End-of-Life Discussions and the Uneasy Role of Nurses

Amanda Anderson, BSN, RN, CCRN, is a critical care nurse in New York City and enrolled in the Hunter-Bellevue School of Nursing/Baruch College of Public Affairs dual master’s degree program in nursing administration and public administration. She is currently doing a graduate placement at AJN two days a week, working on a variety of projects. Her personal blog is called This Nurse Wonders.

Evelyn Simak/ via Wikimedia Commons Evelyn Simak/ via Wikimedia Commons

Nurse and writer Theresa Brown wrote a piece for this past Sunday’s New York Times on the dilemmas physicians face when their patients want to stop aggressive treatment (the latest installment of Brown’s quarterly column, What I’m Reading, is in the September issue of AJN [paywall]).

Brown’s Times column talks about physicians who have trouble letting patients go and instead push for more unnecessary and often unwanted treatment. She describes a case in which—after palliative care has been decided upon by the patient’s family members, the palliative care team, and even the heartbroken oncologist—the patient’s primary care physician intervenes and pushes for still more futile treatment. (Much of the article delves into the broader issue of palliative care and the benefits it has for patients in many stages of chronic illness.)

Have you ever disagreed […]

2016-11-21T13:03:57-05:00September 11th, 2014|career, Ethics, Nursing, nursing perspective, patient engagement, Patients|1 Comment
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The ‘Inexhaustible Well’: Notes from a Trauma Nurse on Mortality

By Marcy Phipps, RN, a regular contributor to this blog. Her essay, “The Love Song of Frank,” will be published in the May issue of AJN.

Years ago, long before I was a nurse, I read The Sheltering Sky, by Paul Bowles. He speaks of the tendency of people to take life for granted, and says that in the unpredictability of death there lies a presumption that everything is limitless:

“Because we don’t know when we will die, we get to think of life as an inexhaustible well. Yet everything happens only a certain number of times, and a very small number really. How many more times will you remember a certain afternoon of your childhood, an afternoon that is so deeply a part of your being that you can’t even conceive of your life without it? Perhaps four, five times more, perhaps not even that. How many more times will you watch the full moon rise? Perhaps 20. And yet it all seems limitless.” 

Lately, especially at work, that quote has edged forward and lingered with me. The ICU I work in is primarily devoted to trauma, but there’s been a recent shift in patient demographics. Last week I took care of only one trauma patient—an athlete who’d had […]

2016-11-21T13:10:16-05:00April 19th, 2012|Nursing, Patients|7 Comments
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Notes from the Healthweb and Nursosphere

This week Not Nurse Ratched has an amusing, meandering, and thoughtful post about the uses of Facebook by patients in the hospital. There’s a short excerpt below, but read the whole thing here.

They update Facebook constantly. CONSTANTLY. They have us take photos of injuries they can’t reach so they can post the photos to Facebook. I am not making this up. “I want a photo of my hideously dislocated ankle/knee/shoulder but I can’t move, so would you mind using my phone to take a picture for me?” And they keep updating and updating. I have actually said, “I’m about to give you a medicine that is going to render you unconscious immediately, so you should set your phone down.”

How could we have a weekly Web roundup that doesn’t at least mention health insurance reform? The spotlight has been slowly turning toward the insurers themselves, a crucial part of the equation (along with cost control and many other factors). This week Secretary of Health and Human Services Kathleen Sebelius met with the top executives of insurance companies to demand an explanation for the steep increases in rates seen in the last year.

If you’re looking for yet another reason why processed food isn’t good for you (besides the frequent presence of high fructose corn syrup and massive doses of salt, and the inaccurate packaging claims that the foods are “healthy” and “lean”), this week the NY Times reported news […]

2016-11-21T13:18:59-05:00March 5th, 2010|health care policy, nursing perspective|1 Comment
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Voluntarily Stopping Eating and Drinking (VSED): What Is It and How Does It Work?

Is there a legal end-of-life option for people who are terminally ill or whose quality of life has reached what they feel to be an unbearable level? Even in states without right-to-die laws, there is. It’s  called voluntarily stopping eating and drinking (VSED). Judith Schwarz wrote about VSED in the September 2009 issue of AJN. The article includes a case study. Here’s an excerpt:

Gertrude (not her real name; other identifying details have been changed) was 99 years old. Having survived the Holocaust and overcome many other challenges in her long life, she thought it ironic that she had to ask her children to help her die.

Although she was not terminally ill, the quality of her life was significantly diminished by many chronic ailments. Despite two hearing aids, her hearing loss was such that she could no longer indulge her one remaining pleasure: listening to classical music. She had fallen and broken a hip when she was 96 and now had to use a wheelchair when moving around her apartment. She had severe arthritis, and she rarely left her apartment except for medical appointments. All friends and many family members had long since died, and her deteriorating vision-a result of a recent bout of shingles-left her unable to read or watch television. After years of living with these and other chronic conditions, she told her family she was tired of life and was ready to leave. Her children and grandchildren told her to be patient. She was almost 100; […]

2016-10-23T10:59:26-04:00September 18th, 2009|Ethics, Nursing, Patients|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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