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SuffyAnn
PeaNut 181,774
December 2004
Posts: 7,862
Layouts: 17
 |  Posted: 3/3/2013 9:37:40 PM
When my MIL was admitted to a nursing home, a DNR order was required for admission. We had to sign a legal document.
A DNR cannot be forced or required under any nursing home arrangement. It is illegal as hell, and I never would have placed my parents in one that "required" one. | |
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Katlaw
Send in the Monkeys!
PeaNut 86,755
May 2003
Posts: 6,556
Layouts: 20
Loc: Canada
 | Posted: 3/3/2013 9:49:46 PM
He said it was the policy of the facility to not render aid. I had also mentioned the woman did not have a DNR on file...but IF she knew about the policy, then it amounted to having signed a DNR.
A policy to not render aid is not the same as a signed DNR.
A DNR is signed when a patient is seriously ill or terminally ill. CPR may not work or may only partially work with a patient who is already very ill, leaving the patient brain-damaged or in a worse medical state than before the heart stopped.
A DNR is signed with the doctor and the patient or a proxy for the patient.
There is no such thing as a "blanket-policy" DNR. That is implying that everyone who lives in this home has chosen to not be resuscitated in the event of a cardiac event.
The home has a policy to not provide CPR.
I think they are wrong to have that policy. The right and humane thing to do is to offer the best medical care possible for the seniors that have chosen to live there.
But that is my opinion.
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IScrapCrap
PeaAddict
PeaNut 570,639
October 2012
Posts: 1,033
Layouts: 0
Loc: pea formerly known as GIPfunny
| Posted: 3/3/2013 9:52:51 PM
I worked at an assisted living center and the DNR or end of life treatment was thoroughly discussed with each new resident and the family. Each building had a list in the office with each residents' name and if they were DNR or not. Each resident had a file as well with the DNR information as well as medical information. If the dd of this woman is not upset by what happened it sounds as if she was well aware of the policy.
I get that it sounds cruel. I also find it cruel my grandmother suffered numerous strokes, lost an eye to cancer, could not talk or walk well and wanted to die. If euthanasia had been legal when she was alive, I know she would have chose that option.
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Nightowl scrapper
Intl Assoc of Epic Length Posters - USA Chapter
PeaNut 103,889
August 2003
Posts: 24,783
Layouts: 0
Loc: Colorado
 | Posted: 3/3/2013 10:46:26 PM
There is no such thing as a "blanket-policy" DNR. That is implying that everyone who lives in this home has chosen to not be resuscitated in the event of a cardiac event.
The home has a policy to not provide CPR
I agree with the above. The home's policy is NOT the same a "blanket policy" DNR. And it's not a "home" in the sense many of you are thinking. It is not assisted living or skilled care, both of which are the sort of places where some medical assistance is being paid for.
It is apparently an independent living facility. basically an apartment complex for seniors. It is apparently understood by the family (and presumably the residents) that they do not do CPR. What they do is call 911. If a woman collapses at home alone, she has no chance whatsoever. In the facility in which she is living, there was someone to call 911. That is the extent of the service agreed.
No one is doing a defacto DNR by living there. They are recognizing that the facility will not provide medical care of that nature and will summon an ambulance and paramedics. They may be revived by the paramedics, or at the hospital. Quite different from a DNR.
It's just that there is an agreement between resident and facility that the staff is not permitted to resuscitate, only to summon professional assistance. That's what happened. It is much like your mother lives in an apartment, the apartment manager calls 911 when she collapses. That is the service agreed upon. It has nothing to do with a DNR, written or assumed.
If the woman's family is okay with what transpired, I can only wonder who brought this to the press. Was it the angry 911 operator? That seems like a problem. |
"Until you put a thought into words, clearly and precisely, it is not a thought at all. It is a kind of fog rolling around inside the skull."
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Zella
PeaFixture
PeaNut 434,965
August 2009
Posts: 3,322
Layouts: 5
Loc: Puget Sound
 | Posted: 3/3/2013 10:48:15 PM
RN here. My perspective? If that is indeed company policy, the residents MUST know about it.
I would NOT want to do CPR on anyone, and certainly not on an 87 year old! Look, CPR is rarely effective. RARELY. I would do it on a child with no hesitation. I'd do it on a family member. I might or might not do it in other circumstances.
The chance of this woman surviving WITH CPR would have been way less than 10%. Furthermore, if done correctly the CPR itself would have broken her ribs, which is very distressing to the person administering CPR, and very painful for the victim on the off-chance they survive.
Is it sad? Yes. Is it wrong not to do the CPR? I don't think so.
Another thing about legalities. As an RN, I have to exhibit the skills and knowledge of an "average" RN in any of my undertakings, whether I am at work or not, as long as it is a health related situation (were my actions in keeping with my training; would a resonably competent RN have done what I did?). If I perform a procedure that only drs do, for example, even if I save a life, that is MY ass and MY license on the line! It is no surprise to me at all that many medical professionals don't want to be involved. |
Trying to live each day for itself
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Nightowl scrapper
Intl Assoc of Epic Length Posters - USA Chapter
PeaNut 103,889
August 2003
Posts: 24,783
Layouts: 0
Loc: Colorado
| Posted: 3/3/2013 11:34:07 PM
Thank you, Zella, for an actual professional perspective. Unfortunately, so many people are convinced that one must do something, anything, they aren't going to listen to the fact (stated multiple times) that CPR on an elderly person, can do more harm than good.
If someone's grandma was brought back to a wonderful few more years by CPR, that's marvelous. Be thankful she didn't come back to the excrutiating and debilitating agony of broken bones. Because that's reality when you give CPR to an elderly person. It's not always the pretty sight with adorable grandchildren surrounding a beaming and completely lucid grandma standing in the kitchen baking a fresh batch of cookies. And if it's not the fairytale ending, another person's career may be at an end, their life savings lost to painful litigation. An employer destroyed, putting people out of work, and what happens to the innocent residents who, like the patient, understood the risk and accepted it?
If you work for a company with this policy, you know that you have agreed to abide by it. No drama of momentary heroics - this policy is what you sign up for, and chances are you know far better than laymen what brings a company, and its employees, to this policy. Only if you are trained, experienced, employed, and THEN are faced with the decision can you understand the judgment call that has to be made. If you aren't in that situation, don't be so sure you would opt for the heroism and defy everything you've been taught and agreed to as a condition of employment. And if you didn't agree to it, you would not be working there and put in a position that makes you uncomfortable. |
"Until you put a thought into words, clearly and precisely, it is not a thought at all. It is a kind of fog rolling around inside the skull."
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PennyPaws
PeaAddict
PeaNut 551,978
April 2012
Posts: 1,426
Layouts: 59
Loc: Canada
 | Posted: 3/3/2013 11:45:35 PM
And even still, while I understand that this nurse did what she was supposed to, the problem *I* have with this story is that she refused to pass the phone to anyone else. And THAT is cruel.
When I listened to the call, I didn't hear her outright refuse - I heard her say that there was no one around to pass the phone to that would be able to do CPR/break the rules... She sounded under pressure (understandably) and that often makes people even more focused and think "do what I've been told to do"... That's why the dispatcher was trying to think outside the box and make suggestions to the nurse... Can't speak for them, just going based on my own experiences and how it's unfolded in cases I've dealt with...
So would a nurse in another facility that provided the same type of care also refuse to do CPR? Refuse to get someone else on the phone who would do CPR? More than likely CPR would have been initiated in another similar facility.
If the facility had the same policies, then I would expect the staff at the other facility to also refuse to perform CPR... Again, just going by my experiences, but less than a quarter of the calls I've been on for a pt that required CPR and was in a facility (retirement, assisted living, or nursing home) have been given CPR by staff... This case is not unusual... The calls where CPR has been performed have almost exclusively been assisted living facilities where it was another resident that called 911 and performed the CPR... I have only been on one call where a nurse performed CPR, and it was on her partner while they were in their home... I can't speak to why those are the numbers, but it is that rare that staff do perform CPR in the areas that I serve...
I'm sorry, I missed the part where we are told she had no idea that staff couldn't perform CPR, and that the facility couldn't be bothered to explain it in the eagerness to get the resident to sign and move in. Just because the 911 dispatcher doesn't know the policy doesn't mean the residents are not fully aware of what they signed.
This is true - I can't find a quote/statement where the family says that the patient did not know that CPR wouldn't be performed... I'm sorry for adding that to my post and confusing things... I can say that it is very rare for a patient to indicate that she wanted measure to be taken (she was a full code, indicating that she wanted to be 'saved'), but then decline or agree to CPR not being performed... For patients that do not want CPR to be performed, they file/request a DNR order and staff do not even call 911 - there is no reason for them to call if the person doesn't want treatment... The DNR paperwork has a contact number that staff/family are to call instead of 911, that service then sends out a doctor to pronounce the patient... So while I did make that assumption and it may be wrong, both the patient's request to be a full code and the fact that staff called 911 indicate to me that she did want measures taken... Maybe that clears up what I was thinking a bit? It's a good point that you make...
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pjaye
The only happy ending will be mine
PeaNut 111,502
October 2003
Posts: 6,177
Layouts: 59
Loc: Vic, Australia
| Posted: 3/4/2013 12:51:58 AM
Good Lord, when I am 87 and living in a care facility, I sure hope my nurse follows policy and doesn't jump on my chest.
I haven't read through all of the details, but at 87 it is very likely this lady had several health conditions. We are meant to die when our organs give out, we are not meant to be kept alive against all the odds at that age - even if she could have been resuscitated doesn't mean it is the morally right thing to do to someone.
I don't want my last few breaths and minutes to be someone pounding on my chest and having my ribs broken while a tube is forced down my throat, or being in ICU hooked up to multiple tubes for days and then die.
At 87 for many people death is imminent, let them go when their body gives out and let them go in peace.
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missbitts
Know-It-Most
PeaNut 273,938
August 2006
Posts: 5,223
Layouts: 50
Loc: Hawthouse
 | Posted: 3/4/2013 8:58:54 AM
I'd also like to add that during my time as a 911 dispatcher, easily 90+% of callers DID NOT do CPR when it was suggested and instructions offered. Many, many times those who said they WERE doing it, turned out not to be doing it at all even when they pretended to be following your verbal walk-through. I also don't appreciate the 911 operator in this case saying "or are we just going to let this lady die?" Absolutely inappropriate. | |
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bear_mom
StuckOnPeas
PeaNut 142,661
April 2004
Posts: 2,986
Layouts: 3
| Posted: 3/4/2013 9:34:46 AM
A DNR is signed when a patient is seriously ill or terminally ill. CPR may not work or may only partially work with a patient who is already very ill, leaving the patient brain-damaged or in a worse medical state than before the heart stopped.
A DNR is signed with the doctor and the patient or a proxy for the patient.
There is no such thing as a "blanket-policy" DNR. That is implying that everyone who lives in this home has chosen to not be resuscitated in the event of a cardiac event.
The home has a policy to not provide CPR.
I just wanted to clarify something here:
A DNR can be signed by anyone, it doesn't have to be someone seriously or terminally ill. A DNR order does not have to be signed by a doctor. It should be a leagally prepared document and appropriately witnessed though. When admitted to a hospital it IS important that the DNR be ordered by the physician for legalities and to ensure that all staff are aware of the request.
My 57 year old Mom has a DNR order and has had this for the last 10+ years. In the past she was in a car accident and ended up on a vent and has no desire to ever be there again. Plus she is aware of the damage (broken ribs) done during CPR.
Emily | |
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Nightowl scrapper
Intl Assoc of Epic Length Posters - USA Chapter
PeaNut 103,889
August 2003
Posts: 24,783
Layouts: 0
Loc: Colorado
| Posted: 3/4/2013 9:39:27 AM
I also don't appreciate the 911 operator in this case saying "or are we just going to let this lady die?" Absolutely inappropriate.
I agree. If this is a widespread policy for facilities of this type, then it seems the 911 operators in the area need a bit more training. That comment from her was one of the things that made me wonder if she's the one that got the press all worked up over this. Would such a thing be ethical, for her to go to the press and complain about what happened? |
"Until you put a thought into words, clearly and precisely, it is not a thought at all. It is a kind of fog rolling around inside the skull."
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missbitts
Know-It-Most
PeaNut 273,938
August 2006
Posts: 5,223
Layouts: 50
Loc: Hawthouse
| Posted: 3/4/2013 10:18:35 AM
Would such a thing be ethical, for her to go to the press and complain about what happened?
No, not at all! Where I worked -- and I can't imagine it would be too different anywhere else -- you didn't speak to the press EVER on your own. That would've been grounds for dismissal.
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Newbie2
StuckOnPeas
PeaNut 178,513
November 2004
Posts: 2,187
Layouts: 0
Loc: New England
 | Posted: 3/4/2013 10:20:56 AM
If someone's grandma was brought back to a wonderful few more years by CPR, that's marvelous. Be thankful she didn't come back to the excrutiating and debilitating agony of broken bones. Because that's reality when you give CPR to an elderly person. It's not always the pretty sight with adorable grandchildren surrounding a beaming and completely lucid grandma standing in the kitchen baking a fresh batch of cookies. And if it's not the fairytale ending, another person's career may be at an end, their life savings lost to painful litigation. An employer destroyed, putting people out of work, and what happens to the innocent residents who, like the patient, understood the risk and accepted it?
This may be a first, but I agree with Nightowl.
My Memere & Pepere were in assisted living/nursing homes at the end of their lives, so I've been on the other end.
This woman was 87 years old....administering CPR may not have worked and even if it did, may not have been worth it to her or her family, if she suffered injuries. | |
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Sharna_G
PeaFixture
PeaNut 314,157
May 2007
Posts: 3,966
Layouts: 8
Loc: Delaware
| Posted: 3/4/2013 10:24:57 AM
Good Lord, when I am 87 and living in a care facility, I sure hope my nurse follows policy and doesn't jump on my chest.
I haven't read through all of the details, but at 87 it is very likely this lady had several health conditions. We are meant to die when our organs give out, we are not meant to be kept alive against all the odds at that age - even if she could have been resuscitated doesn't mean it is the morally right thing to do to someone.
I don't want my last few breaths and minutes to be someone pounding on my chest and having my ribs broken while a tube is forced down my throat, or being in ICU hooked up to multiple tubes for days and then die.
Sadly, ITA. 
I think with all the medial advancements in the last 50 years, we (society) expect medical intervention to save everyone - always. We have been conditioned that anything is treatable, and that in every circumstance, we should do all we can to keep someone alive. |
~~Sharna
"You think they're onto us?"
"Shhh... Let me call my attorney"
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3kidmama
AncestralPea
PeaNut 268,201
July 2006
Posts: 4,926
Layouts: 8
Loc: Northwoods
| Posted: 3/4/2013 10:44:16 AM
I suspect those who are outraged at the facility policy are not that familiar with such facilities and the residents who populate them. As the child of parents who have spent years in elder care facilities with varying levels of care from assisted to skilled care, I can absolutely understand why a facility may have such a policy in place. Don't like it? Don't move grandma in there.
You would be wrong in my case!
I've been a RN for 29 yrs. My Mom is a retired Hospice nurse (who spent last month in a nursing home facility undergoing reha , my brother is a Emergency Room nurse (24yrs), my daughter is currently studying to be an RN, and because of where he works and this being a public forum I can't be specific -- just know my spouse thoroughly "gets it" too. 
What sickens me is that this nurse REFUSED to even hand the phone to a passerby in spite of the requests of the 911 operator. I disagree with the other RN who posted. The "success rate" of CPR depends on when it is started and what caused the "code" in the first place, so statistics about CPR can be used to make nearly any point you wish. However, in this case you have a woman who was still breathing with TRAINED medical people on hand - depending on the cause of her respiratory distress, she statistically she might be in the "best chance."
I just watched a newschannel debate between a Medical Doctor and a Lawyer on this very incident. Only is wasn't' a debate! They both agreed that there was NO medical or legal defense for not administering CPR to this woman (well within the "scope of practice" or a nurse). Both were shocked and disgusted at the actions of this facility and this nurse!
I just had heart related surgery on Friday. I had to sign 4 different double sided, fine print forms even though I was there for a day. I have no idea what most of those forms said. The clerk said vague things like "This gives us permission to treat you" as she handed me the fine print double sided form - and I signed! Even as a well educated and experienced medical professional, I honestly would have zero idea if the form I signed said they would only call 911 and not do CPR. I was again asked if I have a DNR order or a living will. I'm asked that every.single.time I am admitted to a medical facility.
The fact that this woman did not have a DNR order on file, bothers me greatly! She obviously would have been given opportunity to make her wishes known (even in this facility) and she DID - by not writing out the order. 
I have done CPR on MANY people through the yrs. Some people made it and others did not. Some people we never thought had a chance - but I'd later see them walking around my hospital laughing with their family. I have done CPR on a man I just saw lying passed out on the street. He didn't make it, but I was able to give some measure of comfort to his family knowing that people did everything they could to save him rather than stand by and just let him die. They thanked me.
I, myself, have been defibrillated or "shocked back to life" when my own heart stopped. Fortunately, it worked and while my ribs felt like I had been kicked by a horse - I am still here 15yr later. I can't imagine saying I'd rather be dead than risk a cracked rib.
So believe me, I DO disagree with many opinions on this thread, but it's not because I'm inexperienced!  | |
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I-95
It's all just nonsense anyway!
PeaNut 97,456
July 2003
Posts: 19,547
Layouts: 0
Loc: California, NY & Orlando
| Posted: 3/4/2013 10:46:47 AM
A policy to not render aid is not the same as a signed DNR.
A DNR is signed when a patient is seriously ill or terminally ill.
Yes, I misspoke when I said they had a policy to not 'render aid'. I realize that covers everything from dialing 911, to employing heroic intervention. I should have said their policy was to not render CPR. Mea culpa.
With regard to a DNR being signed by a seriously ill/terminal patient. That may be when it normally happens, but one can sign one at any time. My mom was perfectly healthy when she did hers. She was getting up in age, and she was quite clear that if, at any point from then on, she had a heart attack or anything that would cause her natural death, then she wanted to be allowed to go on home to God.
NightOwl....I understand the policy of this facility, and I have no problem with it. I wouldn't have a problem with it if it were my mom in that situation. My questions/arguments were more from an analytical POV. Having a standing no CPR rule for someone who is 87 years old is pretty much a DNR, IMHO. Not that administering CPR is any guarantee of saving her life anyway. My curiosity was solely about whether the family was clear on the policy, and it appears they were, so that answers my question. | |
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blondiek237
StuckOnPeas
PeaNut 70,239
February 2003
Posts: 2,855
Layouts: 8
Loc: Massachusetts
| Posted: 3/4/2013 11:47:27 AM
Designing--that is exactly what happened when my dad died last December. We got the call that he coded--it wasn't until we got there that we were told that they brought him back, but he had been without O2 for 15 minutes. They were talking about "freezing" him and a bunch of other stuff, until my DH said wait--he was without O2 for 15 minutes why are we trying to save him. Mom said no lets let him go and we were all with him as he passed a couple of hours later. I can't even image what his chest looked like after 15 minutes of CPR on an 85 year old man | |
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PennyPaws
PeaAddict
PeaNut 551,978
April 2012
Posts: 1,426
Layouts: 59
Loc: Canada
| Posted: 3/4/2013 11:59:38 AM
If this is a widespread policy for facilities of this type, then it seems the 911 operators in the area need a bit more training.
911 services/staff are not affiliated or overseen by the same bodies that oversee the facilities... Just because they're both healthcare doesn't mean they're part of the same agency/company/etc... 911 dispatchers are not trained and do not need to know the internal policies of facilities... They are governed and regulated by a separate agency so that they react and provide the same level of service to anyone calling regardless if it's a call from someone on the street or staff within a facility... Even if the policy was known, what could/should the dispatcher do different? Not try and find someone around that is able to do CPR, not thoroughly confirm the refusal, not be blunt and explicit about the consequences of not doing CPR? If the dispatcher/911 agency does not go through every step with every caller they run the risk that someone visiting the facility, who just happens to be a nurse, calls 911 and isn't offered help performing CPR because she's 'a nurse at X facility... 911 sets the rules so they're equal across the board and it is the caller's choice what they want/can do... It's just extra hard to hear a refusal from another medical professional...
The dispatcher was very blunt and I agree, not her best moment... I'm assuming, so could be wrong, that her tone and choice of words was strongly influenced by the fact that she was talking to someone who identified them self as a nurse, a staff member, and who placed an emergency call requesting help for the resident... Her tone/words would have likely been very different if it had been a passerby or family member... Her job was to provide assistance and listening to the tape, you can hear how her tone/words change as staff continually identify themselves while saying they couldn't do anything to help... There are times when callers, even nurses and medics, are either shocked or emotionally thrown by the situation that you have to try and grab their attention and be very direct, firm, and blunt... To speak about death with a nurse that has been trained to deal with situations like that is usually a much more 'cold' conversation than when you are talking to someone not in the field, a family member, etc... For example, a nurse telling me the patient was taking 5 breaths a minute would hear me say, "okay, that's not good - let me send a quick update to the crew, stay on the line"... A person/family member would hear me say," okay, that's good she's breathing, we're going to help make that a bit easier for her, so I want you to..." Dispatchers are taught to change how they speak/direct callers based on who the caller is and how the caller is reacting...
Again, not saying it was the best choice of words, and it sounds horribly cold and harsh after the fact... Just offering that in the moment, when you are trying to get the caller's attention in order to help someone, dispatcher can and sometimes have to be very blunt and cold...
Also, in some jurisdictions dispatchers need to confirm refusals by asking a crew, "are you refusing this call?" or the caller, "are you refusing first aid instructions?" We have to be explicit and the tape has to document that the caller did truly understand what they were refusing... It is a job requirement placed on us so that you don't have dispatchers not offering help and passing it off as the caller 'didn't want any'...
It might have also altered their response - if CPR was being performed Fire might have been tiered, an additional unit might have been sent for manpower, a higher level crew might have had to also respond, a supervisor might have had to be notified, and it can change the priority of the call, and change if police are required to respond, etc... To cancel off those parts of the response, both the call taker and the dispatcher have to be sure, and it has to be equally clear to the QA review staff that there was a clear, well understood refusal on the tape... 911 calls are all recorded, and have a very high audit/QA rate... Dispatchers are acutely aware of what is required of them, and extremely aware that nothing goes unnoticed... |
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PennyPaws
PeaAddict
PeaNut 551,978
April 2012
Posts: 1,426
Layouts: 59
Loc: Canada
| Posted: 3/4/2013 12:06:19 PM
What sickens me is that this nurse REFUSED to even hand the phone to a passerby in spite of the requests of the 911 operator.
I can't pull up the article on my iPod for some reason... Did the nurse actually refuse to pass the phone or did she say that there's no one to put on the phone to that could do CPR?
I know the dispatcher asked about other residents getting on the phone for CPR instructions, but I would guess the facility would have a rule against asking them to do that... Worried that it could cause harm to the resident helping - CPR is hard and very physical, and that they asked the resident to do it... |
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Nightowl scrapper
Intl Assoc of Epic Length Posters - USA Chapter
PeaNut 103,889
August 2003
Posts: 24,783
Layouts: 0
Loc: Colorado
| Posted: 3/4/2013 3:19:44 PM
What sickens me is that this nurse REFUSED to even hand the phone to a passerby in spite of the requests of the 911 operator.
But you don't know what her employer's instructions were. Is she as liable if she hands the phone to an amateur who agrees to try to follow instructions and give CPR? Is handing the phone construed in court as DIRECTING the passerby to do it? Were there in fact any passersby ready and eager to take on the task?
And for all the nurses on this thread - it's been awhile since I had CPR training, but my memory is that you absolutely don't do CPR on someone who is breathing because, well, they are breathing. So I'm really confused as to why the dispatcher was ordering CPR started on someone who was "barely breathing". Barely breathing is, nonetheless, breathing. Can someone clarify? |
"Until you put a thought into words, clearly and precisely, it is not a thought at all. It is a kind of fog rolling around inside the skull."
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Katlaw
Send in the Monkeys!
PeaNut 86,755
May 2003
Posts: 6,556
Layouts: 20
Loc: Canada
| Posted: 3/4/2013 3:24:08 PM
A DNR is a Do Not Resuscitate order. It is entered into by a patient with medical advice. You can choose a DNR that states no CPR but other medical measures can be taken. For example an ill patient with an infection can choose to not be medically treated for the infection, just for pain management. Or they can choose to not accept CPR but be treated for all other medical problems that arise.
A Personal Directive is a document that states you do not want any extraordinary measures taken to keep you alive. No intubation for example. The Peas saying their healthy family member has signed a DNR are more than likely talking about a PD, not a DNR.
The bottom line is the facility is all about money, not patient care. Why hire nurses if they cannot provide care because of policy?
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Nightowl scrapper
Intl Assoc of Epic Length Posters - USA Chapter
PeaNut 103,889
August 2003
Posts: 24,783
Layouts: 0
Loc: Colorado
| Posted: 3/4/2013 3:25:53 PM
Why hire nurses if they cannot provide care because of policy?
They may be onsite to help with other, non-lifethreatening matters. A serious cut, taking blood pressure for a resident who needs that done frequently, etc. |
"Until you put a thought into words, clearly and precisely, it is not a thought at all. It is a kind of fog rolling around inside the skull."
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expoedu1
PeaNut
PeaNut 441,182
October 2009
Posts: 358
Layouts: 0
| Posted: 3/4/2013 4:12:33 PM
Regardless of the legal issues medical professional face in a CPR situation, the reality is that they've probably rarely, if at all, seen a successful resuscitation where the patient recovered fully and lead a normal life. I've heard two stories about this recently that completely changed my view of CPR. I haven't found the information I heard on the radio anywhere online just yet, but here are two stories that illustrate the same point. In the study I heard about, people thought that the chance of success from CPR was >80% and related stories of how it's portrayed on TV where everyone walks out of the hospital a few days later as if nothing had happened; in reality, the success rate is very small (<10 , and very few people come out with no effects. After all, you are dead, and the CPR is trying to bring you back to life. The longer that takes or the older you are, the poorer the outcome. You may not be dead after CPR, but you might be in a permanent coma or you may still die within a couple of days. Not saying that CPR isn't important in the right situations, but I'm not sure if I were elderly and my heart stopped that I'd want to be put through the trauma of CPR to be permanently brain damaged and/or on a respirator.
http://thehealthcareblog.com/blog/2012/08/06/how-doctors-die/
http://thehealthcareblog.com/blog/2013/02/28/how-mom%E2%80%99s-death-changed-my-thinking-about-end-of-life-ca/ | |
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expoedu1
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| Posted: 3/4/2013 4:12:35 PM
Regardless of the legal issues medical professional face in a CPR situation, the reality is that they've probably rarely, if at all, seen a successful resuscitation where the patient recovered fully and lead a normal life. I've heard two stories about this recently that completely changed my view of CPR. I haven't found the information I heard on the radio anywhere online just yet, but here are two stories that illustrate the same point. In the study I heard about, people thought that the chance of success from CPR was >80% and related stories of how it's portrayed on TV where everyone walks out of the hospital a few days later as if nothing had happened; in reality, the success rate is very small (<10, and very few people come out with no effects. After all, you are dead, and the CPR is trying to bring you back to life. The longer that takes or the older you are, the poorer the outcome. You may not be dead after CPR, but you might be in a permanent coma or you may still die within a couple of days. Not saying that CPR isn't important in the right situations, but I'm not sure if I were elderly and my heart stopped that I'd want to be put through the trauma of CPR to be permanently brain damaged and/or on a respirator.
http://thehealthcareblog.com/blog/2012/08/06/how-doctors-die/
http://thehealthcareblog.com/blog/2013/02/28/how-mom%E2%80%99s-death-changed-my-thinking-about-end-of-life-ca/ | |
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PennyPaws
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| Posted: 3/4/2013 4:48:24 PM
And for all the nurses on this thread - it's been awhile since I had CPR training, but my memory is that you absolutely don't do CPR on someone who is breathing because, well, they are breathing. So I'm really confused as to why the dispatcher was ordering CPR started on someone who was "barely breathing". Barely breathing is, nonetheless, breathing. Can someone clarify?
If I remember right, the caller first said breathing about 5 breaths per minute and the dispatcher asked that the patient be put flat on the floor and for the caller to do the head tilt to help maintain the airway... Later the caller says she's not breathing and so it went from airway management to CPR...
The dispatcher timed the respirations (something we don't do/have directive to do here)... Maybe they have a threshold that at a certain point they consider things like agonal resp or PEA? Patients can go through the movements of breathing while being able to benefit from CPR, but not sure how someone bit near the patient would ever be able to assess that... |
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mtomseth
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| Posted: 3/4/2013 4:57:27 PM
"First do no harm"
Fragile bones can be easily broken causing extreme pain when CPR is performed on an elderly person.
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Nightowl scrapper
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| Posted: 3/4/2013 5:06:01 PM
"First do no harm"
Fragile bones can be easily broken causing extreme pain when CPR is performed on an elderly person.
Yep, that's pretty much it. It's not just a matter of "cracked rib but you're alive". I think people really, truly do not understand that damage that can be done and the incredible pain that would be endured by an 87 year old woman who had CPR performed, much less had it done by a willing amateur who was handed the phone, as the dispatcher begged, and some posters are insisting should have happened.
The older and more frail someone is, the lesser chance of a good outcome of CPR is, and the more 'harm' can be done.
As much as I love my own 84yo mother, I would never, ever, want her put through the pain that was described to my sister by the doctor as she worked on the DNR form. If she stops breathing, let her go. |
"Until you put a thought into words, clearly and precisely, it is not a thought at all. It is a kind of fog rolling around inside the skull."
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NativeNewYorker
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 | Posted: 3/4/2013 5:09:15 PM
I haven't read through all of the details, but at 87 it is very likely this lady had several health conditions. We are meant to die when our organs give out, we are not meant to be kept alive against all the odds at that age - even if she could have been resuscitated doesn't mean it is the morally right thing to do to someone.
Well, crap. My grandma was almost 97 when she died. She had long, thick silver, hair and was a spry old lady. |
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Nightowl scrapper
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| Posted: 3/4/2013 5:34:46 PM
Well, crap. My grandma was almost 97 when she died. She had long, thick silver, hair and was a spry old lady.
That's wonderful. Did she collapse and need CPR? Because collapsing and needing CPR is a dire situation for an elderly person, and often means that their body is saying it's done. The specific age is irrelevant. Or maybe she passed peacefully in her sleep.
Often elderly people die in their sleep. That's the dream of most people, to enjoy life and be relatively spry, then go to sleep and not wake up again, rather than an agonizing death. Everyone is sad to see them go, but glad they died in relative comfort. Now I wonder how many of those elderly people who die peacefully in their sleep, would instead have been pumped and shocked back to life, or if it would have been attempted on them, had they experienced the exact same life-ending event in the middle of afternoon bingo instead of 2am in bed. |
"Until you put a thought into words, clearly and precisely, it is not a thought at all. It is a kind of fog rolling around inside the skull."
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melanell
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| Posted: 3/4/2013 6:26:47 PM
Good Lord, when I am 87 and living in a care facility, I sure hope my nurse follows policy and doesn't jump on my chest.
I haven't read through all of the details, but at 87 it is very likely this lady had several health conditions. We are meant to die when our organs give out, we are not meant to be kept alive against all the odds at that age - even if she could have been resuscitated doesn't mean it is the morally right thing to do to someone.
I don't want my last few breaths and minutes to be someone pounding on my chest and having my ribs broken while a tube is forced down my throat, or being in ICU hooked up to multiple tubes for days and then die.
Personally, I agree. And I would sign every form possible to prevent someone from trying to save my life in that way. If I am 87 and perfectly healthy and spry, then chances are good I wouldn't be collapsing in a care facility, kwim?
I don't know the specifics, but I can guess she wasn't the picture of health anymore.
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3kidmama
AncestralPea
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| Posted: 3/4/2013 6:59:54 PM
First do no harm????
Surely willingly watching a breathing woman die while preventing the 911 operator from talking to ANYONE else who would be able and willing to offer help would qualify as "doing harm"???? More than harm - certain DEATH!
Shaking head here. If you guys don't want to be resuscitated, then fill out your DNR forms as part of a living will NOW. This woman did not have one although she certainly would have been asked about it. By NOT filling out an order - she makes her wishes known - resuscitate please!
I used to think that many Americans would have gladly been "Todd Beamers" (passenger heroes from 9/11). By that I mean willingly sacrificing yourself to save your fellow man. But honestly, the opinions on threads like this sadly make me rethink that.
I think you guys will find after the dust settles from this and an investigation occurs that this nurse and facility will be shut down/disciplined by State regulatory boards. | |
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mtomseth
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| Posted: 3/4/2013 7:11:40 PM
Here is an editorial that discussed both sides of the issue. To perform/or not perform CPR on elderly patients.
CPR For the Elderly
If I'm in my 80's and in poor health, I do NOT want anyone pounding on my chest.
Bottom line, have your medical directives and DNR's in place and then make sure they are will publicized, so that your wishes are known. | |
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OSUBuckeyeFan
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| Posted: 3/4/2013 7:23:20 PM
Another RN here.(15+ years experience and 11yrs in ICU) It's my understanding that the family was well aware that this facility had a blanket DNR policy for all the residents. The daughter of the deceased lady is also an RN and had no issues with the care of her mother.
I've never heard of a facility wide DNR policy. This isn't how it's done in the nursing homes & assisted living facilities where I live. That said, the nurse was following the policy by not administering CPR.I'm sure the policy of that facility is most likely known by the state of California. After all, the state is what gives the facility the license to operate and inspects it regularly.
Was the person who called 911 actually a nurse? Earlier in my career, before graduating from RN school, I worked as a resident care aide in an assisted living facility. I passed meds and gave insulin to the residents. Once the Director of Nursing, who was an RN, left the building at 5pm, there wasn't another nurse(RN or LPN) in the building until the next day. She was available 24-7 for emergencies but we rarely needed to call her and I was NOT required to be CPR certified( I was because it was required for nursing school-but no one else was). That was 1991. I'm sure the regulations for personal care homes/assisted living facilities has changed.
Seeing as how the person was following facility policy, I don't think she did anything wrong and was obviously ok at working in such a place. CPR on an 87 year old doesn't usually end well I've seen MANY families override their loved ones DNR orders because they weren't ready to say goodbye.   |
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mtomseth
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| Posted: 3/4/2013 7:25:02 PM
First do no harm????
Yes. That is right.
If the life saving measures performed on the patient causes a persons end of life to be a living hell, with broken bones, tubes, and ICU stays, where death quickly follows, then what is the point?
Having spent a tremendous amount of time in and around care facilities with both of my parents, I've witnessed how agonizing end of life is for many people. I had to endure my own father begging me to end his life as he died slowly and painfully from primary liver cancer. It would have been unconsciounable if he had a heart attack and someone tried to resuscitate him.
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Zella
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| Posted: 3/4/2013 8:03:07 PM
I'm not a heartless person; quite the opposite, actually. . . I'm a softie. As I said,there are definitely times when I would perform CPR. But there are probably more times when I wouldn't. It's complicated, not a simple case of "well, you have an obligation to do it." No, I really don't. Neither does anyone else.
As for this:
The definition of Gross Negligence is "An indifference to, and a blatant violation of, a legal duty with respect to the rights of others."
There should be a right to die. It is a human right that has somehow been forgotten about, at least in this country. Sometimes the right thing to do is NOTHING. I can't say for sure if that's the case here, but I suspect so.
One more thing: on duty as an RN in a nursing home, I had an elderly man have a stroke literally in my arms. His very last words were spoken to me right before he lost the ability to speak. He was taken to the hospital where they "saved" his life, only for him to be transferred back to our facility and end up dying a month later, without regaining the ability to speak, walk,or care for himself in any way.
There are many outcomes in many situations that are far worse than death. |
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I-95
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| Posted: 3/4/2013 8:25:34 PM
Another RN here.(15+ years experience and 11yrs in ICU) It's my understanding that the family was well aware that this facility had a blanket DNR policy for all the residents. The daughter of the deceased lady is also an RN and had no issues with the care of her mother.
I was just listening to the news and they had a report on the 'National outrage' over this story.
The reporter said the family had initially agreed with the way things went down, until they heard the 911 call. Apparently they are not so fine with it any more. | |
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OSUBuckeyeFan
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| Posted: 3/4/2013 9:04:46 PM
And again, the media is sensationalizing this story. |
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twinsmom-fla99
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| Posted: 3/4/2013 9:11:24 PM
I am confused. A lot of this outrage seems to be directed at the facility as if it were paid to provide care for this woman.
Isn't it really just an apartment building? My mom and her sisters looked at some assisted living facilities for my grandmother several years ago, and there were several different types of homes that they found.
The highest level of care was a nursing home that provided actual medical care. I am sure that if someone is living in this type of home, the staff is expected to do whatever medical attention is necessary unless the patient has signed a medical directive otherwise. This type of living arrangement is just shy of a full-blown hospital, with nurses in attendance but not necessarily a doctor there all the time. This is obviously an expensive living arrangement.
The next level was assisted living, which was basically a "dorm" for seniors--you got a room/bathroom of your own and meals/activities are provided for you in a common area. Some facilities provided transportation on a weekly basis to the mall or the pharmacy or for outings, but generally it was up to the residents' families to provide everything beyond the meals. My grandmother had to be pretty much able to care for herself and even did her own laundry in the machines they provided, but she could have paid extra for that service. The facility she moved into when she could no longer manage an apartment of her own did not even administer medications. They did provide a delivery service and would pick up her orders at the pharmacy, but that was it. There was no nursing staff on duty, although some of the workers may have been nurses (they just weren't acting as nurses on behalf of the facility). This living arrangement was significantly cheaper than the nursing home, but it was still pretty pricey.
The next level down was an "independent living facility", and from the articles I have read, it seems that this is the type of facility involved in this case. It really isn't anything more than a glorified apartment. Sometimes you can sign up for a meal plan at the assisted living facility if one is attached to it, but for the most part this is just an apartment complex built with seniors in mind. There may be social activities planned for the residents and a shuttle bus for those who have had to give up driving, but there is NO expectation of any medical care at all in an independent living arrangement.
I guess I don't see it as any different than any other apartment complex--the manager/staff of a regular apartment building has no legal duty to provide medical attention to a resident. It may not be written into most leases b/c I don't think most people have to be told that apartment staff are not there to provide you with medical assistance. I can see it being written into the lease for an independent living facility to make it clear that they are NOT providing medical services as part of the lease.
It don't think the lease clause implies any kind of DNR on the part of the resident. It just clarifies what the apartment staff will do in the event of a medical emergency. | |
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TinCin
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| Posted: 3/5/2013 8:25:42 AM
This does make me wonder what would happen if someone cut themselves badly or fell down some stairs. Would the staff just watch them bleed to death or help them. Where is the moral obligation to help another human being in pain or in danger? Would the staff just phone 911 and not get a towel to help stop the bleeding ? Would they just tell the 911 operator that they were not allowed to apply direct pressure and attempt to stop the bleeding? Was it only because the woman was so old that this is their policy? Thinks that make me go hmmmm. |
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mom_to_a_girl
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| Posted: 3/5/2013 9:11:50 AM
Good Lord, when I am 87 and living in a care facility, I sure hope my nurse follows policy and doesn't jump on my chest.
I haven't read through all of the details, but at 87 it is very likely this lady had several health conditions. We are meant to die when our organs give out, we are not meant to be kept alive against all the odds at that age - even if she could have been resuscitated doesn't mean it is the morally right thing to do to someone.
I don't want my last few breaths and minutes to be someone pounding on my chest and having my ribs broken while a tube is forced down my throat, or being in ICU hooked up to multiple tubes for days and then die.
Sadly, ITA.
I think with all the medial advancements in the last 50 years, we (society) expect medical intervention to save everyone - always. We have been conditioned that anything is treatable, and that in every circumstance, we should do all we can to keep someone alive.
I'll agree with all this too. | |
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cannmom
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 | Posted: 3/5/2013 4:42:57 PM
Current advanced cardiac life support (ACLS) guidelines emphasize early defibrillation over chest compressions. If an AED was not available CPR may not have made a difference. There are some things that are worse than death. I see it everyday at work. ITA that CPR in real life is not like TV CPR. It's hard to understand if you don't work in the medical field. | |
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cannmom
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| Posted: 3/5/2013 4:42:57 PM
Current advanced cardiac life support (ACLS) guidelines emphasize early defibrillation over chest compressions. If an AED was not available CPR may not have made a difference. There are some things that are worse than death. I see it everyday at work. ITA that CPR in real life is not like TV CPR. It's hard to understand if you don't work in the medical field. | |
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