First I would like to start with I am not a nurse, but I have heard about this situation and would like the input of other nurses.
There's a patient in his 70's that is dying from liver failure. He was actually dead in the ICU and was revived, but perhaps this wasn't the right thing to do. At the time he wasn't a DNR/DNI (but he is now). His family has four children and two believe that whatever can be done to prolong life including restraints to stop him from pulling out tubes is okay. The other two believe that he should be allowed to die with dignity. He isn't competent according to the hospital so he can't decide. Currently he has both wrist AND mitt restraints stopping him from pulling out drains, ng tubes, foley, etc.
He also has a sitter that is constantly watching him.
When around him all he does is cry out for you to kill him and let him die, he just wants this to end. Two children that want anything to happen want him to remain restrained anyway possible to force him alive. They also wrote a living will that stated he wanted this but these two were the witnesses. The other two children don't believe that he should be going through this and now there is a court battle between them for how is to become the medical proxy.
My personal feeling though is that this is wrong. This is human torture. He does not want to live like this, yes he isn't competent but all he does is cry out for his death. As soon as you remove a restraint to check for range of motion and circulation he immediately begins trying to rip things out. I also feel that it is wrong to use both wrist restraints not allowing motion as well as using mitt restraints all at the same time.
Shouldn't there be something a hospital can do? Shouldn't nurses stand up and not take this patient because no one likes caring for him? Nurses have the right to refuse a patient, so what happens if everyone refuses? What if doctors refuse to care for him and the order for restraints expires? Don't they have to be removed?
I just don't understand how our health care system is okay letting things like this happen.
Am I wrong to believe this and to feel this way?
*sorry this was long, I just needed to let this out*
It always amazes me what family will do to one another. When my dad was diagnosed with lung ca, he made me swear that he wasn't going to be one of the horror stories I see at work. We had a long talk that was 50% me crying, over such things as "if you come out of surgery on a vent, what do you want done? If they can't wean you? If you stroke out? What about later? How much would you want done?" The simple truth is, I know my dad is depending on me to never let the bad stuff happen to him, and I've got a mom and a sister who are going to be "Do everythings." But I'm my dad's medical POA, they aren't. So, I'll do what he wanted, and in the process, probably lose my relationship with my mom and sister who are the kind that will think I'm a murderer because I won't leave a dead body on a vent.
I've seen this sort of thing happen hundreds of times, and it is always sad. It is what it is. No, there isn't anything we nurses can do about it. It won't go on forever, but it will be h*** while it does. How unfortunate.
It always amazes me what family will do to one another. When my dad was diagnosed with lung ca, he made me swear that he wasn't going to be one of the horror stories I see at work. We had a long talk that was 50% me crying, over such things as "if you come out of surgery on a vent, what do you want done? If they can't wean you? If you stroke out? What about later? How much would you want done?" The simple truth is, I know my dad is depending on me to never let the bad stuff happen to him, and I've got a mom and a sister who are going to be "Do everythings." But I'm my dad's medical POA, they aren't. So, I'll do what he wanted, and in the process, probably lose my relationship with my mom and sister who are the kind that will think I'm a murderer because I won't leave a dead body on a vent.
Sometimes, life stinks.
NTN, I can so relate to this. I took over as my father's MPOA and made the very difficult decision to withdraw support because we were chasing our tails with MRSA pna, a lower GI bleed, 100% FiO2 for days and high PC vent settings, intubated for 14 days, CRRT dialysis, tons of blood products, extreme blood pressure swings on moderate amounts of pressors, acute liver failure, unresponsive to commands with sedation holiday, on and on and on. He died very quickly thanks to to the wonderful assistance of 55mg of morphine. My dad's mother only came to see him the day we withdrew care, and didn't understand why we were giving up. She had my grandfather trached and back and forth between rehab and ICU for over a year before he died a miserable death, and to her my dad didn't look as bad as my grandfather (I had them stop all the blood products, dialysis, antibiotics, and just asked to keep his feeding tube and and pressors until we could have all the family in to say goodbye, so she didn't see him connected to all the tubes and wires). His side of the family is still angry with my family to this day. My cousin (my dad's brother's daughter) is an ER nurse and kept instilling them with false hope that he could still make a recover and that we should go ahead with a trach. It's a rift that will never be healed, and you know what? I could care less. I did what I know my dad wanted. He made me promise to never put him through what my grandfather had to go through, and we were heading down that road. I know for sure he would rather be free in heaven playing cards with my grandfather and eating my great mama's spaghetti than to be stuck in a dying body unable to move or talk. Those heavy-hearted decisions are the ones that solidify our decisions to remain in this profession. :redbeathe
First I would like to start with I am not a nurse, but I have heard about this situation and would like the input of other nurses.
I can understand how this scenario would be upsetting. However, the statement above makes it pretty clear that you are not involved with this patient's care, so my first thoughts are why and how have you "heard about this situation" when it seems that you have no business knowing about it at all?
I can understand how this scenario would be upsetting. However, the statement above makes it pretty clear that you are not involved with this patient's care, so my first thoughts are why and how have you "heard about this situation" when it seems that you have no business knowing about it at all?
From the roundabout way this was addressed, I would guess that the OP is in some way related to the individual described.
Nurses can't just refuse to take care of a patient because they don't like them not unless they want to be fired! If there was some ethical reason a nurse felt they couldn't care for him ie he was a relative or something along those lines they could speak up and the assignment would be changed.
In alot of places we can't even go home if they are short staffed and demand that we stay. No matter if we have children or family isssues, we are expected to drop everything and work 16 hours without notice. If you leave you will probably be fired or at least disciplined and could be threatened with patient abandonment.
This patient's situation will be played out by legal fights and ethics committees. It's out of our hands in these situations. Sometimes it makes you wonder, does the family hold on because they can't let go or because they are angry at the patient and want them to suffer. Remember abuse is a common and prevalent problem in many families so who knows the whole dynamic involved.
From the roundabout way this was addressed, I would guess that the OP is in some way related to the individual described.
Maybe, I thought about that, but it doesn't seem likely. Even if the OP isn't an RN, he/she does seem to have some knowledge of nursing care and how things are done in the hospital (maybe a CNA?), and if the OP was related, he/she would have been more likely to say so instead of "I heard about this situation" because it would have lent more credibility to the story as someone with intimate knowledge of the situation.
I just have to say thank God for the family I had this weekend...Mom was doing very poorly, severe dementia, and they made it very clear from the get go that if she con't to decline (which she did rapidly), pain control and comfort were the top priority. She died a painless death with supportive loving family at her side. They were all heart-broken but put Mom's needs first the entire stay regardless of how difficult for them. I truly wish, for all the pts out there in similar situations, that they were not the exception.
Working oncology with in-pt hospice pts, we see the other kind all too often. It's so very difficult to be in a career where the expectations and culture are about taking the best care possible of the pt, and having to go completely against that and basically outright torture people b/c the family just cannot put the pt first. It infuriates me to no end to be forced to inflict suffering on those who cannot speak for themselves, especially when the family often isn't even there to witness what they are making us put the pt through.
Sorry, although I did have that one great family, I had another one I've been dealing with all weekend that is the exact opposite, as well as having the attitude that they're at the Drake Hotel and we're their personal maids.
First I would like to start with I am not a nurse, but I have heard about this situation and would like the input of other nurses.
There's a patient in his 70's that is dying from liver failure. He was actually dead in the ICU and was revived, but perhaps this wasn't the right thing to do. At the time he wasn't a DNR/DNI (but he is now). His family has four children and two believe that whatever can be done to prolong life including restraints to stop him from pulling out tubes is okay. The other two believe that he should be allowed to die with dignity. He isn't competent according to the hospital so he can't decide. Currently he has both wrist AND mitt restraints stopping him from pulling out drains, ng tubes, foley, etc.
He also has a sitter that is constantly watching him.
When around him all he does is cry out for you to kill him and let him die, he just wants this to end. Two children that want anything to happen want him to remain restrained anyway possible to force him alive. They also wrote a living will that stated he wanted this but these two were the witnesses. The other two children don't believe that he should be going through this and now there is a court battle between them for how is to become the medical proxy.
My personal feeling though is that this is wrong. This is human torture. He does not want to live like this, yes he isn't competent but all he does is cry out for his death. As soon as you remove a restraint to check for range of motion and circulation he immediately begins trying to rip things out. I also feel that it is wrong to use both wrist restraints not allowing motion as well as using mitt restraints all at the same time.
Shouldn't there be something a hospital can do? Shouldn't nurses stand up and not take this patient because no one likes caring for him? Nurses have the right to refuse a patient, so what happens if everyone refuses? What if doctors refuse to care for him and the order for restraints expires? Don't they have to be removed?
I just don't understand how our health care system is okay letting things like this happen.
Am I wrong to believe this and to feel this way?
*sorry this was long, I just needed to let this out*
I See this frequently enough at work. No one has ever refused to care for a pt because of this reason. Although I think more of my co workers would be puttig dnr bracelets on themselves than society at large. I don't think a dr would refuse to care for him or refuse to order the restraints in this situation. I guess if a nurse or dr disagreed enough he/she could consult the ethics committee but I am pretty sure this type of stuff happens often enough in most hospitals? .
nerdtonurse?, BSN, RN
1 Article; 2,043 Posts
It always amazes me what family will do to one another. When my dad was diagnosed with lung ca, he made me swear that he wasn't going to be one of the horror stories I see at work. We had a long talk that was 50% me crying, over such things as "if you come out of surgery on a vent, what do you want done? If they can't wean you? If you stroke out? What about later? How much would you want done?" The simple truth is, I know my dad is depending on me to never let the bad stuff happen to him, and I've got a mom and a sister who are going to be "Do everythings." But I'm my dad's medical POA, they aren't. So, I'll do what he wanted, and in the process, probably lose my relationship with my mom and sister who are the kind that will think I'm a murderer because I won't leave a dead body on a vent.
Sometimes, life stinks.