This time of year, we get them. Patients so gravely ill that they must be placed on life support. Ventilator, pressors, art lines, central lines, Swans, trans venous pacing, CVVH. And when all of these have failed, or are failing, the families want to keep their loved ones 'alive' until the holidays are over. I'm talking about patients for whom the term "futility of care" was created. And I just don't know which is worse...The families who want their loved ones to maintain a heartbeat until the holidays are over or the physicians who acquiesce to their demands.
Have we, as a society, become so reality averse that the thought of a family member passing during the holiday season is simply unbearable? Which would people have as a last memory of their loved ones? Passing peacefully at home on hospice...? Or tied to multiple life support systems as their systems shut down, they weep from every extremity and their skin sloughs off to the touch?
Too many families faced with this insist on 'everything' being done for their loved ones with no real comprehension of just how much and how far 'everything' can go. And the healthcare community won't stop and educate them as to just what 'everything' entails. It's a sad fact at this time of year, and it will continue so long as physicians fail to make the situation crystal clear to families with a loved one at the end of their days. Such cases not only use up valuable resources and critical care beds, they deny access to those who would benefit most from them. Never mind the emotional toll such patients take on the staff assigned to care for them, as they watch their efforts go for naught. And all because people fear their own, and their loved ones, mortality. Fear begins when you suspect your mortality and ends when you accept it.
Last I knew lewy body dementia could only be dx on autopsy, as one has to dissect the brain to find said lewy bodies.
I thought u could detect it on PET scans now? I remember one of the hospice doctors was talking about it one day. But yes, you could be right.
Anyway, I know in our hospice the doctors usually put this as a diagnosis, (1) because that's what they just put cos they didn't actually know the dx, (2) the computer usually had codes in there for the dx (cos they were so common), & the Drs just used to pick one/two, whatever, as the computer wouldn't save the record without something typed in the dx section. After autopsies etc were finished with, the diagnosis/ses would be added to, such as: "confirmed by autopsy - whatever it was".
Sometimes they used to put dx unkown just so the computer would save the record.
Specializes in Spinal Cord injuries, Emergency+EMS.
Let's just remember that the "choice" here belongs to the family, not the physician or any other healthcare staff, and it's not our place to judge it.
at what point does the futility of prolonging treatment and clinical best interests of the patient come second to the wishes of family ?
the ultimate accountability for the decision making process in care is in the hands of the Consultant / Attending bearing in mind all factors including the wishes of the patient and their family / friends but also the clinical realities and best interests of the patient.
at what point does the futility of prolonging treatment and clinical best interests of the patient come second to the wishes of family ?
the ultimate accountability for the decision making process in care is in the hands of the Consultant / Attending bearing in mind all factors including the wishes of the patient and their family / friends but also the clinical realities and best interests of the patient.
I wish it were so ... but that is not the case in the U.S.
Specializes in Management, Emergency, Psych, Med Surg.
A bit off topic I suppose but I had a friend once who worked as a cruise ship nurse. She told me once that the holidays were the worst times for them because the "kids" would get together and give "mom and dad" their dream cruise for their Christmas gift. She said these people were so sick, they could hardly get around. She said sick bay was full all the time and these old folks were on all the medications and had either forgotten them or were now mixing them with alcohol and their scop patches and were higher than kites. Falling, could not roll their wheelchairs, one almost fell overboard. Having strokes, heart attacks, having to get evacuated from the ship. It was a hoot!!! She HATED working over the Christmas holidays.
Not saying that I agree or disagree either way. But WHO are you to question a family's motives?
What gave you that right?
Just because you believe some families do it does not mean that ALL families do it, or have selfish intentions.
YOUR job is to be the nurse and take care of that patient.If that has surpassed your capabilities, then relinquish it to another who is better capable of doing so without passing on judgement to the family.
at what point does the futility of prolonging treatment and clinical best interests of the patient come second to the wishes of family ?
the ultimate accountability for the decision making process in care is in the hands of the Consultant / Attending bearing in mind all factors including the wishes of the patient and their family / friends but also the clinical realities and best interests of the patient.
Sounds like you are saying that the doctor gets to decide when to discontinue any and all treatment; is that correct?
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
not saying that i agree or disagree either way. but who are you to question a family's motives?
what gave you that right?
just because you believe some families do it does not mean that all families do it, or have selfish intentions.
your job is to be the nurse and take care of that patient.if that has surpassed your capabilities, then relinquish it to another who is better capable of doing so without passing on judgement to the family.
i'm not sure who you're referring to here, but i'll bite:
what gave you the right to pass judgement on a nurse who is off duty, posting on a vent thread. you have no right to comment on the nurse's capabilities; i doubt you even know what those capabilities are. nor is it your place to advise someone to relinquish their job.
I lost 2 friends this year around the holidays. One, a week before Christmas. I actually went to the funeral on my birthday (Dec 17). The other one passed Dec. 24. So I'm sure that every year I will think about it but my kids, gkids etc. make me thankful for the time that we do have to walk on this earth.
Last I knew lewy body dementia could only be dx on autopsy, as one has to dissect the brain to find said lewy bodies.
I think most dementias fall under this category and when we see it listed as part of the patient's history it is more d/t a differential diagnosis based on set signs and symptoms and likelihood of being, say Lewy Body, or whatever else type of dementia. The actual pathology could only be confirmed through autopsy.
Nascar nurse, ASN, RN
2,218 Posts
In the US, the Dr. must sign off of the DNR but they can not issue it without the family signing as well.
Also a DNR does not mean do not treat...the family can still insist that absolutely everything be done to save them until their heart actually stops.