In: Nursing
David, who has suffered from ALS for 20 years, is now hospitalized in a private religious hospital on a respirator. He spoke with his physician before he became incapacitated and asked that he be allowed to die if the suffering became too much for him. The physician agreed that, while he would not give David any drugs to assist a suicide, he would discontinue David's respirator if asked to do so. David has now indicated through a prearranged code of blinking eye movements that he wants the respirator discontinued. David had signed his living will before he became ill, indicating that he did not want extraordinary means keeping him alive. The nursing staff has alerted the hospital administrator about the impending discontinuation of the respirator. The administrator tells the physician that this is against the hospital's policy. She states that once a patient is placed on a respirator, the family must seek a court order to have him or her removed from this type of life support. In addition, it is against hospital policy to have any staff members present during such a procedure. After consulting with the family, the physician orders an ambulance to transport the patient back to his home, where the physician discontinues the life support.
USING THE CASE STUDY ABOVE ANSWER THESE QUESTIONS
VI. Assess the consequences. Identify short-term, long-term, positive, and negative consequences for the major alternatives. The short-term gain or loss is often overridden when long-term consequences are considered. This step often reveals an unanticipated result of major importance.
VII. Make a decision. The consequences are balanced against one’s primary principles or values. Always double-check your decision
Amyotrophic Lateral Sclerosis (ALS) also known as Lou Gehrig's Disease is the progressive degeneration of the nerve cells that controls muscle movement.
Ventilator withdrawal is a multidisciplinary with a complex and evolving history involving ethics,law and culture.once a decision is made to withdraw the ventilator the physician must be able to manage symptoms which may include dyspnea and anxiety during the pre withdrawal period.
Once it is decided that further aggressive medicare is incapable of meeting the desired goal of care of a ventilator withdrawal from ventilator care and allowing death is appropriate.Such a decision is not easy to make .
That too in the above mentioned case it is the decision of the patient to withdraw ventilator care at his own will. All the members of the health team are to be involved in the decision making process and have the opportunity to
Discuss the plan of care.
As a nurse present during medical aid in dying I promote patient dignity as well as symptom relief, comfort and emotional support to the patient and family.As a nurse I maintain confidentiality and privacy in the aid in dying process.
The nursing priorities in the management of a dying patient are
- recognising that someone is dying
- communicating sensitivity with them and their family.
- involving them in decision making
- supporting them and their family
- creating an individual plan of care which includes adequate nutrition and hydration.
It is very challenging situation for a nurse in this sensitive situation.
The role of a nurse during the active dying phase is to support the patient and family by educating them on what might they expect to happen during this time, addressing their questions and concerns honestly,being an active listener and providing emotional support and guidance.
A nurse cries when their patients die and rejoice in lives that are saved. However, many people do not see this but see our profession as cold and uncaring. At the same time, they expect us to be strong.
Prior to the procedure:
1) Family member's or siblings are encouraged to make decisions to stay with the patient.
2) Document clinical findings, discuss with family and plan of care in patients chart.
3) The physician should personally supervise that all the monitors and alarms are turned off . Ensure that alarms are override that cannot be turned off once triggered.
4) Remove all restrains or paraphernalia( eg NG tube or venous compression tubing.)
5) Turn off life sustaining treatment.
6) Turn off blood pressure support medication and paralytic medication and discontinue other life - sustaining treatment.
7) Clear space for family near bedside
8) Establish adequate symptom control prior to extubation.
9) Have a syringe of sedative medication to use in case of distress or tachypnea.
Nurses are at the bedside during the dying process; they spend entire shifts with the patient and families, they develop trusting relationships, and they are competent to assess patient and family needs so a nurse's role is a very difficult and challenging one when it comes to Mortality and Ethics.
All the decision making and progress of the procedure is double checked to avoid any mistakes.