In the Nick of Time: Advance Care Planning in the ICU

Marian Grant, palliative care NP

I’m a health policy consultant for national palliative care organizations and often advocate for advance care planning, a process that helps people with serious illness prepare for future decision-making. I also work as a palliative care nurse practitioner (NP) in an academic medical center where I see the real-life aspects of advance care planning.

I recently saw a patient whose case typifies how advance care planning and policies to support it can work. A middle-aged woman with metastatic breast cancer at our cancer center had been seen the day before by the palliative care NP there. The NP was called to help assess the patient’s new-onset dizziness. While seeing the patient, she also spoke to her about her cancer status and suggested completing an advance directive. According to the NP’s note, the patient’s son, who was there with her, seemed surprised that things were not going as well for his mother as they had hoped.

The ‘Five Wishes’ advance directive.

Later in that same visit, the patient became profoundly hypotensive and was sent to the emergency department and then admitted to the medical ICU. The team there put in a request for a palliative care consult for metastatic cancer. I first saw the patient the next morning. […]

2022-09-22T10:08:13-04:00September 22nd, 2022|end of life, Nursing, Palliative care|1 Comment
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DNR Does Not Mean Do Not Treat

Nurses and the meaning of DNR.

I recall a patient I had as a very new nurse who was designated as do not resuscitate, or “DNR.” The patient had suffered an intracranial bleed and because of his advanced age and untreatable cancer, his family had agreed that no CPR should be used. I remember the nursing supervisor asking me why the patient didn’t have a footboard and foam heel protectors on (that’s what we did back then); my answer was that he was a DNR patient. She basically handed me my head and said that his DNR status had nothing to do with good nursing care.

I never forgot that incident, and when I spoke with the authors of a mixed methods study with direct care nurses on three different units that found that “varying interpretations of DNR orders among nurses were common,” I immediately said yes. Their article is the original research article in AJN‘s January issue, “Nursing Perspectives on Caring for Patients with Do-Not-Resuscitate Orders.”

Families and providers may understand DNR differently.

And it’s not just nurses who may have different ideas and think differently about what should or shouldn’t be done for these patients who hover between life and death—other health care providers and families need to be clear on what that designation […]

2021-01-27T11:35:45-05:00January 27th, 2021|Nursing, nursing research|1 Comment
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October Issue: Treating Hemorrhagic Shock, Pain Management and Opioid Use Disorder, Workplace Violence, More

“Violent behavior seems to be an . . . increasingly frequent occurrence in hospitals and nursing care facilities. More and more, such violence is the result of intentional harm.” —editor-in-chief Shawn Kennedy in her October editorial

The October issue of AJN is now live. Here are some of the articles we’re pleased to have a chance to publish this month.

CE: The Use of Resuscitative Endovascular Balloon Occlusion of the Aorta in Treating Hemorrhagic Shock from Severe Trauma

Efforts to prevent death from hemorrhagic shock have resulted in the emergence of a new tool—resuscitative endovascular balloon occlusion of the aorta (REBOA), a less invasive option for controlling hemorrhage in noncompressible areas of the body. This article outlines REBOA, describes its evolution, and discusses various considerations, pitfalls, and nursing implications.

CE: Perspectives on Palliative Nursing: Acute Pain Management for People with Opioid Use Disorder

The authors of this article—one in a series on palliative care developed with the Hospice and Palliative Nurses Association—discuss how to manage acute pain effectively in patients receiving medication-assisted treatment for opioid use disorder, which incorporates methadone, buprenorphine, or naltrexone.

Original Research: Journalists’ Experiences with Using Nurses as Sources in Health News Stories

The authors of a 2018 replication of the 1997 Woodhull […]

2018-09-28T10:05:14-04:00September 28th, 2018|Nursing|0 Comments
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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 a […]

2018-05-18T14:04:40-04:00May 18th, 2018|Nursing|1 Comment
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Caring with Intention: Palliative Care and the Human Family

Vivian Dee, APRN-BC, RN, lives in Texas. She works on a bone marrow transplant unit and is and a doctoral student in the DNP program at Walden University.

In 2008, our organization created a new palliative care wing. No one was certified yet or knew much about caring for palliative care patients. The leadership scrambled to put together learning instructions in the form of PowerPoints and seminars.

In the midst of this flux, our unit admitted a homeless man as one of our first patients. Larry was an alcoholic who’d been out on the streets for many years. His health had deteriorated, and he’d developed liver cirrhosis. Since he couldn’t afford medical care, he’d opted for palliative care.

Larry was unpretentious and polite, and he soon became one of my favorite patients. I met him at the initial team meeting, where we established goals of care. As the days passed, I got to know Larry and his wishes, dreams, and desires. He would talk about his family, his cousins, and his mother. How he longed to see them one more time. To ask forgiveness and to say goodbye.

Days soon turned into weeks, weeks into months. Larry became weaker. Soon it was apparent that it would only be days before Larry took his last breath. Knowing Larry’s […]

2018-03-22T08:25:34-04:00March 22nd, 2018|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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