alert, oriented, and talking to me all night. No complaints of chest pain, SOB, or distress. I was in the room about 20 minutes before it happened and pt was talking to me said he was feeling fine. Fast forward to coding pt. He survived, but passed away on day shift.
My question... is it normal to replay the night and wonder if you missed some subtle sign or symptom? I keep trying to figure out if I missed something earlier that could've been treated prior to the actual code. I know it's not my fault and that I can't change it... I dunno.

Absolutely normal. I have run a few codes in my 32 years and to this day i will go over the situation in my mind. Ultimately, I conclude that i didn't miss anything. Stuff happens and it doesn't mean you weren't doing your job. Try to let it go and don't beat yourself up. :twocents:

ChristyRN2009 · Jan 18, 2010

I had a somewhat similar situation as you just recently, and I am doing the same thing. Ultimately, as I replay in my mind I could've done things slightly differently but the outcome would've been the same. Ive been a nurse for two years and it seems like the issue of constant death has only caught up to me now which is weird. But I'm trying to deal with it just the same as others have told you to, talk about it, replay it a little to try and learn but do not obsess over it because that doesn't change the outcome of the patient. Say a little prayer for the patient and know you did what you could (or if you don't pray just a well wish and positive thought for the family, sort of has helped me say goodbye to the patient).