the other day, a group of us ex-nursing students were discussing end of life issues. after being in clinical and seeing the sickest of the sick in our icu observations, i made a decision that should anything go south, i want my family to let me go for the following reason:
-if my quality of life after the event should be worse and i am kept alive by machines,with no hope of getting better, i do not want that for myself or my family.
i know that some people make dnr decisions and then rescind them when death looms in the shadows..
my question is, as a nurse in your day to day activities, do you believe some of your patients changed the way you looked at dnr, cc, full code status?
(for example the 92yr old lol emaciated and stage 4 ca, decubs up to the bone, who kept saying she wanted to go and join her long deceased husband, yet her family insisted that everything be done-full code status. a bunch of broken ribs later, she died a traumatic unnecessary death)
*** what decisions have you made personally about your code status that were influenced by what you see on a day to day basis as a nurse.
i believe we should try to respect our PT's families in their decision making, and not try to impose our beliefs as a previous poster noted.
However, from our own experiences as NS's or LPN's or RN's, i think its critical that we take care of our advanced directives, and POA and educate our families.
Before i was a NS i would have argued that we need to do everything we can, modern medicine can keep people alive, etc. But throughout my journey i have witnessed cases that made you want to break down and cry.
Critically ill Pt's telling you point blank that they want to die, yet the family is insistent on aggressive treatment, feeding tubes, central lines, rectal tubes, respirators etc...
That is not quality of life. And no matter how much we love someone, we have to think, if we were in their shoes, would we want to live like this?
It is true we should not judge others for the decisions that they make, but i think families need to know that it is OK to let their ill family member go when treatment is futile.
I have had the conversation many times with my parents about feeding tubes, etc and at first my mom said she would never want one. However, there are times that it is only temporary and once the belly heals, etc, the tube comes out and the pt recovers. In situations like that, I am OK with a peg. My son had a J tube s/p abdominal trauma. It worked for 8 weeks, then his belly started working again and it came out. 11 years later, he is a normal, happy, healthy child. If there are a lot of other coexists with it and no hope, I too would say no to a peg.
I sat in with an MD having a conversation with a family once about tx, etc and the best thing he said to her POA was, I am not going to ask you what you want for your mother, it is about what your mother wanted for herself. Would she want us to keep doing tx, put in a feeding tube, etc when all it will do is prolong her life, as she is now, for a little bit longer? Woudl that be what she would want for herself? It was perfect. He stressed that it isn't about what the family wants but what she would want if she could make the decisions for herself.
I am a DNR. I decided while in nursing school if I ever had to be dependent on a vent, trach, PEG, or tube feedings AND my quality of life is no longer, then take me out.
I do not want to be a burden on my family and especially if I'm not the same person I once was. All my family is aware of my status and I keep my DNR in my office in a place my family can get to it in such an event should happen.
I also want to add, it is unfortunate in this economy that sometimes people are kept alive because it is the only income the family has. Sad, but true.
I once had an 18 y.o. pt with a DNR order. I cringed, at first, until it occurred to me that her condition would have to deteriorate a lot before it became an issue, but there was some potential to deteriorate a lot. I hope she's healthy at 90, and that's entirely possible.
I've seen a pt who was DNR coded ineffectually for the family's sake. I'm glad it wasn't my patient (I know that doesn't really let me off the hook) because I wasn't real easy with the ethics of it. But I don't see it as all black-and-white. Sometimes the "patient" is a group, and the best you can do for the one dying is to care for the one's who'll survive.
My one comfort for myself is that I'm sure my cats will do the right thing, when the time comes.
OhioCCRN, MSN, NP
572 Posts
i believe we should try to respect our PT's families in their decision making, and not try to impose our beliefs as a previous poster noted.
However, from our own experiences as NS's or LPN's or RN's, i think its critical that we take care of our advanced directives, and POA and educate our families.
Before i was a NS i would have argued that we need to do everything we can, modern medicine can keep people alive, etc. But throughout my journey i have witnessed cases that made you want to break down and cry.
Critically ill Pt's telling you point blank that they want to die, yet the family is insistent on aggressive treatment, feeding tubes, central lines, rectal tubes, respirators etc...
That is not quality of life. And no matter how much we love someone, we have to think, if we were in their shoes, would we want to live like this?
It is true we should not judge others for the decisions that they make, but i think families need to know that it is OK to let their ill family member go when treatment is futile.