Facility Nurse Watches Patient Slowly Die, Refuses CPR

Originally posted by stars15k
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When we signed her into the home, we signed a DNR. We were told at the time that it would mean a heart attack, stroke or illness would not get any CPR. If she would stop breathing, no mouth-to-mouth or oxygen.

A fair choice, made carefully no doubt. However, your relative was sick with Alzhiemers, where as the deceased lady in the article was sound enough of mind to be allowed to opt in or out of a DNR for her self. She chose life over death, while still capable of sound reason, and despite that, her wishes were not followed.

I feel for the family.
But most I feel for the nurse, and the people who have been demonized because of this policy. Old sick people die. That cannot be helped. When that policy is stated, understood and signed, this happens. It's not anyone's fault.

I cannot agree. The lady mentioned in the OP stated clearly that she did not want a DNR notice placed upon her, meaning she wanted to be saved if just such an event, as the one which came about, were to transpire. Her wishes, as a customer, as a resident and as a human being were completely ignored, in the most callous and utterly unacceptable manner, in the presence of people who were qualified to save her life, just unwilling to get in trouble with thier paper pushing, money grubber of a boss.

Worse than that, from the sound of the conversation between the operator and the nurse, the dying woman was treated like an inconvenience, rather than a valued human being at the end, and that will never be appropriate. Reserve your feelings for the operator who was on the telephone, possibly the only person in this whole sorry episode who actually gave half a crap about the dead woman.

Originally posted by Hushabye
This was posted the other day....several times

There are several reasons not to perform CPR on an 87 year old woman who was most likely not in good health.

Originally posted by Hushabye
The patient might have had a DNR. The cpr could have been caused damage to the patients' frail body...broken ribs from chest compressions, etc could have punctured the heart or lungs...or both.

87 years old is a good, long run.

edit on 4-3-2013 by Hushabye because: (no reason given)

Every second in this life is precious.Every minute, every smile, every small joy. What kind of monster would rob that old woman of even one more day of a chance of experiencing just one more little joy! It sounds more like her kids were uncaring and just didn't want to be burdened with her. What gives nurses the right to decide who dies.

As a nurse who has real life experience of being involved in some very complex resuscitation cases I feel it is my duty to interject and add some more sanity to this thread.

Firstly, as has already been said, when the women went into the care facility she was informed that in the event that her heart was to stop staff would not preform CPR but rather would call 911 and that her daughter who is a nurse agreed with this and has said that she has had no problem with the care provided.

I cannot tell you if what the nurse (if she is a RN) done was right or wrong because I was not there however speaking from personal experience I can understand why a nurse would not preform CPR even in the absence of a DNR form. There is a strange misconception that I blame on the media and particularly on medical tv shows that depicts CPR as some magic tough that we have that can jump start a heart and bring a patient back exactly as they were once before. This is not true I can tell you that it is not a pleasant experience for anyone but worst of all for the patient. A full resuscitation involves a someone pounding so hard on your chest that they can snap your ribs, putting in large bore needles in you, inserting endotracheal tubes and lots and lots of body fluids. If a person survives the initial CPR they are going to be in a intensive care unit for quite some time and they are more than likely to have significant brain damage and will probably die soon after with more tubes than you can count sticking out of them.

So its not so much about preserving live, but rather it is about preserving quality of live.

We know this woman is 87 and required residential hospital care, that means she probably had multiple core-morbidities. The changes of CPR being successful for a person of that age in residential care are next to none, the odds of her having a good therapeutic outcome probably even lower. I can recall one case where I saved a 74 year old lady with CPR she spent the last 3 days of her life on life support with every tube you can think of sticking out of her. In another case I didn’t do CPR on a man of the same age using my clinical judgement and he passed away peacefully with me holding his hand that was actually a much better outcome. Yes he might have survived the initial cardiac arrest but its not worth if for weeks of pain that follow after only to die at the end in hospital.

I think all these “arm-Chair Nurses” posting about how horrible this nurse is and about how she should be up on murder charges and lose her job are quite frankly idiots who have clearly never been in her situation and as such are in no place to judge. Saying “the nurse should have done CPR” is a bit like telling a solider he should have shot the suicide bomber on the leg, you can’t possible say such a thing unless you are directly involved.

So would all the people who quite clearly know nothing about emergency nursing care please do us professionals who know what we are talking about a favour and shut up and stop making our already difficult jobs even harder by second guessing us.

Would I have done CPR on that woman, no.

The Nurse and any other medical people that were there, should have ALL there medical liscenses and certificates removed, and banned from ever practices medicine and life saving procedure again. SHE and The fellow people FAILED miserably

reply to post by Glassbender777


No they shouldn’t please read my above post.

reply to post by OtherSideOfTheCoin


Yes she was 87, but I still think CPR should have been preformed. If she doesnt come back after that, then So be it. But just to stand around and watch her die, is a bit much. If this is the way most nurses act, then something should be done. I understand its about quality of life, but No one has that authority except the patient, and sinse they are now dead, I guess her quality of life was made by someone who wasnt even going to live that life. Weird and a bit Evil if you ask me

reply to post by Glassbender777


no if you were a experienced nurse you would not have such a view.

Its not simply a matter of CPR and everything is all better, if you do CPR on a woman of that age she will suffer needlessly for it and her death will be longer and less dignified. She will spend her last days on life support and eventually die.

I have watched countless people die, I have spent nights will old men on their way out as the confide in me their inner most daemons then watched them take their last breath and as cold as this may sound after words I have went for a tea break then gone hope and slept like a baby knowing I done the right thing. CPR is not always appropriate sometimes just holding a person’s hand is enough

reply to post by OtherSideOfTheCoin


I second this. There are FAR worse things than keeling over and dying quickly at 87, believe me. Like the court case that drags on for years bankrupting your family while doctors, judges, lawyers and other sharks and scumbags all argue over whether to pull the plug on you now that you're brain dead but taking up hospital space anyway. Meanwhile the care you're getting is maybe good enough to come in and turn you once or twice a day and change your diaper within several hours of you messing in it... and all your food comes in a tube down your nose and there's never a moment's peace around the clock, with regular stabbings AKA blood draws every day. Fun, fun.

The people who have active RESUSCITATE ME NO MATTER WHAT orders at that age are living in fear of the inevitable. GO ALREADY!! The other side is wonderful!

reply to post by OtherSideOfTheCoin

if you do CPR on a woman of that age she will suffer needlessly for it and her death will be longer and less dignified. She will spend her last days on life support and eventually die.

Most of your post seemed objective here so I have to ask if you're being so with this statement. Every time you do CPR on an 87 year old it will result in that person spending the rest of their life on life support?

reply to post by signalfire

The people who have active RESUSCITATE ME NO MATTER WHAT orders at that age are living in fear of the inevitable. GO ALREADY!! The other side is wonderful!

Which is completely unproven. We have no idea what if anything awaits. This thread isn't about your faith, or faith in general.

Originally posted by OtherSideOfTheCoin
As a nurse who has real life experience of being involved in some very complex resuscitation cases I feel it is my duty to interject and add some more sanity to this thread.

Firstly, as has already been said, when the women went into the care facility she was informed that in the event that her heart was to stop staff would not preform CPR but rather would call 911 and that her daughter who is a nurse agreed with this and has said that she has had no problem with the care provided.

I cannot tell you if what the nurse (if she is a RN) done was right or wrong because I was not there however speaking from personal experience I can understand why a nurse would not preform CPR even in the absence of a DNR form. There is a strange misconception that I blame on the media and particularly on medical tv shows that depicts CPR as some magic tough that we have that can jump start a heart and bring a patient back exactly as they were once before. This is not true I can tell you that it is not a pleasant experience for anyone but worst of all for the patient. A full resuscitation involves a someone pounding so hard on your chest that they can snap your ribs, putting in large bore needles in you, inserting endotracheal tubes and lots and lots of body fluids. If a person survives the initial CPR they are going to be in a intensive care unit for quite some time and they are more than likely to have significant brain damage and will probably die soon after with more tubes than you can count sticking out of them.

So its not so much about preserving live, but rather it is about preserving quality of live.

We know this woman is 87 and required residential hospital care, that means she probably had multiple core-morbidities. The changes of CPR being successful for a person of that age in residential care are next to none, the odds of her having a good therapeutic outcome probably even lower. I can recall one case where I saved a 74 year old lady with CPR she spent the last 3 days of her life on life support with every tube you can think of sticking out of her. In another case I didn’t do CPR on a man of the same age using my clinical judgement and he passed away peacefully with me holding his hand that was actually a much better outcome. Yes he might have survived the initial cardiac arrest but its not worth if for weeks of pain that follow after only to die at the end in hospital.

I think all these “arm-Chair Nurses” posting about how horrible this nurse is and about how she should be up on murder charges and lose her job are quite frankly idiots who have clearly never been in her situation and as such are in no place to judge. Saying “the nurse should have done CPR” is a bit like telling a solider he should have shot the suicide bomber on the leg, you can’t possible say such a thing unless you are directly involved.

So would all the people who quite clearly know nothing about emergency nursing care please do us professionals who know what we are talking about a favour and shut up and stop making our already difficult jobs even harder by second guessing us.

Would I have done CPR on that woman, no.

edit on 5-3-2013 by OtherSideOfTheCoin because: (no reason given)

First , sorry for my english.
I am myself a nurse with over 15 years experience , mostly with end-stage diseases.
I am so sorry to hear such a words from a collegue of mine...
"our already difficult jobs" says it all for what you think about our proffesion . One work is difficult only if is done without dedication.
There is no other job on this world more beautiful than to help other people EVERY day.
I don't agree with "quality of life" . Who am i to judge the "quality of life" of other person ? Who are we to judge that ?
Every measure should be taken to save every life under our care, without discimination . And i am not "guessing it".

Would I have done CPR on that woman, YES.
By All Means Necessary !
And not only in my working hours , but EVERY TIME my help is needed and i have the competence to help.

In my country, is LAW : "...Nurse, midwife and the medical assistant were required to take first aid measures. ,
...Nurse, midwife and the medical assistant are required to provide medical care and necessary care within their professional competence..."

It doesn't matter if she is 85 years old or 58 or whatever . That's not the point . Please talk sometime with a oncology nurse , or a ICU nurse, you will find more on that subject. They are fightin everyday with death. Sometimes they win , sometimes they don't.
UNLESS :
If the patient is in a physical or mental condition that does not allow lucid expression of will, the family members or relatives suffering should be advised and informed of the right to decide on its behalf, except impossibility (identification, communication, travel etc..) or EMERGENCIES.

It's sad. That is my humble oppinion.

reply to post by OtherSideOfTheCoin


holding a patient’s hand is the priest job. Our job is CPR.

If, and only if, that person was your mother , what would you do ? Stand beside and watch ?

Originally posted by CALGARIAN
She was under STRICT ORDERS to not medically assist these people, they are to CALL 911 and stand by.
THAT IS IT.

She was on duty. She would have lost her job if she provided CPR. I understand a life is more important than her job BUT.. thats how it is

DONT BE MAD WITH HER, BE UPSET WITH HER EMPLOYER!

If your job is more important than even the least important life, you have failed as a human being.

What part of "she was misidentified as a nurse" do people not get?

She called herself a nurse on the 911 tape, but her official job capacity at the home was not a nurse, she was a Residence Services Coordinator or some such.

She may be an LPN or RN at another facility, but that residential home is NOT LICENSED to provide medical care. Regardless of the outcome, had she lived or died, if anyone, in their official capacity had provided medical treatment, the home could lose their license.

This is why they sign the contract illucidating that they understand this and agree, which the daughter and Ms. Bayless signed.

It is an apartment for elderly people. Do you tell your apartment manager if you have a DNR? No! Then why would this apartment for the elderly have, or not have, a DNR on file?

If they did, if would break Federal Law to tell the press. Remember that HIPAA law everyone throws around at the wrong time? This is actually the right time. Ask yourselves, before eating up everything the media says, where they got that information?

If she did state she wanted everything done, then it was for nothing more than to pass on to the EMTs when they arrived.

The one thing people are glossing over. She didn't die at the home.

She died later at the hospital.


So, unless you are psychic, God, or have some other magical knowledge, no one knows the cause of death, and it's relation to what happened at the home. If she died LATER at the hospital, then perhaps nothing could be done in any capacity to save her. Without more information, that you will likely never have, it is impossible to judge.

reply to post by OtherSideOfTheCoin


Now having the full facts I also would not have done CPR.

We should learn how to let go of the dying sometimes, It will save a lot of pain for those dying.

reply to post by OtherSideOfTheCoin


Nurse here as well.


Agree with pretty much everything you added.
Its in no way as simple as people seem to think.

When I first saw this on the news the other day I was disgusted. Reading a bit more, well, can somewhat understand.
Wouldn't wished to have been in that position for sure.

End of the day you make the call at the time and in the context...pretty much all you can do.

Originally posted by Lucid Lunacy
reply to post by OtherSideOfTheCoin

 

if you do CPR on a woman of that age she will suffer needlessly for it and her death will be longer and less dignified. She will spend her last days on life support and eventually die.

Most of your post seemed objective here so I have to ask if you're being so with this statement. Every time you do CPR on an 87 year old it will result in that person spending the rest of their life on life support?

edit on 5-3-2013 by Lucid Lunacy because: (no reason given)

Just to note, she said rest of her DAYS, and I would say 99% of the time, yes.

Broken ribs, people are saying, "So what? A few broken ribs is nothing!"

Not the case. Most elderly people are thin and small framed. The broken ribs can puncture lungs, resulting in a pneumothorax, a chest tube, and a pathway for infection and pneumonia.

Broken ribs can also puncture the heart, resulting in massive blood loss into the chest, which leads to othe graphic things I won't go into.

All you have to do is stand at bedside ONE time and witness CPR on an elderly person to understand.

If the broken ribs puncture other organs, liver, stomach, well - you cannot even imagine the things that can follow.

I have seen family memebers that "want everything possible to be done" standing at bedside during CPR, within a minute, beg for them to stop. It is NOT what you see on televsion.

It is brutal, tortuous, and painful - even for the healthier and younger people with more flexible bones, but no one can describe the sights and sounds, nor the feeling, of an 87 year old chest and ribs literally crushing beneath your fingers, and what follows next.

ETA: also, one thing to keep in mind, a lot of elderly people have a condition called kyphosis, which literally keeps them from lying flat. This causes two major problems during CPR. First, it makes intubation difficult to impossible, and second, once chest compressions are done, the persons back BREAKS. This, in itself, usually causes almost instant death.

reply to post by Libertygal


Yup.

Having had to perform such on a number of elderly people over the years...high chance you're pretty much just shattering already brittle bones and turning every organ under it into a pin-cushion...

...its a pretty messed up place to be in...

EDIT TO ADD: 18 years in the profession - I thankfully only had to do two on patients over the age of 70 and about half a dozen 'assists'...none survived.
Well, one did, for about a week...passed due to the inevitable trauma and complications it creates...and it wasn't a pleasant way to go either for them.
No rationalisation in my mind could ever put to rest the pain that elderly gentleman was put through.

Pretty much why I got the heck outa General Med and specialised in Mental Health.


Sucks mightly.

Originally posted by Catalyst317

Oh the inhumanity (I'm serious), that's just terrible, and it was as if the nurse who answered was responding to what she felt was a demanding lady on the phone and didn't like being bossed around and didn't care.

Then to add insult to injury, at the very end we learn that the lady's daughter also a nurse was completely satisfied with the help and aid her mother received (did not receive) as if to say that she was satisfied with her inheritance.

Things are starting to get absurd in this crazy world of ours.

I'm so glad that this is making the rounds to raise awareness about what's falling through the cracks of our modern "civilization".