Morally Conflicted

[mmccool719]

I recently started a private duty job for an affluent 91 year old total care, advanced dementia, stage 3 bedsore from hospital stay, persistent pneumonia, non responsive, non ambulatory, vegetative, pitting edema all over. Now receiving NT suctioning 2-3 times per day, up and down in lift 4-5 times per day to recliner for various therapies-PT, massage, manicures. legal paperwork apparently calls for full code/all measures to preserve life. I cannot imagine this is a good quality of life. During the last hospital stay, ethics got involved as he was a full code on a vent and near death at the time. But we are expected to carry out all therapies to keep patient alive. The care supports many jobs as there is full house staff, 24 nursing care. The more I see how uncomfortable this all seems for the patient, the more morally conflicted I become as a nurse. It just 1-2 times per week side work for me. I’m curious what other nurses would feel if they worked in an environment like this. I knew what I signed up for but am now seeing how awful all of this aggressive treatment is for him.

[Kaisu]

Did the patient have a living will? Who is the POA?

[mmccool719]

Yes. Family member is POA.

[Daisy4RN]

I would be uncomfortable with the situation also. I worked Oncology, Palliative/Hospice and have also seen many situations where trmts etc were pushed on pts with no positive outcome expected and some that would actually cause more discomfort as end of life nears. Assuming all the paperwork is in order it is a patient and family decision. I have seen many end of life cares that if it were my decision I would most definitely do different for my family. That is the key though, it was not my family and this is not yours. If they have already made up their minds they probably won't change them, some people just want their loved one to hang on as long as possible (no matter how much pain etc). If you think it might help you can talk to the POA with questions like "do you think that your (family member) would want to do this/that". From your post it sounds like they have already had the conversation but as time goes on and they see the suffering they might change their minds. Meanwhile it is not your decision so just provide the best care you can while you are there. I am assuming all avenues have been exhausted at this point but if not seek involvement from Social worker, Chaplain, Palliative etc.

[Matikins RN, BSN]

That would be very challenging to address. We as nurses have to educate our patients/ caregivers and advocate for patients in general. Sometimes families have a lack of understanding and continue with aggressive treatment options when that is not where the answer lies but more simply hospice / palliative. The above individual has a poor quality of life. We as nurses would have to respect the client/ POA wishes- but could attempt to advocate and educate first.

[caliotter3]

If you feel uncomfortable with the situation then leave the case. You are not going to effect change in your limited contact role.

[DeeAngel]

Speaking only for myself, I would resign, I would want absolutely no part of this.