Responsibilities re. removing from life support

nurseabc123 · Nov 12, 2007

Hi, I start my orientation in MICU tommorrow at a large teaching hospital. This will be my first nursing job but I have been around health care a long time and it has been a long time since I questioned my values and belief system. Then I read a thread tonight that made me think "Am I going to have the responsibility of removing people from life support?" That idea blows me away. Saying it is acceptable in many cases and believing it is acceptable and being the one to actually do it is very different. I hate to sound naive or stupid but I need to hear from you seasoned and maybe not so seasoned ICU nurses out there. I am feeling more than a little shakey right now. Thanks!

Withdrawing supporting/terminal weans are rather common. Your role primarily will be to provide comfort care to the patient and to the family. I actually had to do this last night. It's difficult each time, however in most cases, I feel it is for the best.

Azee · Nov 12, 2007

Am fairly new to ICU, yet have seen handful of these cases already. If you have been around healthcare a long time then you know that sometimes these things (vents) just prolong the suffering. I agree, sometimes it is for the best.

cardiacRN2006, ADN, RN · Nov 13, 2007

I've withdrawn care several over the 1.5 years as an ICU nurse.

And although it sounds terrible on paper, more often than not it by far in the pts best interests.

This is your greastest opportunity as a nurse-you can fully concentrate on comfort care for your patient without having to worry about the vital signs, boluses, central line placements, dialysis, abgs, ...etc, etc.

You get to support the family and the pt as his soul passes. It's a beautiful experience, and saddening all at the same time.

Nursing...there's nothing like it....

Mahage, LPN · Nov 13, 2007

I teared up as i read your beautiful reply. Yesterday was my first day and it was intimidating to say the least. As a new grad I know enough to know that I know nothing. The amount to learn in 14 weeks is amazing. I find myself wondering, will I ever be able to learn to do what I need to do when I need to do it? I asked for this job. I have had my doubts as to whether or not it is where I need to be, but yesterday some of it felt right. A patient who had been removed from life support passed. She was alone. This was 1 hour into my first day. My preceptor was focusing on the young man who was being discharged to the floor then became tachycardic. I would have loved to have stood by the patient's side who died but I was certain I had to follow my preceptor. We hung Amiodorone and the young man stayed on the unit but his BP came up and his heart rate slowed down and he is on bipap. He will probably go to the floor today she says. I helped with a man who is in liver failure and his skin is sloughing off. He was alert much of the time as we bathed him and changed his bed. Pure hell. He has been this way for months. maybe that is one of the situations you speak of. I don't know, I will just have to see how this all goes. I really feel drawn to it in one sense and scared sh....tless in another.

Mahage

I've withdrawn care several over the 1.5 years as an ICU nurse.
And although it sounds terrible on paper, more often than not it by far in the pts best interests.
This is your greastest opportunity as a nurse-you can fully concentrate on comfort care for your patient without having to worry about the vital signs, boluses, central line placements, dialysis, abgs, ...etc, etc.
You get to support the family and the pt as his soul passes. It's a beautiful experience, and saddening all at the same time.
Nursing...there's nothing like it....

bigshoelover · Nov 14, 2007

Ahhh, yes this is shocking to a new grad/nurse as it was for me when I first began.

You will learn to realize, when death is imminent and the family is suffering, and at times it's because of the agony of the decision alone, the decision to withdraw support is an easier death than to prolong the inevitable.

Your role will not only be the angel to the patient, but the family as well. That patient's family will look in to your eyes and pray thay you not only have compassion, but the skills to reassure them that their loved one is not suffering.

I have said so many times, and will again-it does not make you 'strange' to comfort family; to cry over the loss of a patient; grieve while trying to be professional for their sake. I do quite frequently. I have a hard time bearing the thought of someone dying alone. I have been known to hold a hand, stroke hair, and sing. You do what you have in your heart to give.

I hold an honor by knowing that the 'elder' (by elder, I mean worked in MICU for 20+ years) will assign me a dying patient, because they know that I care for the family during this time as much as the patient. It's ESSENTIAL.

I am honored by an obituary that was in this past Sunday's paper that at the bottom thanked their father's MICU nurse Lisa. That is the meaning of 'total care' for me in this situation.

Mahage, LPN · Nov 14, 2007

I don't know what all is in store for me but I usually find that my higher power puts me where ever I am for a reason. It is my job to do what I am supposed to do. Thanks for your beautiful post.

Mahage

Ahhh, yes this is shocking to a new grad/nurse as it was for me when I first began.
You will learn to realize, when death is imminent and the family is suffering, and at times it's because of the agony of the decision alone, the decision to withdraw support is an easier death than to prolong the inevitable.
Your role will not only be the angel to the patient, but the family as well. That patient's family will look in to your eyes and pray thay you not only have compassion, but the skills to reassure them that their loved one is not suffering.
I have said so many times, and will again-it does not make you 'strange' to comfort family; to cry over the loss of a patient; grieve while trying to be professional for their sake. I do quite frequently. I have a hard time bearing the thought of someone dying alone. I have been known to hold a hand, stroke hair, and sing. You do what you have in your heart to give.
I hold an honor by knowing that the 'elder' (by elder, I mean worked in MICU for 20+ years) will assign me a dying patient, because they know that I care for the family during this time as much as the patient. It's ESSENTIAL.
I am honored by an obituary that was in this past Sunday's paper that at the bottom thanked their father's MICU nurse Lisa. That is the meaning of 'total care' for me in this situation.