resuscitation

well am not too sure about this. my dad is in hospital and I have seen how busy the nurses are( am afraid some are just lazy!) and I do wonder if they work long hours and are very tired would not be able to make right decisions even if they are experienced.
what if bringing patient back to life helps instead of letting her/him pass away? what about the hippocrates oath?

Amethystfairy:confused:

well am not too sure about this. my dad is in hospital and I have seen how busy the nurses are( am afraid some are just lazy!) and I do wonder if they work long hours and are very tired would not be able to make right decisions even if they are experienced.
what if bringing patient back to life helps instead of letting her/him pass away? what about the hippocrates oath?

Amethystfairy:confused:

My main concern is that a patient may not be in a position to make a judgment because of their condition.

Also that I do not believe that nurses really know their patients. Their knowledge is only usually based on the condition/mind of the patient whilst they are ill and as many of us know that may not be the normal mind set of a person when they are healthy.

Nurses assume they know best thats the problem. They think my dad is thick but in fact he is not and they pretend not to hear my dads requests etc .what if they assume the patient is better off dead they would think let her/him go?when it is in fact wrong decision? Would they let disabled person pass away?( reason is disabled people better off dead?)

Amethystfairy:mad::confused:

To clarify i dont mean all nurses. some are nice and kind hearted!

Amethystfairy:)

I would be thinking, do our doctors in hospitals make any better decisions than the Nurse-Practitioners. Nurse Practitioners are a fairly new concept and have training to enhance their skills to this high level of responsibility. Does this then suggest a pride in their abilities and a better standard of working?

Also with our ever more Americanised way of life, wouldn't most practitioners always resuscitate if for nothing more than the fear of being sued if they made a decision someone opposed.

I have been in this kind of situation twice in my life and 'danger to life' situations a number of times (career choices) and your instincts tell you to save life. I trust in human nature and would hope this instinct would come through for others too especially those trained to save and enhance life.

I think the issue of lazy health professionals is another story. I've mentioned before in another thread that because of the ever increasing apathetic nature of our hospital care I chose complementary therapy instead of orthodox training. I think we are in danger of breeding a culture of uncaring nurses and doctors because of the pressures our government has placed on our NHS (a sweeping statement, I know).

Amethystfairy, I hope your father is well soon and able to come out of that situation soon.

Rx

As a nurse (although it be newly qualified) I do think that there is scope for very experienced nurses to be involved in this discussion.

They are not talking about withdrawing treatment, only about attempting to resuscitate.

Having been involved in resus attempts (some lasting over an hour) I know that they are actually very physical interventions, and that they also have only a low success rate.

Often in hospitals the consultants will meet their patients for only a brief few minutes during a ward round - a visit to the ward to assess their patients - and review the patients notes sometimes only pausing briefly to actually see the patient. The nursing team is there with the patient day in day out and through the night and are trained to observe those patients and how their condition progresses.

I do not think that any nurse would undertake such a decision lightly - we are all bound by a code of ethics as mentioned above - and we will only act in the best interests of that patient. Yes we consider the family that the patient has and the life that they may be able to go on and achieve - that is always in our mind - after all we are there when patients' families visit and we can see the bonds that exist - the doctors often aren't.

I think that as long as there are set guidelines about the experience of the nurse involved in the decision, and that it requires more than one person to agree to the decision then it is an acceptable move.

Regards

Wispy~Misty

As a nurse (although it be newly qualified) I do think that there is scope for very experienced nurses to be involved in this discussion.

They are not talking about withdrawing treatment, only about attempting to resuscitate.

Having been involved in resus attempts (some lasting over an hour) I know that they are actually very physical interventions, and that they also have only a low success rate.

There are many treatments that have a low success rate, but that should not preclude anyone having resusitation.

Often in hospitals the consultants will meet their patients for only a brief few minutes during a ward round - a visit to the ward to assess their patients - and review the patients notes sometimes only pausing briefly to actually see the patient. The nursing team is there with the patient day in day out and through the night and are trained to observe those patients and how their condition progresses. I do not think that any nurse would undertake such a decision lightly - we are all bound by a code of ethics as mentioned above - and we will only act in the best interests of that patient. Yes we consider the family that the patient has and the life that they may be able to go on and achieve - that is always in our mind - after all we are there when patients' families visit and we can see the bonds that exist - the doctors often aren't.

IMO and experience the patient can often hide their true feelings from both nurses and family in an attempt to try not to be a burden to both.

I think that as long as there are set guidelines about the experience of the nurse involved in the decision, and that it requires more than one person to agree to the decision then it is an acceptable move.

I have to say that there are many set guidelines within the NHS that are not followed. Nothing makes me confident that the guidelines for resuscitation will be followed.

I think the issue of lazy health professionals is another story. I've mentioned before in another thread that because of the ever increasing apathetic nature of our hospital care I chose complementary therapy instead of orthodox training. I think we are in danger of breeding a culture of uncaring nurses and doctors because of the pressures our government has placed on our NHS (a sweeping statement, I know).

Sweeping or not Cirrus you have made a very good point, one I believe is gaining momentum.

This is just a recognition of what's always happened unofficially- junior doctors have always been expected to learn from senior nurses, just as army sergeants have always told young officers what they should do.

As to resucitation, the ideal person to decide is the patient, however they would need to decide this in advance, as by the time they're having a cardiac arrest they will not be in a fit state to decide anything. Many people nowadays make a "Living Will", in fact last week I saw a patient who had her own wishes about resucitation printed automatically on her prescription form, this is a new thing that I must find out more about, it seems a good idea.

As regards NHS staff, sometimes a senior nurse might know the patient best, sometimes a consultant, sometimes a GP, sometimes no one, it all depends.

The reality in my experience is that NHS staff always try to resucitate if there is any reasonable chance of restoring a worthwhile quality of life. We are all going to die eventually, whatever happens, and Gods forbid we ever get to the American situation where people are compelled to stay alive even when their quality of life is zero.

if there is any reasonable chance of restoring a worthwhile quality of life.

There in lies the problem for many people and the 'Patient's Association' I believe.

For an individual to make the decision that your life is worthwhile or not will give many people great fears and concerns. But this is not a new issue and does not only apply to Nurse Practitioners; it is a modern-life issue that applies to all professionals with this level of responsibility and has worried us all for a long time now.

Where is the line drawn on the definition of 'worthwhile'? Who has the spiritual right to tell me that mine or any member of my family's lives is 'worthwhile' or not.

Who is better placed to make such a decision a Practitioner or a family member???

Rx

Having worked in ITU (paediatric) for many years, I can say with experiance that, although the decision to withdraw treatment for critically ill patients was the final decison by doctors, many consultants would listen and agree with what these experianced nurses advised and they would agree and it would be written in the patients notes as 'After discusion with family, no rescusitation if patient deteriates further'.
So from what I understand about this new law, it would be a senior nurse that would make that decision and document it.

After all doctors are not there 24 hrs a day with a critically ill patient.
ITU nurses have a continuity with their patient so they know every sign and symptom and can access the deteriation through observation.

I do take your point Healistic about many other interventions not being successful, however not many of them invovle manipluating a patient's chest to the point where broken ribs occur (and this does happen) that said a fear of failure should NEVER be a reason not to try - and this applies to everything in life ~ not just healthcare.

Again it is true that patient's can and do try to hide their feelings and this can be successfully done from family etc when they are visiting for a short time - it is not so easily done on a longer term basis when nursing staff are present 24/7. I do speak from a position of working at a lovely hospital where the nursing staff are very involved with all their patients - and I do know that unfortunately there are other hospitals where the nursing staff may not be quite so "interactive" for want of a better word.

As for guidelines not being followed - this does happen everywhere, but I have yet to come accross a nurse who does not take her registration with the NMC seriously (please don't mention Beverly Allitt) and I do honestly feel that as long as there are 2 practitioners involved in finalising any such decision ~ the right decision will be made.

Cirrus - you are right about the pressures placed on the NHS by the Govt, unfortunately this is driving many fantastic staff away - on all levels.

And Caringsoul you are right that many doctors already take the lead from nursing staff in considering a patient's treatment with regards to resuscitation.

There are no doubt many stories - all heartbreaking with relation to decisions about all treatment being wrongly applied - I myself lost my father when he was aged only 41, and for a long time felt very angry from outside the system - but I know for certain that if my mother (in her 60s now - but very frail) was to suffer a cardiac arrest in hospital she would not survive a resuscitation attempt and I would not like to think of her final moments being surrounded by several medical professionals battling in futile with her body - it is undignified - if it were my step-father on the other hand who is extremely fit & strong I would expect every attempt to be made.

These decisions are made on an individual basis and most certainly will continue to be so - each patient is an individual - they may be the same age with the same condition but circumstances can still be different. Nursing staff are just as qualified to be able to maintain awareness of this individuality and make realistic and sensible decisions.

Ooh I'm sorry :023: just reading this back and its beginning to sound like a lecture so I'm stopping here!!

Love & Hugs to everyone

Wispy~Misty xx

There in lies the problem for many people and the 'Patient's Association' I believe.

For an individual to make the decision that your life is worthwhile or not will give many people great fears and concerns. But this is not a new issue and does not only apply to Nurse Practitioners; it is a modern-life issue that applies to all professionals with this level of responsibility and has worried us all for a long time now.

Where is the line drawn on the definition of 'worthwhile'? Who has the spiritual right to tell me that mine or any member of my family's lives is 'worthwhile' or not.

Who is better placed to make such a decision a Practitioner or a family member???

Rx

I agree. I get the feeling that the medical profession view some patients' lives as being "less worthwhile" than others - which is quite scary and really alarming. These include those who are elderly and those who have disabilities.

Slightly off topic - When i was younger I visited Russia (before Gorbachev) and found that most Russians were terrified of ever being ill and having to go to hospital due to the lack of care, dirtiness etc. Me, being young and naive, couldn't imagine a situation where I'd be scared going to hospital. Given the fact that I now don't know ANYONE who has come out of hospital in the last few years who has had a good experience (some have caught MRSA, others been treated with no dignity, others been left to fall and lie there until found, long queues/waiting lists, unable to get drugs they need, no back up care, helplines unobtainable - the list is absolutely endless) I can honestly say i'm terrified at the thought of ever having to go in.

Some of the posts seem to be along the lines of Doctors will value a patients life more than a Nurse will.

Nurse's are just as committed as Doctors in saving a patient's life and are often more qualified than a junior doctor to decide when a resucitation attempt should be made. For many people these attempts are unsuccessful and achieve nothing but the fact that you ended your life in an extremly undignified way.

Doctors do not resucitate every patient so why do we feel that they are more apt to make these decisions than nurses?
xx

ps: sorry for such a rushed post on my way to an appointmnet!