I disagree w/ J. Paradisi RN, who said that no one should die in a residential bed “or on the floor”……we don’t know where the ill woman was. Probably in her bed, I’d assume. WHY would she have moved her? Instituted WHAT “comfort care”??? If the woman was in the process of dying, perhaps even comatose, she needed LESS, not MORE intervention by strangers.
The facility should have had mandatory DNR’s in the files of patients who wished for them. Otherwise, they should have supported the nurse (if she was a nurse, not an aide) in doing CPR. BUT, if the patient had an understanding, even verbal, that she was a DNR, then that should have been lived up to.
I don’t understand WHY the “nurse” called 911…..that’s another unanswered question in this confusing case.
As a lay-person who has cared for several family members at this stage of life (that is, impending death) and observed others still, my feeling is that the most humane and ethically sound action is to let the person die, if that is what they would have wanted, which is how the caregiver and the family evidently understood the person’s wishes. I would be very thankful to the caregivers who have worked with my family members when they were in senior living if they had acted as did this nurse.
A major part of the lack of public understanding is that a lot of the general public choose not to have “the discussion” about end of life wishes feeling it is “too morbid”. Everyone knows you don’t get out the world alive but subscribe to the Scarlett O’hara school of thought-“I’ll think about that tomorrow”. The general public has little perception of the realities of what happens when we resuscitate someone but their body is devastated from the initial insult. Just once I would like to see a general public medical show that shows “survivors” of resuscitations where we really shouldn’t have given that “last dose of epinephrine”. I recall that a few years back, the Advanced Cardiac Life Support manual included a statement that sometimes the last beat of a patient’s heart should be the last beat. It has been removed from subsequent manuals.
The US has about 850,000 licensed physicians and about 2.7 million licensed RNs working as nurses (and many with advanced degrees including PhDs) – yet journalists rarely interview nurses. Thank goodness for publications like AJN!
This is an excellent post regarding the pit falls of trial by media, public perception of emergency care, CPR, and end of life issues.
As mentioned by the author, the facts of this story remain unknown. Most importantly, is knowing the patient’s POLST (Physician’s Orders for Life Saving Treatment) status. Secondly, if a POLST exists, outpatient facilities must have a mechanism to provide comfort measures for a patient with a signed DNR. It is inhumane and inappropriate to allow a human being to expire on a lobby floor or resident bed (we don’t know) without initiating comfort care. It may mean the patient requires medical transport to a location where this can be accomplished, without initiating the EMS (Emergency Medical Response).
Just reinforces we nurses could be doing more to educate the public re: end of life decisions. Plus who we are and what we do.
The “nurse” in this nursing home could have been an aide since the term nurse is applied to others besides registered nurses.
Yes, our journalists are woefully uneducated and have little incentive to become more knowledgeable. How I wish they would ask a nurse!
Well put Doug!
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