Nurse refuses to perform CPR on elderly woman

[Hunter]

http://www.ems1.com/ems-news/1413517-911-call-nurse-refuses-to-perform-cpr-on-elderly-woman/

Wow... I'm not sure what to say.

No DNR and daughter says she remains satisfied with the care her mother received at the facility. Sounds like someone wants some inheritance money.

 

[Veneficus]

http://www.ems1.com/ems-news/1413517-911-call-nurse-refuses-to-perform-cpr-on-elderly-woman/

Wow... I'm not sure what to say.

No DNR and daughter says she remains satisfied with the care her mother received at the facility. Sounds like someone wants some inheritance money.

or somebody realizes an 87 y/o in a nursing home probably isn't going to have any quality of life post resuscitation.

 

[STXmedic]

They made it sound like she was never even in cardiac arrest.

The policy of no CPR seems kind of ridiculous, though.

Seems like there's some things missing from the story.

 

[DesertMedic66]

Not in my scope...

 

[Hunter]

or somebody realizes an 87 y/o in a nursing home probably isn't going to have any quality of life post resuscitation.

She lived in an independent living facility, people who live in places like this are usually, independent... able to walk on their own or with a walker, feed themselves, usually on the healthier side for elderly people. But the policy of no CPR is what bothers me, what if an 50 year old employee has a heart attack. No CPR then?

 

[Veneficus]

She lived in an independent living facility, people who live in places like this are usually, independent... able to walk on their own or with a walker, feed themselves, usually on the healthier side for elderly people. But the policy of no CPR is what bothers me, what if an 50 year old employee has a heart attack. No CPR then?

I am just going to take a wild guess that it applies only to the residence which likely at some point to get into the facility, have expressed if they face the possibility of not living independantly then they want to die with dignity.

People do that all the time. In fact my mom did.

In order to get a DNR in most places you have to have a specific terminal condition. It does not take into account an acute terminal decompensation from random pathology.

 

[EpiEMS]

Let's put it in chart form:

Per a 1998 study on physician preferences for end-of-life care, physicians don't want aggressive care at the end of life. And they *especially* don't want CPR. I almost get the feeling that the more you see futile treatments performed (*cough* ACLS *cough*), the less you want them done on yourself or family members.

 

[Veneficus]

For many years now, at least 7 that I know of, and I stipulate many more, the healthcare community has changed from a philosophy of single combat with death for life immortal, back to seeing death as a phase of life.

Whether we like it or not, eventually we all die. At some point nothing can stop that. It is just a question of how much suffering we are willing to endure before the inevitable.

EMS might be a bit behind the times as usual, but the general populous is starting to accept this again. As you can see from the chart, doctors have for a long count of years.

 

[EpiEMS]

For many years now, at least 7 that I know of, and I stipulate many more, the healthcare community has changed from a philosophy of single combat with death for life immortal, back to seeing death as a phase of life.

Whether we like it or not, eventually we all die. At some point nothing can stop that. It is just a question of how much suffering we are willing to endure before the inevitable.

EMS might be a bit behind the times as usual, but the general populous is starting to accept this again. As you can see from the chart, doctors have for a long count of years.

Do you think that at one point people were more of the "If the doctor says they can't be helped, they can't be helped" mindset prior to the last cycle of "save all the patients"?

 

[Veneficus]

Do you think that at one point people were more of the "If the doctor says they can't be helped, they can't be helped" mindset prior to the last cycle of "save all the patients"?

Absolutely. Just about everyone prior to the late 60s.

 

[VFlutter]

They are never specific when the use the term "nurse" in news stories. Especially at a nursing home where they use the term very loosely. I am really hoping it is not an RN.


Also, it sounds like she was never in cardiac arrest? She was having trouble breathing

 

[Aidey]

Some places have some strange policies, so I could believe they have a policy against it. We've got a couple places around here that refuse to honor DNRs. They've said if we want to honor it we can, but they won't.

 

[Handsome Robb]

Some places have some strange policies, so I could believe they have a policy against it. We've got a couple places around here that refuse to honor DNRs. They've said if we want to honor it we can, but they won't.

Agreed. They're definitely some strange policies out there.

I didn't listen to the tape but I read the article. Weird situation.

We have a few places that I've responded to cardiac arrests and the patient was a DNR. I asked why they called, since they are a medical facility with an MD, RNs, LVNs and CNAs and was told they couldn't pronounce the patient...I'm giving them the benefit of the doubt and assuming the doc was tied up. At least that's not a long chart to write. Pretty simple one actually.

 

[ExpatMedic0]

wow I just watched the 5 minute video with the 911 dispatch recording.... pretty interesting stuff....

 

[the_negro_puppy]

Very weird.

But it seems counter-intuitive that the Nurse would call 911 for EMS help yet actually obstruct help for the patient by refusing to do CPR or give the phone to someone else.

 

[Handsome Robb]

Very weird.

But it seems counter-intuitive that the Nurse would call 911 for EMS help yet actually obstruct help for the patient by refusing to do CPR or give the phone to someone else.

I don't understand how dispatchers do it.

During my required annual dispatch time I listened to a call taker take a cardiac arrest call and the caller refused to do CPR and kept threatening the dispatcher that "you're going to have to send an ambulance for ME if you don't stop asking me questions and trying to get me to touch her!!" She followed through too.

It was a "senior apartment complex" and the caller was an employee. She kept saying "I can't believe this is happening!" It's like lady, you work at a SENIOR apartment complex...did you really think you weren't ever going to experience this?

 

[WTEngel]

I find myself conflicted on this matter.

On one hand, I think, this lady was in fact elderly, the likelihood of a positive outcome was virtually non existent even if immediate CPR was started (for multiple reasons, the nurse would have done poor CPR, the patient probably had multiple co-morbidities, etc.) and if there was ROSC, it likely would have extended her suffering, only to see her removed from life support a short time later.

The main issue I have though is that all of those reasons I stated above had to be qualified with "likely" which means I am guessing, and don't really know what would have happened. In reality, with the way things went down, we know that no CPR was performed, we know the patient was having agonal respirations ("breathing difficulty" indeed!) and we know that the "nurse" used every excuse in the book and flat out refused to even identify another person to assist.

What makes that nurse judge, jury, and executioner in this case? What gives her the right to say, no I will not perform CPR, and I will not attempt to identify anyone who will? I am not even talking about the legal right to state these things, I am talking about the ethical and moral right to do these things.

Furthermore, I agree with previous posters who ask why even bother calling 911? What kind of weak individual punts all of the tough decisions to EMS?

The case does irritate me quite a bit, even though I think in the end, the outcome would be no different had alternate events transpired, and this outcome was likely the one that involved the least amount of patient suffering in the end.

I wasn't going to initially post on this matter, but after hearing the 911 tapes this morning it kind of got me flustered about it.

 

[MrJones]

I'm still trying to figure out how a health care professional can, with a clear conscience, work at a facility with a policy that prohibits taking any lifesaving actions beyond calling 911.

 

[Household6]

Exactly why my retirement plan is to rob a bank when I'm 80.. I'll get three hots and cot at the Hoosegow, and state funded medical care..

I don't understand this situation at all..

 

[firecoins]

This sounds like an assisted living facility and not a skilled nursing home. The nurse is most likely an lpn.