As a nurse it is important to discuss a patients advanced directives wishes. Believe it or not but many patients and their families have no idea what an advanced directive is, let alone how to begin the process of filling out the necessary paperwork to complete one. The best time to talk to a patient and their family about advanced directives is during the admission process. This will let both the nurse and doctor know what the patients wishes are if a code situation was to happen and who the patient would like making decisions about their health care.
Here is an excellent story that was submitted by one of our readers regarding her personal experience with advanced directives. This story is really unbelievable and here at RegisteredNurseRN.com we had to share it with our readers. Feel free to share this story with your friend and colleagues!
How Often are You Discussing Advanced Directives with Your Patients?
Thoughts from a Reader
Last weekend when I worked I experienced something with another nurses patient that made me think about the importance of discussing your patien’s code status with them. As you probably already know, many patients and their families do not fully understand what it means to be a “full code” or a “do not resuscitate (DNR)”. By talking to a patient and their family, about a patients code status you are able to follow out their wants and needs therefore providing the type of healthcare they would want.
So here is a story about why I think discussing a patients code status with them is very important. It was a typical Friday on my unit. Everyone getting discharged and new admissions coming in. One of the nurses I worked with was talking to me about something interesting her patient asked her and asked me how I would have handled it.
She stated she assisted her patient up to the chair and while she was walking out her patient asked her, “What would you do if I died in this chair?”
Caught off guard the nurse said, “Well I would resuscitate you.”
The patient in turn said, “Well what if I don’t want you to resuscitate me?”
She replied. “Well according to what the doctor wrote in your chart you are considered what is a full code and that means if anything happens to you I must resuscitate you.”
The patient then replied, “That is not what I want!”
The patient’s nurse then discussed with the patient and his family about what being a full code means and what type of measures would be used if he were to die. Then she explained to them about what a “DNR” was and what type of treatment would be provided if he was to die. After the explanation the patient decided he wanted to be a “DNR”. The primary doctor was informed about this and wrote an order in the chart for the patient to be a “do not resuscitate. After she finished explaining this to me I told her she handled the situation very well.
Then came the next day, Saturday. It was around noon time when that nurse came running down the hall asking for assistance while at the same time our telemetry station was calling to say that a patient was in v-fib (ventricular fibrillation). It was the same patient that the nurse was telling me about the day before. The patient passed away sitting in the chair, almost like how he predicted he would have the previous day.
The nurse was upset but relieved that the patient had brought up the subject the previous day and his wishes were carried out. She was a little bit “freaked out” about how coincidental it was and she kept saying it was like he knew it was going to happen.
When I look at a situation like this I always think about the what ifs. What if that patient would have never asked his nurse what would she do if he died? What if the nurse never took the time to explain code status to him because she was too busy? Would he had made the same choice?
The key is to always assess your patients understanding of their code status and always take the time to explain it to them. This situation may seem unbelievable but if you have been a nurse for any amount of time you know that it is always possible for the unbelievable to happen in the nursing setting.