Nurses and the Cessation of Life.

[Kwackerz]

For the first time in the history of the profession, senior clinical nurses have been given the authority to decide whether or not patients should be resuscitated.

The official guidance, issued by the British Medical Association, started a fierce debate last night. Although some medical professionals welcomed the new rules, patient groups voiced concerns that they could place unfair pressure on nurses.

Previously, only consultants and doctors of General Practitioner rank had the power to decide not to resuscitate. However, under the new rules, "properly experienced" clinical nurses will be able to make that judgement.

The BMA's guidance is partly in response to the Mental Capacity Act, which came into force earlier this month. This introduced the concept of a living will, which allows patients to state in advance their wish not to be resuscitated in the event of their heart or breathing stopping, or to choose someone to make the decision for them if they are incapable of doing so.

Full story: http://www.telegraph.co.uk/news/main.jh ... rse127.xml


Anyone got a view on it? I dont really know, but there is a hint of uneasiness about the issue. I want to live! How can a nurse say I cant? I know that nurses do do a lot of learning, our next door neighbour was an SRN and had to do loads for her position as a mental nurse (read either way.. she was.. ) but.... well...

Views?

[Samray]

Not too sure whether nurses or doctors would have more interest in 'meeting targets'.

[Gio]

If I was to be carried into hospital tomorrow with no chance of a proper life, ie a living cabbage thats kept alive by a machine, then I'd want it turned off, I've always been felt that way

[Aladinsaneuk]

in the main, its bullshit

we have been doing it for years

The difference is, the role nurses play as patient advocates is being recognised, and the fact that we are closer to the patients, and know them generally better, is being officially recognised

it is very hard to explain exactly what or how we do things, but, trust me, nurses have been making these sort of decisions for a long time

[Kwackerz]

Maybe nurses who're designated as responsible should get a procedures book they have to tick all the boxes but then can say yay. A legally binding thing, a record book.


I do think it will be open to misuse though. But isnt everything nowadays?

[Aladinsaneuk]

doesn't work like that mate

ok, a couple of facts

a few years ago I was involved in some research around cardiac arrest outcomes - Pre Arrest Morbidity scores.

Basically, we went through a huge number of cases of people who had had cardiac arrests and analysed the conditions that they had - and what they had had in the past disease wise.

certain diseases, renal failure, strokes, cardiac disease etc were given a score of one

the results were astounding - effectivly if you had a PAM score of 3 or more, you would not survive a cardiac arrest and be discharged home.

Now lets factor in another thing - arrests are brutal, violent events - forget the clean scenes you see on holby city or where ever, they are not nice - and they can go on for a long time - I know I have still been doing cpr on some one after 30 minutes....
If we consider that the person, though clinically dead due to no cardiac output, is being artificially maintained by cpr, then we must also accept that the person can still feel. Certainly, many people who have been successfully resuscitated have reported that they were aware of some events.

That makes you think a little doesn't it?

Now, I teach my staff to accept that if someone arrests, they have died - but we are going to try and give them a second chance - that way they can deal with the failures a little better - and again trust me, the effect on staff after an arrest is traumatic, even if you are successful.

so, we have to treat each person as an individual - the PAM score may make us fill in some tick boxes etc - but as nurses we may be able to see beyond that... I know that I have kept some one alive for nearly 30 hours, with the help etc of the medics, just so that the individual's family could get to the hospital from abroad - to say good bye. If I had of followed what my brain said - this is a hopeless case, its time to stop, that family would not have had that chance....

So - as soon as you start allowing the twats in whitehall to dictate actions by paperwork, then the raison d'etre of care will suffer - so no tick lists, lets just be allowed to care and act in the right way for each person

and for the record, have a close look at who decides on resus status for someone now.... it is, in real terms a medical only decision - though they are supposed to discuss this with other members of the health care team, the family and most importantly, the patient themselves - that rarely happens if the truth were known

[BikerGran]

I'm another who believes that if I'm that bad there's any question of turning off the machine, or deciding not to resuscitate, then please let me go! I'm not all that bothered who decides, and it would be good if my family were able to be there but that would be for them rather than for me.

[Samray]

Having twice been in the position where I was the one that had to make the decision to switch off life support I would not wish that quandary on anyone.
Fortunately for once in my life I was not indecisive.
I'm sure it would be easier to live with if the persons wishes were known in advance.
My wishes are known.

[Aladinsaneuk]

I'm sure it would be easier to live with if the persons wishes were known in advance.

spot on