Question

You are the nurse caring for Mr. Jones, a 61-year-old male, in the Neurological Intensive Care Unit. Mr. Jones was found to have a benign brain tumor and is scheduled to go in for surgery to resect (remove) the tumor in a few days. Over the next few days you develop a therapeutic relationship with Mr. Jones. He tells you that he lives a very active life, engaged in multiple organizations, sports groups, and works as a coach for young children. Before going into surgery, you discuss his advanced directive and living will wishes. He states that he lives such an active lifestyle that he can’t imagine being in a debilitated state. He becomes emotional but confides in you and says “I would rather die if I would not be able to live the kind of lifestyle I have today. I would never want to be on a ventilator.” He tells you that he loves his family, but they would not understand so he has never had this conversation with them. He fears it would make them sad. Before going into surgery Mr. Jones completes an advanced directive form that states, “Do Not Resuscitate” and “Do not Intubate.” Upon returning from surgery, Mr. Jones seems to be stable. However, just before change of shift, Mr. Jones has a change in mental status. The physician believes he may have suffered from brain damage, likely permanent, during tumor resection. Mr. Jones is continuing to decline, with unstable respiratory and cardiovascular status and the physician is preparing to intubate this patient using mechanical ventilation. The family has been notified and states they want every heroic measure in order to keep Mr. Jones alive. You remember, however, the conversation you previously had with Mr. Jones and the advanced directive that he signed. What would you do as the nurse in this situation? How would you respond?

Answer 1

Mr Jones, being a physically as well as mentally  active throughout his healthy times before catching up with a tumour , could not emotionally accept the true after effects that would follow post his surgery. As a nurse i would -

●keep mental well being of Mr Jones at balance.

●convince the family of Mr Jones about the importance of physical & mental peace , concerning Mr Jones,so that they would take appropriate measures/decisions to keep Mr Jones happy ,both in mind & body.

●I would try my best , to not disclose the advanced directive/ the therapeutic conversation, Mr Jones had with me ..& instead try other means to keep the pace of a succesful treatement regimen.

●To the treating physician, i would convey all the the details of Mr Jones's unsaid side, and also the advanced will petition, Mr Jones had sighned. So that the physician can make a much wiser decision & impart a successful treatement protocol, which keeps both Mr Jones & his family satisfied.