So in my few months as a nurse I have come to find that ethics play a major role in the day to day life of a nurse. IS this news? No. But it seems that every single day there is some sort of moral issue that comes up.
Now, these issues aren't Private Practice or Grey's Anatomy worthy, but I think they are worthy of being discussed. At least on my blog.
*ALL DETAILS HAVE BEEN CHANGED. TIMES, DATES, PRONOUNS, ETC WILL NOT LEAD YOU TO IDENTIFY THESE PATIENTS.*
Patient is in hospital for End of Life & Comfort Care. The patient is lucid. The patient and the family are all aware of DNR status, goals of care and prognosis.
In our hospital (and most others I suspect) IV fluids is not a part of Comfort Care. This particular patient happens to have an IV with fluids running; the fluids were started on admission before goal of care was determined.
The physician and nursing staff have all educated patient and family on the dying process. They are aware and understand that IV fluids will prolong the dying process.
After 2 weeks and a very slow dying process, the patient is in distress. The fluids are still running. The patient is still lucid and the patient has told the family that s/he wants to the IV continued. The family has echoed the decision. Everyone knows this is prolonging a (now unpleasant) death.
So. I am the nurse. I have been the nurse for this family often. I believe in advocating for my patient and I believe very firmly that a patient has the right to die according to their own wishes.
My co-workers have been around for many, many years. They have seen similar scenarios. They believe the IV should be discontinued.
The subject came up several times, and each time I fought for the patient to keep the IV. More times than I can count I was told my my co-workers that should the IV came out or stop infusing that they "won't be able to get another line in."
I was disheartened. I was blown over. Really? This is how you nurse? I understand that my co-workers have extensive experience with death, however at what point does that experience trump dignity? At what point does that experience become a handicap?
The patient has since expired. The line did come out and couldn't go back in. I was on vacation.
I will never know what really happened. And I will always hope that the family will think they had the best possible care. But somewhere inside me I don't believe they did.
Suffice to say, I don't fit in on my unit very well.