Nurses, Dying, and Who Gets to Decide

by Ramon Peco/via Flickr

On Wednesday, a California court declared the state’s right-to-die law unconstitutional. The End of Life Act (AB-15) was passed in 2016 in a special session called by Governor Gerry Brown, and permitted physicians to prescribe medications to a patient “for the sole purpose of ending his or her life.” California was one of just a handful of states that had such legislation. Reports note that an appeal is likely.

And also last week, Australian scientist and right-to-die advocate David Goodall, who was 104 years old, flew to Basel, Switzerland, to take advantage of its right-to-die law and end his life. According to the New York Times, Goodall, whose health had been deteriorating since a fall, said, “One wants to be free to choose his death when death is at the appropriate time.” Mr. Goodall lamented that his home country didn’t allow him to die there.

An ongoing debate.

These events last week underscore the struggle over whether people have a right to choose to end their lives and who should decide that. It’s also why we are very pleased to highlight this important topic in the current issue of AJN.

In “Assisted Suicide/Aid in Dying: What Is the Nurse’s Role?”, ethicist Ann Hamric and colleagues report on […]

2018-05-18T14:04:40-04:00May 18th, 2018|Nursing|1 Comment
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Honoring the Moral Concerns of Caregivers Afraid of Giving Morphine

Joan’s breathing relaxes as the morphine starts working. Her son Travis, on the other hand, is clearly upset as we sit at her bedside where she is dying. Despite his mother’s intense respiratory distress before he gave her the morphine, he’s convinced that he’s just made a big mistake. “I’m sorry, mama,” he whispers.

He turns his head my way. “I wish you hospice folks had never brought that morphine out here,” he says. “Now she’s dead for sure and it’s my fault.”

A sometimes essential medication.

For caregivers with this level of fear about morphine, it’s a painful dilemma. If you don’t use the best, sometimes the only, medication we have for getting acute respiratory distress in terminally ill patients under control, both patient and caregiver suffer. But if giving morphine is freighted, as it is for Travis, with a belief that it causes death and/or signifies giving up on, even betraying, a loved one, it can intensify a caregiver’s distress.

The hospice nurse had already given the standard education, assuring Travis that in patients near the end of life morphine is safe and effective when used as prescribed. We had given him written information debunking some of the common myths about morphine—“it kills you”; “makes you crazy”; “it’s addictive”—when used appropriately with hospice patients who have active symptoms. We had promised […]

2018-01-22T10:19:38-05:00January 22nd, 2018|Ethics, family caregiving, Nursing, pain management|0 Comments
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Integrating Strong Emotions as a Developing Nurse

Most people, I would venture to say, start off in their profession with a fair degree of idealism, and this certainly holds true for nurses. When I talk with nursing students or new grad nurses and ask their story about why they chose nursing, the most common response runs along the lines of wanting to help others in meaningful ways.

Preparing new nurse grads for nursing realities.

In fact, I will meet with such a group of students this afternoon as I speak on a panel in the ethics class at my nursing alma mater. I, and other colleagues on this panel, want to encourage and inspire. But we will also be telling the students about the challenges we have encountered in situations involving moral distress, ethical dilemmas, and personal burnout. We will present situations when we felt that what we were doing at the bedside was not meaningful because we were only prolonging suffering—or, in other cases, so full of emotion and significance that it felt overwhelming to process.

We want to present the reality of nursing to these students, not to shatter their idealism, but to push them towards meaningful self-awareness from the start of their nursing career so that they are not caught off-guard by the degree to which they will be […]

2018-01-18T10:04:09-05:00December 8th, 2017|Nursing|2 Comments
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PTSD and Falls: For the Elderly, a Lost Sense of Safety and Control

Jack lowers his head and presses his temples with his thumbs. He whispers, “Am I going crazy?”

In the weeks after his fall and trip to the emergency department, something has gone painfully awry. He’s been having episodes of anxiety when transferring from bed to chair as well as difficulty sleeping. His once unflappable optimism has been blunted by intrusive memories and ruminations about the fall and a sense of foreboding about the future.

Psychological Aftereffects of a Fall

Though he sustained no serious injury and had been quickly returned to the assisted living facility where he lives, the fall has left him with symptoms of posttraumatic stress disorder (PTSD). Most health care professionals are unaware that falls in the elderly can cause posttraumatic stress symptomatology, acute stress disorder, even PTSD. Indeed, in some settings falls occur frequently enough to insulate nurses and other medical staff from the awareness of how terrifying such an event can be or how it can undermine one’s sense of safety and control, particularly when it results in injury and/or invasive medical treatment.

Although Jack was under hospice care at the time of his fall, the facility sent him to the hospital because of its policy on ruling out head injury. Most hospices and facilities have protocols governing their response to falls. These typically include […]

2017-07-19T07:34:30-04:00July 19th, 2017|Nursing|2 Comments
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Nursing Stories: Celebrating a Family Matriarch’s Life as Death Approaches

Illustration by Gingermoth for AJN. All rights reserved.

In this month’s Reflections essay, “Helen’s Family,” a home health nurse remembers a family that was not ashamed to celebrate life around a beloved matriarch even as her death approached.

The author, Cyndy Irvine, understands the crucial and difficult role played by family caregivers, who were “often partners in caring for” her patients:

. . . Some situations were not so difficult for them, perhaps a course of IV antibiotic therapy for osteomyelitis, or a posthospital assessment of medication compliance and mobility issues; others were more daunting, such as the last stages of an incurable disease.

The timing of Helen’s illness was not convenient—the march of family responsibilities carried on in the lives of her children, yet they recognized her final weeks and days as a sacred part of her life, and of their own.

Every family has a style, an energy, a way of relating or not relating. The author finds something special in this family’s efforts to fill “Helen’s” home with laughter, beauty, and a kind of celebration. The essay is rich in sensory details, and pervaded with a poignant awareness of the gift of life, even when it’s most fragile and in question. To read this one-page essay, which will be free until February 24, click here.

 

2017-02-10T11:45:50-05:00February 10th, 2017|Nursing, Patients|0 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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