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.*
Situation #1:
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.
Thank you for being one of the good nurses. One of the ones who listens to her patients. I can understand how working in a hospital for a long time would make a health care professional think that they "know best" but honestly, I appreciate that you listen to your patient and his/her family and take their wishes seriously. I think that is really important. I hate that you are the only one on your unit that feels that way. Please don't ever change.
ReplyDeleteI wouldn't say I'm a new nurse ... or a seasoned nurse ... more of a 'middle of the road' nurse with 8 years under my belt.Being an oncology nurse I have more experience with death & dying than I would like. You should read up on IVF & dying. Fluids can actually make a dying person very uncomfortable, with the fluids filling up the lungs and not actually hydrating the patient. And as you may have experienced, a dying patient with filled lungs is very distressing on a family. Also, I would NEVER restart an IV on a dying patient. Never. IV starts are painful and not appropriate. If a patient absolutely wanted one, ofcourse I would honor their wishes. However you must reassess their wishes throughout their journey. If you talk harm vs benefit, at the point the IV came out, they may have been ready to stop the IV as well vs get poked (likely) multiple times.
ReplyDeleteJust another perspective from another nurse.
Hey red1976,
ReplyDeleteThanks for the perspective!
This particular patient had no issues with FVO and fluid in her lungs.
As I had mentioned, the pt and family was very well educated by physicians and all of the nurses as to what the benefit and harm was.
Because of that and his/her determination to have the IV fluids maintained I absolutely stand by my assessment that s/he should have the right to die however s/he pleases, and I would again fight for it.
I fully believe that while medical personal have more experience and know more, no one has the right to not try to help someone die the way they choose, including starting a new IV site.
With that aside, I'm thrilled you found my site and welcome you to post and comment on any posts as often as you like! It would be nice to hear from a "middle of the road" oncology nurse that I don't work with.
Here in the US, hospice care can take many forms. I have seen it look many different ways and include G-tubes and IV fluids even though we don't recommend it. Here, a patient can change his/her mind about end of life care as often as s/he wishes. Up until my hospic rotation in nursing school, I didn't know that it was possible to be a full code and be on hospice, but apparently it is (or at least that's what I've seen and been told).
ReplyDelete