procedures on dead people

[canoehead]

How many hospitals allow practising procedures on dead people by students? Do you prolong codes in order to allow the students lots of time to be successful? Do you charge for those procedures that are done after the code is obviously going to be unsuccessful (ie asystole since found 40min ago).

And even worse...Do you open the morgue so students can practice on newly dead during slow times?

I think that all these are insane but I am a minority of one at my hospital, because

"how else will they learn,

it leaves no permanent mark on the body,

it doesn't hurt the patient,

and if the public needs practitioners with excellent skills in an emergency situation they have to tolerate (and pay for) procedures on the dead"

So who is right? I need input from both sides so I can decide what MY response will be in these situations.

[disher]

Agnus your words are elequent, this thread is reassures me that many nurses believe informed consent is the priority any time we care for patients. Thanks for starting it canoehead.

[Agnus]

THANK YOU ALL VERY MUCH FOR YOUR FEED BACK.

I dashed my last post off quickly while I was still bleary eyed between 4 and 5 am. as I was on my way to work. This is a very dangerous time for me to answer posts or email because I have been know at thes times to say things that I was later embarrassed by, as the brain WAS NOT fully turned on, and I am apt to say just about anything. So I am amaized at your responses. I had to go back and read my post after reading yours.

After posting this, as I drove to work, I figured there would be no feed back and I would take that as good (at least not bad). However, I lamented that sometimes I wished for feed back on certain post that I never received and I really wished for but did not expect to get any on this one.

I must be talking to the choir here, but I want you to know that I do appreciate this feed back. Feed back tells me how my thoughts are comming across and can tell me when I need to change my thinking. Or if I make sense or hit the mark. With no feed back I sometimes wonder like the radio anouncer if anyone is out there, even though we know there is.

One more thing I thought about. We know when the heart stop beating, even for the last time, cells still live. Cells continue to live for some time (some longer than others) so when does the essessence leave?

And how soon after "death" is death actually complete, i.e. no life in any cell? Do we have a right to treat this as a dead body before then? O. K. now I'm sounding nutty.

Ok I admit I am just sucking down my my first cup of coffee, as I said a dangerous time for me to post. Oh shut up Agnus! And go take a shower.

[mattsmom81]

I guess I feel like explaining the situations where the intubation practice occurred as I was a bit hurt by the negative responses; we were not disrespectful or invasionary, nor did we injure the body. It was careful, thoughtful, supervised practice with attending doc, nurses and student docs of various levels. The hospital did NOT charge the patient for the ETT/supplies, in most cases the patient was already intubated and we reused the equipment there.

Obviously in a teaching facility, on an elderly DNR patient whose family were not interested in coming to the hospital, death was expected (welcomed) and the patient was an organ tissue donor rejected by Lifegift due to age and illnesses.....

I do understand where some of you are coming from. I guess I just don't feel the weight of some huge ethical dilemna in the above as some of you do. Sorry.

[Agnus]

Originally posted by mattsmom81

I guess I feel like explaining the situations where the intubation practice occurred as I was a bit hurt by the negative responses; we were not disrespectful or invasionary, nor did we injure the body. It was careful, thoughtful, supervised practice with attending doc, nurses and student docs of various levels. The hospital did NOT charge the patient for the ETT/supplies, in most cases the patient was already intubated and we reused the equipment there.

Obviously in a teaching facility, on an elderly DNR patient whose family were not interested in coming to the hospital, death was expected (welcomed) and the patient was an organ tissue donor rejected by Lifegift due to age and illnesses.....

I do understand where some of you are coming from. I guess I just don't feel the weight of some huge ethical dilemna in the above as some of you do. Sorry.

You paint a very different picture than cannonhead.

I believe the negative remarks were directed at cannonhead's delima. They certainly were not directed at an individual.

I am inclined to agree that what you did was probably ok and I doubt there would be much argument. However, if you look closely at the objecting posts you will see, that we object when it is not an organ donor, when it has yet to be determined if the family has an interest, that somone was charged.

And as was suggested in at least one case, the person might not be dead yet, but it was ok because they were going to die.

You in effect had consent. Evidenced both by the volunteering of organ donation, and the family's expressed desire not to be involved. You did the practice proceedured after life had ceased, you did not charge any one for supplies, infact the hospital did not even have to absorb the cost because you reused supplies. You treated the body with respect.

this is precisely what we are asking for.

[mattsmom81]

Thank you for clarifying Agnus! I feel better now. :)

I'm a bit sensitive lately...sorry! (((HUGS)))

[SKM-NURSIEPOOH, BSN, RN]

i see no real reason for students not to practice intubation techniques as well as other relevant medical procedures on the newly dead...as long as prior permission is obtained & the bodies aren't mis-handled. i do believe that students shouldn't just have at it without proper supervision while conducting their practice as that could lead to indifference or abuse by some over zealous individuals...no, this should be a time where the instructor run through the procedure, then walk the student through...until he/she is comfortable with allowing the students to move onto live patients for more practice & experience. as someone else have mentioned above, there's a huge difference between working on manikins, artificial arms, & such...than working with real flesh & fluids.

i definitely am against charging the families for any services rendered, whether supplies or not, after the person has officially been declared dead...i'm also against making families & love ones wait unnecessarily & without prior knowledge of what's occurring to the corpse. the patient may have given their permission only moments prior to them dying & their families aren't around or weren't given that message. perhaps it's not necessary to tell them that their love one is being experimented with while they wait, especially once the permission was obtained by the patient...some family members won't be able to handle that kind of information...perhaps telling them that the body needs to be prepared for viewing might be more appropriate...at least, this might buy the instructors & students time to practice without hurting the surviving relatives...this knowledge would in fact be on a need to know basis. at any rate, this topic is very sensitive to many here...i do understand & agree with most...however, there needs to be some sort of arena for this in order for our new mds./dos, pas, apns, rts, pt, & ots could receive the most realistic teaching tools for their craft.

:imbar at the risk of sounding ignorant & or stupid, i must ask this question for i really don't know the answer...when a person just dies (no brain or heart activity), does the body still retain some if any reflexes...such as the gag or do all reflexes cease immediately with brain death? i've heard of people sitting straight-up or moaning due to gases still traveling through the body. is it possible for students to be able to get resistance say from a gag reflex while intubating a person just passing away? if so, would that explain the importance of doing these practice procedures while the body is, you know, still warm with fluids & gases running about...just after death. just a thought.

[disher]

Nursiepooh, I would have a problem with lack of truthfulness to the family, even if the patient consented prior to death, the family has the right to say what can be done to the person after death.

[SKM-NURSIEPOOH, BSN, RN]

...at what point does patient confidentiality end & the family's right to know begins...only speaking from the stand point of having prior patient consent to use his/her body in that way, that is.

[Agnus]

originally posted by skm-nursiepooh

[ the patient may have given their permission only moments prior to them dying & their families aren't around or weren't given that message. perhaps it's not necessary to tell them that their love one is being experimented with while they wait, especially once the permission was obtained by the patient...some family members won't be able to handle that kind of information...perhaps telling them that the body needs to be prepared for viewing might be more appropriate...at least, this might buy the instructors & students time to practice without hurting the surviving relatives...this knowledge would in fact be on a need to know basis.

i]

a lie of omission is still a lie. legally, if not also morally, the family has the final say.

are you aware that in some religions it is improper for us to do certain activites after death to a person of that faith?

in orthodox jewdaism it is improper for a female to touch the body a deceased male. there are other such beliefs that defile the body in some religions.

we have a responsibility to honnor any such beliefs or desires of both the family and the patient. do you know what they are in every case?

how do you know that you are not hurting the family. perhaps, some of their beliefs are valid. i am not in a position to say who's religion is correct or not.

bottom line once agin, informed consent is not an act of omission. bottom line, the family has the final legal say.

when i was in nursing school i wanted to practice. sometimes a patient would not want a student practicing on them. my education did not suffer because i did not practice on this patient as there were others who did allow it. we did not lie and pretend that i was not a student. we told the truth. sometimes i did not get to do something but other times i did. and sometimes the opportunitiy never came up at all and that was ok too. you will learn your craft if you are honest. maybe not on this patient today but on another tomorrow. and you will know the difference between a lie and truth.

are we protecting the family with a lie? or are we tring to protect ourselves when we are found out? adults can handle the truth. children can handle the truth. it is the lie we can't handle.

i don't mean to be harsh. heavens knows i have at times allowed a lie of omission but it was still a lie and i know better now.

:kiss

these are very difficult issue we are discussing and the right choice is often the difficult one.

unfortunately, a living will or advance directive is not legally binding (at least not in all states) that is why we tell people to inform thier loved ones of thier wishes.

we have a case now going on. a fully cognisant patient expressed a will to die and did not want to be coded or vented. the son had poa. he wanted to override the expressed wishes of his father. while the father was competent he could not. now the father is no longer competent and the son has the legal right with the durable poa, to demand a full code and venting if nescessary which he has done. very sad the son cannot understand that he is prolonging an inevitable death and prolonging his father's suffering. sad but we must honnor the son's wishes at this time.

as for post mortum family rights. if you are a registered organ donnor the next of kin's permission must still be obtained before harvesting can occure.

[SKM-NURSIEPOOH, BSN, RN]

...out right lying to family members nor am i suggesting doing things to corpses that are against that person's religion...all i'm asking is that where does patient confidentiality end & the family's rights to know begins...i'll admit that i don't know all the legalities of this matter...but that's why i asked the above question.

another thing, why are you referring keeping the patient's wishes private as a lie by omission...wouldn't patient confidentiality, in fact be an issue still & why are you adding other scenarios to this situation such as religious customs? i've not said anything remotely resembling dishonoring the patient's religious customs & rights? where are you reading this in my previous posts or were these rhetorical situations?

please help me understand if i'm reading your response correctly...it's far too easy to misunderstand statements of passion on the bbs...you know what i mean?

anyhow, that's not the issue or my point...the issue & my point is that no practice should take place on the newly dead person without consent from either said patient or their families...if that said patient has not given their permission prior to expiring.

again, i do appreciate the touchy nature of this subject as it hold dear to many...but again...at what point do the physicians require permission from the family when the patient has already consented by either signing a release form or having a living will which is fully observed when the patient is dnr/dni/or dnh (& is only changed or reversed when he/she is able to change it)...why can't the living will or consent be observed if the patient wishes to donate their body or organs to science...why can't both stipulation in living wills be equally observed without family interference to the patient's last request...no matter the family's want, religious beliefs included?

i'm just asking for some clarification on this matter...i'm not looking for any flaming or war on words here...thanks :blushkiss

originally posted by angus...a lie of omission is still a lie. legally, if not also morally, the family has the final say.

are you aware that in some religions it is improper for us to do certain activates after death to a person of that faith?

in orthodox judaism it is improper for a female to touch the body a deceased male. there are other such beliefs that defile the body in some religions.

we have a responsibility to honor any such beliefs or desires of both the family and the patient. do you know what they are in every case?

bottom line once again, informed consent is not an act of omission. bottom line, the family has the final legal say....

[disher]

Families have final say in matters of the deceased. If prior to dying, a person had specificallly stated they wanted cremation but the family could not cope with anything but burial, they can legally make the decision to have a burial even if the request for cremation was in writing (this also applies to organ donation and autopsy). Ideally families talk about their wishes beforehand and the surviving family complies with individual preferences. Sometimes for emotional or spiritual reasons the surviving family does not feel they can carry out the deceased wishes, in that case they have to do what they can cope with.

[mattsmom81]

The wishes of the family, IME, will ALWAYS take precedence over wishes of the patient who is dying unless the attending is a very strong believer in patients' rights. Most cave to family.

The reason? the family members are the ones who will survive and can sue.