Let's Talk About Death and Dying
By Rose Tucker MSN, RN / June 1, 2017
Death and the dying process is probably the last topic anyone wishes to discuss. But whether we like it or not, we may be asked to make end-of-life decisions for our loved ones without knowing their preferences. It can be both emotionally draining on family to make these choices and confusing as physicians and health-care professionals use medical terms we may not fully understand. As a registered nurse for nearly 30 years, I have had the privilege to care for many people at the end-of-life and offer support and guidance to their family members. The following is some advice I have for anyone asked to make such difficult decisions for a loved one admitted to the hospital and discuss some common misconceptions about end-of-life care.
Our bodies are so complex and weaken differently that each situation is approached differently. But one general question that will need to be addressed in all end-of-life situations is code status. When a person is admitted to the hospital they will be asked if they have a "living will" This is a document that the patient may have signed prior to their decline in health that indicates they do not wish to be kept alive artificially if their condition is terminal. Unfortunately, not many of us
have prepared a living will in advance and now these decisions are left to a spouse or close relative, often called a health care surrogate.
The options for code status are 'full code' or 'do not resuscitate' (DNR). A full code means that as respirations and heart function become impaired and will soon stop, cardiopulmonary resuscitation is performed. CPR consists of compressing the patient's chest two inches at a rate of 100 times per minute until the patient is either revived or the heart is unable to be restarted and death ensues. If resuscitation is resumed, the patient will be on what is often called 'life-support.' This means that the patient will now be on a ventilator that will be breathing for them. The patient will then be transferred to a critical care area of the hospital if not already there.
A DNR code status means that CPR will not be performed when respirations and heart function are impaired and close to stopping, thus allowing death to occur. Different cultures and religious beliefs may dictate these decisions. Because end-of-life decisions are so emotionally difficult, consulting with a religious or spiritual advisor is suggested. Another recommendation is to ask for a family meeting with the physician and other health care professionals when overwhelmed with the decisions to be addressed.
As care is ongoing, I recommend the health care surrogate consider goals for care. Often, a primary goal is comfort care and pain management may be requested for the patient. Food and water may be provided through tubes inserted in the body. While a health care surrogate may feel hydrating the body will only prolong the dying process, others would not consider withholding water and nutrition when the patient is unable to eat and drink on their own. Tests and procedures may be ordered by a physician but of course, can be refused if it is believed the tests and procedures are futile or causing unnecessary discomfort to the patient.
A hospice consult may be suggested also. I urge anyone not familiar with hospice to accept the consult and listen with an open mind to the hospice nurse. The health care surrogate can always refuse to consent to hospice care when the consult is complete.
There are many options that are available when planning for our loved one's end-of-life care. Knowing what to expect and clarifying any misconceptions can be discussed throughout the admission. Expressing any concerns and asking questions is strongly advised. Health care professionals have experience with end-of-life care and can offer guidance when loss of a loved one is near. So, let's open the lines of communication and start talking.
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