Whatever happened to the patient's rights?

[SharkadelicRN]

Brief scenario: 75 yo, admitted for ulcerative colitis about 3 weeks ago, colon resection with colostomy about 1-1/2 weeks ago, admitted to our ICU, day later necrotic stoma, next day subtotal colectomy with ileostomy, now with comsumptive coagulopathy. Today this pt had a declining respiratory status. He has been lethargic, but very oriented. For the past couple of weeks he has been telling the nurses how tired he is and he doesn't want to fight anymore. His sats dropped in the low 80's and got them back up to about 95 with a 50% ventimask. Asked the patient if he got worse later on, would he want to be intubated, resounding NO! Spoke with the family who said he was not capable to make his own decisions and said they wanted everything done. Called the doc who first, promptly reprimanded me for not calling to increase his O2, then said give him narcan and 20 mg lasix (he had been given some MS about 6 hours before this happened. Gave both, no changes, pt still says he doesn't want intubation. Called doc back who said don't call unless there are respiratory changes, and I said if there are he doesn't want intubation and he is already feeling like he's smothering and can't breathe. Then said it doesn't matter, if he needs to be intubated we'll intubate him. Against the pts wishes? Yes. At this point I broke down crying and he asked how he was doing right now. So I told him, not well, he wants someone to tell him it's OK to die, he's tired, he doesn't want to fight, and he wants peace. He said he was on his way. Gets there, talks with the family, and still nobody asks this man what he wants. He then asks if we can go "have a talk". We go into a private area and he wants to know how long I've been in the unit and then proceeds to say that this man is not capable of making his own healthcare decisions and that if I want to call my lawyer and do something about it go ahead, but he will be intubated if that's necessary. So I tell this isn't about lawyers, this about trying to be an advocate for my pt. I've been his nurse for 3 days now and I don't see that he is getting any better, in fact he's getting worse. He said he had a great level of functioning prior, and he is "salvageable". I asked what he thought his level of functioning would be if he made it through and did he really think this man would survive being put on the vent, he already has no will to get better. He told me he didn't have a crystal ball so he didn't have any idea. If it came to the point where he's on the vent and things are looking like they won't improve, then he'll discuss a DNR status with the family, but until then the man will be intubated if it's necessary.

Then he calls back about 15 min after he left and told the night nurse to not give the family any information about the patients care. If they have questions, he will be by in the morning and they can talk to him because he's tired of having to correct all the wrong information given by the nurses.

So here I am, feeling like I failed my patient. I'm supposed to be the voice for my patient and the eyes and ears for his doctors and nobody's listening, and that is making me hurt and very angry.

I can't sleep, this all just happened this evening (at shift change of course) and I really just needed to get this out.

The nursing supervisor is aware of all this as well as my charge nurse and another nurse who witnessed my patient saying what he did and didn't want.

Oh, and BTW, for whatever it's worth, he has an advanced directive.

[New CCU RN]

HAHA... nice one JMP.

[susanmary]

:)

[Agnus]

Originally posted by susanmary

With HIPPA, how can we even discuss these things with the families against a patient's wishes? A competent patient should be able to choose. As nurses, we can advocate for our patients and their wishes -- but that often is in contrast with the "system" and family's wishes. It's so hard being a nurse.

Well it is still happening. It is usually not the bedside nurse that is doing it. She is to bussy doing the right thing and careing for and advocating for her patient. HiPPA does not seem to have stopped MDs and administration from discussing things with the whole family. I see it all the time. Patient rights and privacy are every bit as much a joke as ever.

I even see RTs, speech therapist, PT, OT and CNAs discussion literally every nursing and medical issue with family and friends of patients and giving them advice and prognosis on aspects of the patient's care that our out side of that person's field of expertise. I see OTand PT advising family that the patient on Vents should be denied ativan, ms etc. They advise on all the meds and nursing treatments. They expect nursing to follow orders from therapist. Oh yea see ilt all the time. Reporting it does nothing.

Patients and family assume that these "medical" people know what they are talking about.

[Zinnia]

I think you were the best thing going for this patient. You didn't fail you were, outnumbered.

[Debra Ruffing]

You are right that the advanced directives are a shameful sham. The other side of the coin is the family who is trying to carry out the patient's advance directives and is constantly harrassed by staff to change them. Who gave any nurse or doctor the right to be judge and jury on what a patient wants? I get so tired of being bombarded by the doctors concerning my Mom's care. When you are on the other side, you see how we fail as health care providers.

[leslie :-D]

Passing Thru, that was some of the crassest garbage I've ever read on the American medical care anywhere! I am glad I live no where near you (I don't even know where you are; but it must be a foreign part of the country and a LONG way away from me because no one I know has that type of mentality here! The idea of docs keeping a pt. alive to suck Medicare dry; and nurses etc. putting up with (and supporting!) it!

What a pile of RUBBISH!

that WAS a hard one to swallow but let me tell you, it's a harsh reality. many of these hospitals are teaching hospitals and will exploit a pt. for the sake of either learning opportunities for their residents OR as a financial incentive via medicare's reimbursement system. yep, it sucks totally. and what's even more outrageous is an icu nurse walking onto their shift w/o knowing what's going on, for whatever reason. every single icu nurse should maintain the HIGHEST standards of care or get the hell out. this crap happens everywhere, and having worked in the icu before, there's an awful lot of political and unethical crap that goes on, at least in the icu where i worked. i left there like a bat out of hell. so people, sometimes we have to remove our rose tinted glasses because our medical system in the good old usa is corrupt and sucks in too many ways. and on day 61, i've seen many a pt. get the boot for their inability to pay. this nurse who advocated for her patient is a hero in my eyes but because of the b.s. that does occur, another pt's rights will go right down the drain. and agnus is so right on.........it's the entire system that has failed us. what passing thru said obviously hit a cord in all of us but there's alot of what she said is so damn true.