Accepting Patients’ End-of-Life Decisions Can Be Hard

“The most important decision an individual can make may be how much treatment they want at the end of life.”

photo from pxhere

When it comes to end-of-life decisions, it may be hard for a nurse to accept to support only what the patient wants, but it’s also vitally important. In the Viewpoint column in our June issue (Viewpoints are free to read), Nadine Donahue, PhD, RN-BC, CNE, describes caring for an elderly patient in his home as he begins to lose the ability to breathe on his own because of COVID-19.

When she implores the normally spry, physically active retired executive to let her call an ambulance to take him to the ED, he refuses. Writes Donahue, an associate professor of nursing at York College, City University of New York:

“He’d always told me that he believed in a time to be born, a time to live, and a time to die. He was not going to be attached to a ventilator and in a hospital if he could help it.”

[…]

2021-06-09T09:31:31-04:00June 9th, 2021|COVID-19, end of life|0 Comments
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Making Sense of Loss, Finding Strength as a Nurse

Maria, day 6.

It was bright outside, the sun was shining, and as I looked at the window in Room 303, I saw the light peering through. Maria, a 78-year-old Hispanic woman, mother of three, could not move and did not see that spring had begun as she struggled to breath. She looked at me with her helpless teary eyes trying to communicate, but I could not hear the words.

I’d d been Maria’s primary nurse for five of the six days that she has been hospitalized. During that time, I had witnessed the tension and anxiety that existed within her family around her admission with Covid-19. I hoped silently that a DNR order would be initiated if her breathing worsened instead of her being placed on a ventilator. But I tried not to express my feelings to her family about this when I helped them to communicate with and see their mother using FaceTime.

Maria’s family watched as she slowly declined, and saw how she didn’t respond to treatments. Feeling hopeless and overwhelmed, I tried to schedule a time to speak to my nursing manager about how I was feeling, but she was always too busy scheduling and assisting on the floor after other staff called in sick.

Hard decisions […]

2021-05-13T10:24:41-04:00May 13th, 2021|COVID-19, Nursing|0 Comments
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DNR Does Not Mean Do Not Treat

Nurses and the meaning of DNR.

I recall a patient I had as a very new nurse who was designated as do not resuscitate, or “DNR.” The patient had suffered an intracranial bleed and because of his advanced age and untreatable cancer, his family had agreed that no CPR should be used. I remember the nursing supervisor asking me why the patient didn’t have a footboard and foam heel protectors on (that’s what we did back then); my answer was that he was a DNR patient. She basically handed me my head and said that his DNR status had nothing to do with good nursing care.

I never forgot that incident, and when I spoke with the authors of a mixed methods study with direct care nurses on three different units that found that “varying interpretations of DNR orders among nurses were common,” I immediately said yes. Their article is the original research article in AJN‘s January issue, “Nursing Perspectives on Caring for Patients with Do-Not-Resuscitate Orders.”

Families and providers may understand DNR differently.

And it’s not just nurses who may have different ideas and think differently about what should or shouldn’t be done for these patients who hover between life and death—other health care providers and families need to be clear on what that […]

2021-01-27T11:35:45-05:00January 27th, 2021|Nursing, nursing research|1 Comment
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Far from Home, a Flight Nurse Cares for One of COVID-19’s ‘Peripheral Victims’

‘Deemed stable to fly home.’

Our fixed-wing air ambulance was recently dispatched to Spain to bring 87-year-old John and his wife of 62 years, Rose, home to the US. They’d traveled to Spain for their annual vacation before “COVID-19” or “coronavirus” were household terms, but John had fallen early on in the trip and broken a hip. He’d spent four weeks in a local hospital and had his injured hip surgically repaired, and then was deemed “stable to fly home” by a doctor. And so he’d been transported back to his hotel two days prior to our arrival. The crew deposited him in the bed, bid farewell to his wife, and left.

Spain’s deserted beaches seen from author’s hotel room, March 2020

And now John was dying. He lay on the twin bed in his hotel room. His eyes were closed. His breathing was rapid and shallow. My partner and I stood, stunned into momentary silence. We had come straight to his hotel from the airport, and his condition was far worse than we had anticipated.

We’d left our equipment in the aircraft, as John’s transport was planned for the following morning to allow time for our pilots to rest. John’s respiratory rate was 60 with frequent pauses, his pulse weak, heart rate about 95 and irregular. He wouldn’t open his eyes or respond to us verbally, but he fought us when we tried to move him. He was covered in feces.

No room at […]

2020-04-09T10:25:10-04:00April 9th, 2020|infectious diseases, Nursing, nursing stories|3 Comments
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A Health Care Proxy and an Act of Moral Imagination

“What would Joanna have wanted?” the ICU fellow (Dr. Smith) asked Sam, Joanna’s nephew and health care proxy, for the second time this week. Sam considered the question, furrowed his brow, and said, “I still don’t know, doc.”

The human costs of indecision.

Uncertainty can at times be better than false certainty. This may even be so, up to a point, when a loved one is on life-support and subject to invasive and painful procedures. It takes time to absorb the reality of a situation.

But any nurse can tell you that, at some point, indecision becomes a decision in itself, one that can lead to many unwished-for consequences.

Seemingly unanswerable questions.It

The quotation at the start of this post is from this month’s Reflections essay, “What Joanna Would Have Wanted” (free until July 15). The story, by nurse Jennifer Chicca, MS, RN, evokes the overwhelming sense of responsibility faced by a thoughtful young man in the role of health care proxy to a beloved aunt.

How is possible to be sure what someone would want, or not want, when their end-of-life wishes have not been clearly spelled out ahead of time? […]

2019-07-01T15:50:47-04:00July 1st, 2019|Nursing, nursing stories, patient experience|1 Comment
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Views expressed on the blog are solely those of the authors or persons quoted. They do not necessarily reflect AJN’s views or those of Wolters Kluwer Health/Lippincott Williams and Wilkins.
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