Sunday, March 04, 2007

Maintaining Patient's Final Wishes Regarding DNR Status

I just had to comment on Kim at Emergiblog's post regarding DNR status for patients. This subject is one that is close to my heart as well. We must find out patients wishes and follow them! Too many times, I have been doing an admission and the family members try to answer the question for the patient.

Nurse:"What are your wishes regarding sudden death situations like your heart stopping or if you stop breathing? Do you want us to do CPR, shock your heart back into rhythm, put a tube down so you can breathe? etc?"

Patient:"No, I don't want you to do anything. Just let me go. (Alert and oriented by the way)"

Family member sitting there:"No, Mom wants to be coded. Don't talk like that Mom!

Nurse:" (Looking back at the patient), This is YOUR decision as long as you are alert and oriented as determined by me and your doctor. You get to make the call."
(Directed to the family member) "No one likes to hear about losing a loved one, but they have the right to make these decisions and we must uphold those wishes if they sign a DNR order with their physician. If they have a living will, the surrogate can help with those decisions if the patient is incapacitated BEFORE their wishes were made known." We cannot make a living will out AFTER the patient has become confused."

Nurse:"It is imperative that we all make our wishes known and to stand by others wishes once they are made. It's hard to let go but it does more harm than good to code someone when they don't want it done."

I have been called the "Angel of Death" by a sarcastic doctor once because I stood up for a patient who did not want to be coded. I told the doctor that I would do EVERYTHING in my power to save my patients but I would also do EVERYTHING in my power to make sure that their final wishes are followed. I have felt that horrible crunch as the frail patient's ribs have cracked under my hands while trying to code them when no paperwork was available.

That feeling is too horrible for words.

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