Jaded with lack of end of life quality?

[shocker29]

So, I was going to post this on the critical care sites, but I think its pretty relevant to nursing as a whole.

I sincerely hope that no one gets the wrong impression here. I am a very empathetic and compassionate person. I love people and I love helping people - that's why I'm nurse! I also feel like I am a pretty moral person. I guess you could call it a little bit of depression that I have been dealing with lately when it comes to a specific group of patients, and I am falling out of mainstream here.

I work in a busy CCU/MICU. Love my job as a whole. Went into critical care because I wanted to deal with the sickest of the sick. Found the prospect exciting. Came into nursing feeling like every life was important (and still do!) and quality was in the eye of the individual. Who am I to say what quality is for each individual? However lately I have found going to work depressing. Not because my patients are sick... I can handle that no problem. It is the people who have "poor" quality of life that we are endlessly keeping alive. This is the end-stage, chronic illness type, usually elderly person who would have probably have loved to "meet Jesus" before the family made the decision to have them intubated, or have other life pro-longing care. I hope this is coming out right.... It just makes me sad taking care of these miserable, elderly people with no quality of life who are being sustained on and on because the family will just not let go! Not because I don't want to take care of them, but because I care about them! I mean, how many of them, if they could see their future would say, sign me up for that! Families have such a hard time letting go sometimes. I guess sometimes it is guilt, sometimes it is desperation and a lot of times it is just lack of education and understanding. Like when when an 80 year old man is resuscitated post cardiac arrest and brought in to us. All of the hypothermia in the world is usually not going to bring 80-yearold grandpa back to where he was (and if he had delayed cpr) or even conscious. If he does go home, he is usually not the husband/father/grandfather he was before and everyone is upset. (Don't get me wrong, hypothermia IS amazing and works out beautifully in alot of cases).

Do you get what I am saying? Sometimes I just feel like I am a villain, working in a torture chamber. Does anyone else feel this way? People just don't get what they are signing their family members up for sometimes. Then again, there are those cases, where everyone said it was pointless, and here the person is, walking out of the hospital as good as new....(exception, rather than the rule, for sure).

Sorry for the super long vent. Tell me what you think. Thanks.

[talaxandra]

I work in acute medical and see this a lot too. It's frustrating enough at that level, and with medical staff who are prepared to overrule families on occasion to block a transfer to ICU.

The only big picture solution is to improve community education about outcomes and what is really involved in ICU-level care (versus what they see on TV), beforefamily members need a decision made. At that point the family and patient are not in the best position to make reflective decisions and may in any case suspect the motives of anyone adbvising them that "doing everything" may not be in the aged patient's best interests.

[Neveranurseagain, RN]

I hear you loud and clear, and no, you are not a villain. In America, death is considered a failure, or defeat, not the natural process it is. Something not to be talked about openly, and save everyone no matter the cost or the condition that the patient is in. If we pass universal healthcare, new guidelines will be drawn up and some of this will stop. We can only hope, especially with the large number of baby boomers that are starting to age.

My husband ended up on life support after a medical incident, and on the 5th day he blew his pupils. I did the kindest, most loving thing I could do, and had the vent turned off. Then I went home and told our then 9 and 10 yr old. He became the first DCD organ donor in our county. That was 4 1/2 years ago.

I hope someone is that kind to me someday.

[Tait, MSN, RN]

I absolutely hear you, and agree with you. End of life is becoming scarier and scarier as people work harder and harder to hold on.

You are not a villian, but a victim of a society trained to believe we can live forever and when they don't they look for whom to sue over it.

:icon_hug:

Tait

[shocker29]

Wow guys, thanks for the quick reply! I was starting to feel like a bad person everytime I went to work! Sometimes it is hard to want to give it your all, when you feel like you are prolonging agony. (I always do, of course, I just feel like "this" the whole time!)

[shocker29]

Awsmom8,

You must be an amazing woman :)

[CABG patch kid, BSN, RN]

Shocker, I hear ya. I recently transferred into critical care and was amazed to see how many people are "trached and pegged", you know what that means. The family wants everything possible done to keep alive 80 year old grandpa because he might come back home. Even though we are a CCU and do many open hearts, we end up with a lot of ventilator-dependent elderly who either couldn't bounce back after surgery or just plain ole went into respiratory failure for whatever reason. Anyway, I totally see where you're coming from and had a feeling getting into this specialty that I would see a lot of these ethical dilemmas. A lot of it comes down to the fact that it is just really really hard to let go of loved ones sometimes, and we all know that denial is part of the grieving process (denying that they won't get better).

To awsmom8, you are one tough woman. I can't imagine being in that position with my husband but hope to God that if I ever am one day, I have the strength to say goodbye

[RNperdiem, RN]

I guess I am biased here, but you could always look into Surgical ICU.

I have worked with frail, elderly medical patients too. Nursing care counts as much if not more than medical care for their quality of life.

We deal with our share of lack of quality of life, but many of our trauma patients do go on to have a good recovery.

[marie-francoise]

I think that families don't see that there are alternatives between the extremes of tubes everywhere vs. doing nothing. I guess it's denial. I heartily agree with what you're saying.

[Katnip, RN]

Shocker, I don't think there's a nurse out there who hasn't felt your frustration.

We really need to get people in our society to understand there's a hug difference between saving a life and prolonging a death.

I just read a journal article that discovered if you use the term AND (allow natural death) and opposed to DNR, families can accept it easier. I guess the Do Not portion is the part that stick in people's head, and they absorb the fact that medical staff is not doing something for their loved one, rather than a more positive allowing.

Until then we can only try to continue educating people, one family at a time.

[HouTx, BSN, MSN, EdD]

I soooo agree with previous posters. As my (costume designer & fashionista) daughter is always reminding me -- "just because you can doesn't mean you should!" Of course, she is referring to trendy clothes in my (generous) size, but the adage is true for health care technology.

I count myself lucky to be working for a Catholic Health system. Even though I'm not Catholic, I think it is a real advantage to have clear and enforcable guidelines about End of Life Care. I recently read some research outcomes indicating that people who count themselves as "religious" were less likely to agree to DNR, but I don't see that in our facilities.

I'd also like for us all to move away from associating negative terms with cessation of heroic measures. Instead of "Do NOT Ressucitate", wouldn't it be better to say "ALLOW Natural Death"?

[HippyGreenPeaceChick]

I am a new nurse relatively, I work ER. This past yr we have saved this one very elderly pt at least 4 times I am aware of. So very sad.

My mother ,now deceased ,was an old ER and ICU nurse, she would come home and talk to my father about how Doctors and Nurses allowed the family to be at the bedside and provided comfort care and allowed the elderly family member to pass with dignity.

We have lost our respect for compassion and dignity, it seems. I don't know why