Posts tagged ‘ICU’

More Thoughts on Dying

Sorry folks, it’s turning out to be a bit of a morbid week but what can I say? Death, dying, and palliative care in the ICU have always been of great interest to me.

The Medscape Nurse blog asks, “Who tells a patient’s family that their loved one is dying?” Specifically, should a nurse initiate this conversation, or should it be left up to the medical team? My answer would be that it’s fine for the nurse to initiate this conversation, in fact many situations it’s preferred. Sometimes the medical team is so wrapped up in finding the answer, and finding sucess, that they forget that there is patient there lying in the bed, suffering, day after day.

As a new nurse, I was very reluctant to ever bring up the DNR conversation without first getting the blessing of the medical team. The more experience I gained, the more I realized that initiating this conversation was not only okay, at times it was necessary.

Sometimes health care providers don’t want to initate the DNR conversation out of fear of offending the patient’s family. My take on this? Death is death. Why should someone get offended by it? As health care providers, we shouldn’t espouse the view that stopping treatment on the dying patient is “giving up,” because really, have we ever actually found a way to beat death altogether? Not that I know of.

But neither is it a black and white issue. I remember an oft-quoted statistic that palliative care RNs love to quote. It’s something along the lines of, when you poll people on the question, “Where would you like to die?” The answer overwhelmingly is “In my home.” But there is a disconnect from what people think they want and what actually happens. And this isn’t necessarily the fault of the health care team for not initiating the DNR conversation in a timely matter. Rather, I think this has more to do with the fact that people are deathly afraid of death. They don’t want to think about it and they don’t want to deal with it.

As a a nurse that has spent some time in the ICU, I urge you to think about your death. Think about what it might be like to die. I’m even giving you permission to think about what it might be like for a close member of your family to die. This does not make you morbid, it merely helps you to prepare for something that it ultimately inevitable. It’s not an easy thing to think about. But thinking about it now might ultimately save you (or your family member) from suffering in the long run.

On Death and Dying and Throwing a Good Party

Thought I could make it out of the MICU without a brush with death. I thought wrong.

Why is it that every time I have a patient that we are withdrawing life support on, I always feel strangely like a hostess? It’s like planning a party; a pre-wake, if you will. There may be friends and relatives there. You want to make sure everyone has a good seat, tissues, maybe some ice water to sip on. It’s a very sad, intense, confusing time and you want to do everything you can to make sure it goes smoothly.

I know it sounds kind of crazy, but the more I think about it, the more true it seems. You want to have everything in place ready to go. You want to have the bereavement packet (“What to do when a loved one dies…”) at arms length, but not in plain view. You have to be ready to give it to the family member who seems least likely to fall apart, and you can’t give it prematurely.

The family will leave the patient’s room for the actual extubation. Make sure they have a place to go. An empty conference room perhaps.

Make sure your co-workers are aware of what is happening and will adjust their voices accordingly. The ICU has a strange tendency to be a jocular place at times, despite (or perhaps because of) all the intensity.

Make sure you adjust the monitor settings so they don’t alarm when the patient starts going into PEA.

Make sure you take off the blood pressure cuff and the SCDs.

Make sure the chaplain is ready and waiting.

Make sure the scopolamine patch is ordered before the patient starts to die.

You see? It’s quite a lot of details. And you want to make sure it all goes off without a hitch. Why? Because the family has just made one of the most difficult decisions they might ever make, and you don’t want them regret it. The best thing you can do is make them feel like they did the right thing.