Dialysis Patients’ Very Different Life or Death Choices

Illustration by Barbara Hranilovich. All rights reserved. Illustration by Barbara Hranilovich. All rights reserved.

This month’s Reflections essay is called “Sitting with Death.” The subtitle provides a little context: A social worker on a dialysis unit bears witness to patients’ life or death choices. Despite the sad stories the author tells, this remembrance doesn’t leave a reader feeling disheartened.

Retired social worker Linda Converse writes that starting work at a dialysis center was at first daunting. How could she talk to patients about such an ultimate choice as whether or not to give up dialysis?

But over time she began to understand that there was usually no right answer. For each person, there was a different personal algorithm that guided the choice, one based on such factors as quality of life, obligations to loved ones, values, and much else. Writes Converse:

I’ll never forget some of the patients who chose to stop dialysis, nor will I forget those who chose to hold on for as long as possible. There was no consistent logic when it came to an individual’s choice. What one person considered an impossible quality of life, another wouldn’t.

[…]

2016-12-05T08:57:58-05:00December 5th, 2016|patient engagement, patient experience|0 Comments
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Information for Nurses on Voluntarily Stopping Eating and Drinking (VSED)

The New York Times recently published an article by Paula Span called “The VSED Exit: A Way to Speed Up Dying, Without Asking Permission.” VSED stands for voluntarily stopping eating and drinking, an end-of-life option that is, on the surface, as simple as its name suggests. Span, who recently attended the first conference devoted to VSED, gives an overview of one mother’s choice to end her life using this method. She also does an excellent job enumerating the ethical, practical, and legal implications of choosing to stop eating and drinking.

screen-shot-2014-11-05-at-4-39-13-pmWhich types of patients is such a choice appropriate for? How much suffering does it involve? Are there legal pitfalls of involvement in the VSED process by nurses and physicians? We can expect that all of these questions and more will be receiving growing attention in the coming years.

Late in the article, Span quotes Judith Schwarz, PhD, RN, now clinical coordinator of End of Life Choices New York. In 2009, AJN published a CE article, “Stopping Eating and Drinking,” by Schwarz. This substantive article centers around a detailed case study. “Gertrude,” we learn, has lived a very full life. All the things that give her pleasure and a modicum of freedom are gradually being removed […]

2016-11-21T13:00:53-05:00October 24th, 2016|Ethics, Nursing, patient experience|0 Comments
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‘She’s Alive Because Of You’: A Nurse’s Advocacy Pays Off

Katie L. George, DNP, RN, AG-ACNP, CCRN. Photo courtesy of Katie L. George. Katie L. George, DNP, RN, AG-ACNP, CCRN

While attending this year’s American Association of Critical-Care Nurses National Teaching Institute meeting, AJN editor-in-chief Shawn Kennedy heard a story that she felt all nurses needed to hear as a reminder of the impact a nurse’s advocacy can have on a patient.

Critical care nurse Katie George, just a few years into her career when the events in the story took place, was caring for Ms. A., a young woman whose spinal cord had been nearly severed in a car accident.

Faced with a prognosis suggesting that Ms. A.’s quality of life would be poor and that she would have to remain on a ventilator, Ms. A.’s family made what they felt was the humane decision to have her removed from life support. But Ms. A.’s fiancé—and her nurse Katie George—were convinced that Ms. A., who seemed to be able to communicate by blinking in response to questions, should at least be given the chance to make the decision for herself.

Ms. A. was suffering from locked-in syndrome, a condition in which the patient is conscious and eye movement […]

2016-11-21T13:00:53-05:00October 20th, 2016|Nursing, nursing perspective, patient experience|1 Comment
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What Patients Told

By Marti Trudeau, RN, CPHQ, MPA, director, University City State Programs Office, BAYADA Home Health Care, Philadelphia

ky olsen/via Flickr ky olsen/via Flickr

I was anxious as I arrived at Mr. Johnson’s house. He was my first centenarian patient. He lived alone, taught Sunday school, and had no ailments. He didn’t need help, but his family thought he should occasionally have a nurse visit. After assessing this healthy man, I asked him, “What has helped you live so long?”

Surely he’d been asked this question many times, yet he thoughtfully answered, “Every morning I wake up, drink a large glass of water, then look in the mirror and smile.”

“You drink a glass of water?” I responded.

“Listen to what I said, sweetie,” he answered.

I recall this because when patients called me “sweetie,” I would say, “Please do not call me sweetie, and feel free to call me Marti.” But I didn’t say anything to Mr. Johnson. I figured that at 101 years of age he could call me anything.

Weaving through my mind as I left were the words, “Every morning . . . water . . . ” Thus began my habit of drinking a large glass of water each morning—not exactly what he recommended, but what I heard at the time.

Through the years, patients told me many […]

2016-11-21T13:00:54-05:00October 7th, 2016|Nursing, patient engagement, patient experience, Patients|2 Comments
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Their Story: Each Patient is Someone’s Family Member

By Amy S. Jacobs, BSN, RN, CCRN. The author works as a critical care nurse in Tampa, Florida.

hospital corridorWhy does it usually take a personal experience of having a family member become a patient to make us see our patients in a new light—to see them as someone’s grandmother, father, sister, or spouse and not just a room number?

I’ve been a nurse in critical care for the past 10 years. Three of those years were spent as a travel nurse working short-term contracts in intensive care units across the country. And most of my ICU experience has been in trauma units.

I’ve watched a family come to grips with the fact their son is now brain-dead after a car accident.

I’ve comforted the husband and children of a patient who suddenly developed an infection and died after an apparently successful two-year treatment for cancer.

I’ve witnessed a daughter realize her dad is never going to be the same after a stroke takes away his mobility and speech.

I’ve seen a patient realize that, while he’s lucky to be alive after his motorcycle accident, he’s going to have to learn to navigate a new world without one of his legs.

As nurses we see these situations. We have sympathy for our patients and their families. We try to keep in mind the emotional support our patients need while also taking care of their physical problems. […]

2016-11-21T13:00:57-05:00September 20th, 2016|Nursing, patient experience|3 Comments
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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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