poor prognosis/family in denial

Nurses General Nursing

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Specializes in ICU.

Hey everyone! I was wondering how everyone deals with a patient who has a poor prognosis, but family insists on everything being done. Sometimes I feel like we're torturing these poor patients. Despite explanations from doctors, and educations from nurses, sometimes it just doesn't get through these families' heads. I support optimism and hope, but when we're allow human beings to live with no quality of life it tears me up inside. Recently I had a patient with hypoglycemic encephalopathy who many doctors told the family that if she ever does "wake up", she won't have a functioning life, and would most likely spend the rest of life in a bed in a nursing home/LTAC. So the family decides they want to trach/peg her anyways. I understand the family is going through a rough time, but so many times they execute their wishes instead of the patients'.

So my question is, how do you deal with these situations? I have been in many of these (working in an LTACH then a neuro ICU), but they still seem to get to me. I come home and just break down thinking of these people's lives, or lack thereof. I don't know if I'm being overly emotional, or if other nurses deal with this also.

Thank you :)

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Specializes in MICU, neuro, orthotrauma.

I have a difficult time with this scenario as well, and see it frequently on my unit. One thing I have found is to discuss with family, or have a doc discuss with family and then reinforce the thought that their loved one is gravely ill as soon as they are admitted and it is obvious. I try not to evade hard discussions because family tends to adjust to the idea of waiting a little while longer and a little while longer with hope for getting better as no one has told them any different during the course of their stay, and when the BIG TALK the "come to Jesus" talk finally arrives, family is totally adjusted to hospitalization of their loved one. Get them while they are still in the acute phase, and if it all works out GREAT! But if it doesn't, family is aware that prognosis was grim from the beginning and seem to be able to let go with more peace in their decision.

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Specializes in Cardiac Telemetry, ED.

It is hard to let go. I've wrestled over when it is "time" with many of my dogs and cats. I cannot imagine how difficult the decision must be with a human family member. Even if you know, intellectually, that it is for the best, that death means the end of suffering, it is still a great loss. Many people feel that everything possible should be tried before "giving up".

I watched my own family struggle with this when my grandfather died of respiratory failure (COPD). Deeply religious, my Aunt held out hope for a miracle, and was in total denial that his COPD had been caused by a lifetime of smoking. She insisted it was the cement dust he had been exposed to as a cement truck driver, while going outside for regular smoke breaks herself.

It's easy to feel angry with these people, who insist on prolonging the patient's suffering needlessly, but it's important to remember that they are suffering too, and that we are there to support the whole family. Eventually, they do see the futitility of it all, and they do get to that point of letting go.

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Specializes in ICU, Education, Peri-op.

this is one of the most difficult aspects of critical care. after years of trying different things, i finally found a "speech" that workes pretty well. when a family is facing a decision such as removal of life support or to trach/peg i say: "you know, this really isn't your decision. in this situation, you are here to be your loved one's voice. you don't have to decide. you just need to really think and be the voice of the decision they would make, given all the information you have been told. if they were able to stand beside their own bedside, look down on themselves, hear what the doctor and nurses have said--what would their decision be?"

many people don't want to feel like they "killed" their loved one. i have found that by effectively taking the decision out of their hands and placing it with the person in the bed is a great relief.

of course, there are circumstances when there are other (read financial) motives for keeping someone alive, then everything else goes out the window!

i know this is hard. i call it "flogging" people to death. you have to grow a pretty thick skin about it, but sometimes it still haunts me.

hang in there.

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