Dnr Dilemma

As a nurse, I believe that it is imperative that the care provided to a patient coincide with their wishes. Sometimes families and providers are left in the position to make many decisions regarding patient care, and it is imperative that those decisions be determined by the patients personalized goals for care. Many caregivers face this challenge more than we would like to admit. I recently experienced this dilemma as I cared for a patient originally admitted for signs and symptoms of cardiac impairment. Her heart checked out fine however, it did appear her cancer had reappeared with an aggressive nature. The patient had become increasingly weak and unable to communicate effectively, leading up to her admission. The patient was very weak
The family continued to decline a change in code status until the PET scan was completed. Furthermore, the healthcare proxy for the patient was strongly against giving the patient anything for pain or anxiety. This made me very uncomfortable as the patient was often restless and appeared to be in pain. Each time a medication was given, she questioned the dose and even instructed some of the staff on how much medication she would like her mother to receive. Thankfully, palliative care was consulted on the patient’s case and enlightened the care team and family of the patient’s living will, stating that the patient wishes to be a DNR in such cases where treatment may lower her quality of life. As you can imagine this complicated matter became even worse; daily the patient was being stuck for labs, iv sites, she was being woke up every four hours for vital signs, and turned every two hours, not to mention the gastrointestinal problems she was experiencing due to her cancer. I was struggling to care for the patient not only due to her complex medical needs, but the ethics surrounding her situation as
The family was refusing to recognize the patient’s living will, asserting that there was an error of some kind. I felt conflicted about the entire situation. I wanted to promote the patient’s wishes but it was impossible to do so if the patient could not even communicate her simple needs or confirm her wishes as stated in her living will. I felt as though I was torturing the patient, prolonging her suffering through repeated tests, procedures, and needle sticks. This predicament validated my belief that care provided to a patient should coincide with their wishes and goals for recovery or comfort. Though the family choose not to recognize the patient’s living will, the patient still had goals of her own, her limited communication affected her care, and quite possible may have prolonged her discomfort against her will. Many people want to see their loved ones healed in the conventional sense of a full recovery with no alteration in lifestyle. This is not possible or reasonable for all patients. Daily, many people and their families are faced with difficult decisions and new realities. There is no one right or wrong answer as to how they should face these difficulties. Unfortunately, every patient does not make a full