Grow Brave Through Reflection: Moral Distress in PICU (Part II)

[anne220]

I have worked in peds critical care my entire career. I can't imagine doing anything else and am so thankful for those who love geriatric patients. I am currently a pediatric CNS and am working on my DNP and plan to continue in the PICU. Many times, physicians, institutions, and many states make it difficult to "do the best" for the patient due to their own personal opinions about saving a life "at all costs". We often do mislead families by using words like "better", "improved", "had a good night". Families interpret these terms as healed. I always try to tell new grads and others new to PICU that, if you get to the point that you cannot cry with a family, you need a new job. By the same token, I also remind them that, if this takes over your life, you also need a new job. I also try to remind them that, even though you are angry at what a family or caregiver has done or allowed to happen (for example, a shaken baby), you are there to care for the child and that has to be first and foremost. There has to be a balance in all things or all the bad will truly bring you to the pit of sadness.

[anne220]

May I ask how an ethics committee is able to override the wishes of the family? I've seen it happen with elderly patients who refuse a PEG and are forced. I don't understand how these wishes can be overridden if the patient/patient's guardian is giving direct instructions. Scary!! Do these ethics committees vary from state to state or do they follow federal guidelines? Anyone know? Thanks!

Yes, laws regarding the ability to override a patient's wishes do vary from state to state. For example, until this past year, Missouri allowed a family member or significant other to override advanced directives and organ donation wishes. That is no longer possible