Well Patient Who Did Not Want to be Coded

Editorial Team / Admin · Jun 12, 2006

Ps I posted this by accident to another log please ingore other -- if you do submit a theat and want to delete it how is this done -- Thanks

You may contact a moderator if you need assistance, Marc.

leslie :-D · Jun 12, 2006

what was the nsg controversy over?

that he wanted to be a dnr? that the surgeon left the case? that the family didn't know? which leads me to,

i think this pt should have told his family about his dnr status.

if he did code and no rescusitative efforts were made, i could see a huge law suit in the making.

no matter what code status a pt is, i've seen way too much interference in my time of nsg.

there is nothing black and white about it; even less so, the younger one is.

even though this gentleman has every right to decide the fate of his life, familial objections often supercede pt wishes. just a sad fact of life.

leslie

SilentfadesRPA · Jun 12, 2006

the staff controversy was over exactly that the family was not included in his decision, that he had no "right" to do this as he is a healthy man, that this was unethical for him as a health care provider not to allow persons to try to help, ad nauseum.

i had initally had to emotionally wrestle with this request (for about 30 minutes lol ) clearly knew that he was entitled to his decision and request.

his not telling the family was based from the idea that he did not want to fight to have rights as a human discussed and argued with. he said he had made up him mind and he thought it was his and only his decision.

though a possible legal action could have happend i do think the psych and internal med guy felt fairly comfortable in thier postions. i happen however to also agree with the surgeon in that he also has a right not to partake in a patients plan when he strongly disagreed and as well would be put at risk.

so one question would be since the md has decided not to take risk in this situation would nurses be wrong not to care for this man as they also would be at risk for legal reprecussions --

i realize that the answer is no however the discrepency in self protection between a physician and nursing is wrong. and perhaps this is some souce that nurses find them selves powerless and not seen in the public and amoung ourselves as professionally as we can not make decisons like this even for our own self preservation and protection. in reality we could and risk termination and a bon hearing and potential loss of license.

does family request always supercede when the patient has been clear and competent to make and justify what is a logical decision to them as a human ?

i also i am sure as some of you have seen md barbaric with end stage patients not give up, not discuss or support the idea of hospice -- much less helping a family to let go sometimes it is ego and sometimes (though i hate to think) it is financially motivated.

you have all seen it.

marc

"oh death where is they victory? oh death where is they sting?"

leslie :-D · Jun 12, 2006

i think i would want him to elaborate on his perception of complications during a code.

complications can be short-lived and completely reversible:

or they can have long-term repercussions.

in the event that a complication was completely reversible, he would still choose to die?

i'm also concerned about his "controlled depression".

just because he's being treated w/an antidepressant, doesn't deem him free of depression.

at 43 yo and in the absence of a life-limiting/life-altering disease, i'm not yet convinced in understanding his reasons for the no-code status.

but still, knowing that he's had a psyche eval and others have talked w/him, i still feel there would be a lawsuit from the family, but just don't know if they would win.

i would hope that every single conversation with this pt., was documented verbatim.

leslie

SilentfadesRPA · Jun 12, 2006

He had done years in ER and simply did not want to be tubed cardioverted and cpr done. He felt that he had been given a second chance when he got sober and was at complete peace with is HIGHER POWER and if the time came he had accomplished what he was suppose to. According to him he was well loved and admired by friends and coworkers -- seemed to have good family and friend support.

I was not there for the psych inteview but the man seemed ok but perhaps he was masking.

It was interesting for the three days he was there. Appreciate your comments.

Marc :)

leslie :-D · Jun 13, 2006

again, in the absence of a major illness, it's just not natural for a 43 yo to request dnr.

it just doesn't make sense.

maybe he interprets a code as a 'calling' from the Higher Power?

maybe he truly is depressed but is not letting on?

i do understand his rights.

i just don't understand why.

leslie

jmgrn65, RN · Jun 13, 2006

I understand that he spent many years in the ER and saw many things, but it was limited he didn't see all the patients that are intubated and come off the vent and return to a full recovery. In our hospital it is policy if a patient is a DNR that it is rescinded for the perioperative period then back to a DNR status.

I also don't agree that he was keeping his family out of the loop they have a right to know his wishes whether they understand them or not. I think they should have gotten another psch eval, i think the doc missed something.

PANurseRN1 · Jun 13, 2006

What is so unnatural about it? I feel the same way. Just because his thinking doesn't conform to yours doesn't mean it's wrong.

I sure wouldn't want to be resuscitated, only to be a veg. I've always made sure that when I was in the hosp., my docs knew about my DNR preference. No one has ever hassled me about it.

Not eveyone wants to be flogged.

PANurseRN1 · Jun 13, 2006

He had done years in ER and simply did not want to be tubed cardioverted and cpr done. He felt that he had been given a second chance when he got sober and was at complete peace with is HIGHER POWER and if the time came he had accomplished what he was suppose to. According to him he was well loved and admired by friends and coworkers -- seemed to have good family and friend support.
I was not there for the psych inteview but the man seemed ok but perhaps he was masking.
It was interesting for the three days he was there. Appreciate your comments.
Marc :)

I may be wrong, but I think there are some circumstances that can override a DNR, and going to the OR is one of them. Maybe this varies from state to state/facility to facility, but at two of the hospitals I worked at you had to get a new DNR order when a pt. came back from te OR, because going to the OR "cancelled" the original DNR.

I don't find his outlook strange at all.

Katnip, RN · Jun 13, 2006

If he has an ER background, then most of the codes he's seen came from the field where they have a very low rate of successful resus. People are usually down so long before getting help that even if resus does work, the pt doesn't make a good recovery.

Many, many codes are reversed successfully when it occurs in a hospital setting, especially when it involves a young and relatively healthy person. He probably didn't get much of a chance to see those.

In any hospital that I've had experience with, it's required that DNR status is suspended for at least 24 hours.

greenjanell · Jun 13, 2006

at our hospital, in order for someone to have surgury, they cannot be a no code, because The OR crew does not want to let someone die on the table as a result of surgury. especially if the problem that causes the code is not related to disease or injury, (blood loss or acute cardiac arrest from anestesia) NONE of our surgeons will operate on a no code patient. after the surgury, they can become a DNR but not untill after the operation and recovery time are complete.