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 as her body’s functions decline. Here’s a brief excerpt from the article introduction:

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.


October 24th, 2016|Ethics, Nursing, patient experience|0 Comments

In Geneva, a Wider Perspective on Clara Barton’s Humanitarian Vision

By Jean Johnson, PhD, RN, FAAN, professor and founding dean (retired) at the George Washington University School of Nursing, member of the Red Cross National Nursing Committee, and Linda MacIntyre, PhD, RN, chief nurse American Red Cross

To Geneva, Oct. 2-3: The Red Cross Mission Is International

Red Cross and Red Crescent Symbols Outside ICRC Museum, Geneva Red Cross and Red Crescent Symbols outside ICRC Museum, Geneva

The Clara Barton Study Tour was the idea and passion of Sue Hassmiller. As you may know from the most recent post in this series, Sue and her husband Bob were prevented from coming on this trip due to Bob’s tragic bicycle accident. Sue had insisted that Geneva needed to be part of the tour because it’s where she learned of Henri Dunant’s work to create the international Red Cross in Geneva. With Bob’s steady support in the planning phase, Sue had somehow made the trip a reality, with the second leg of the tour taking place here in Geneva.

The study tour in Geneva and the organizations we visited on our first two days there were in complete harmony with Bob’s commitment to the Red Cross. While Bob gave his time and energy to the American Red Cross, his spirit of giving clearly crossed international borders into war-torn cities where the International Committee of the Red Cross (ICRC) brings humanitarian aid to victims of conflict—both to the civilian population as well as wounded fighters. The ICRC is led by the dynamic and caring director-general, Yves Daccord (in group photo below), who not only plans for current needs but looks to the future to plan for the future type of war that will be shaped by new technologies such as robots and artificial intelligence. […]

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 things.

Sometimes my effort to comprehend was rewarded with special messages. For example, following her stroke, Mrs. Larson could not utter a word, yet over the times we chatted I learned that her husband had died years ago, she had a son about whom she was very proud, and she was at peace. Each day she looked so happy. Her round face looked angelic as she sat in her wheelchair, properly dressed and primly listing to one side. […]

Getting It Right: Putting the ‘QI’ in Quality Improvement Reports

Towards a Safer Health System

Photo of AJN editor-in-chief Shawn KennedyEver since the famous report To Err is Human: Building a Safer Health System was issued by the Institute of Medicine (now the National Academies of Sciences, Engineering, and Medicine) in 1999, health care institutions have been pushed towards reducing errors and increasing safety.

Changes have been spurred by accrediting and government organizations like the Joint Commission and the Centers for Medicare and Medicaid Services, by independent and professional initiatives like the Institute for Healthcare Improvement and the Magnet Recognition Program, and by consumer advocacy groups like the The Leapfrog Group and the National Patient Safety Foundation.

Nursing Education and Quality Improvement

Nursing, as the largest department in hospitals and the one tasked with shepherding patients through the system, is a key player in any system redesign and many nursing departments are playing an active role in improving the safety and quality of care.

Nursing education has also embraced the QI movement, adopting the Quality and Safety in Nursing (QSEN) program in many curriculums and also making it a hallmark of its doctor of nursing practice (DNP) programs. Developing and implementing QI projects is frequently a requirement for completing these programs. […]

Adapting to the Emotional Toll of Nursing

take2refectionsillustrationsept2016New nurses may find themselves confronted with great human suffering, enormous technical challenges, and the norms and pressures of the nursing profession and the individual workplace.

Most eventually learn the skills and knowledge they need to succeed in the profession. But some may struggle more than others with the emotional intensity of the work. A question that seems to come up a lot when nurses write about their work goes something like this: How do you keep caring as a nurse and not get burned out? How do you develop a resilient professional persona?

This month’s Reflections essay, How I Built a Suit of Armor (and Stayed Human),” by Jonathan Peter Robb, enumerates the challenges faced by a sensitive new nurse and the ways he found to protect himself over time. Here Robb, a district nurse for the National Health Service in London, England, describes one kind of challenge he faced:

The weight of being responsible for a person’s health wasn’t one I had prepared for. Sitting in lectures doesn’t train you for the moment when you’re standing at the end of a bed looking at a patient who is struggling to breathe, semiconscious (but who just last week was sitting up and talking), and thinking: Did I miss something? Is this my fault?

As Robb writes, “caring hurts.” Gradually he found himself building defenses that helped him to continue doing the work. Robb calls the development of these defenses “building a suit of armor,” one he can take off when he goes home to his family—but as he describes the process, it seems clear that he’s never allowed himself to slide into callousness about his patients.  […]

September 14th, 2016|Nursing, nursing perspective, Patients|0 Comments