Ship of Fools: Nurse refuses to perfom CPR

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Posted by lilBuddha (# 14333) on :

An elderly woman died after a nurse refused to perform CPR. Link here. No DNR was on file. Instead, it is the policy of the facility to not perform CPR.
Anybody have a theory why?

Posted by churchgeek (# 5557) on :

I'd suspect some kind of liability issues that regular folks like us can't understand. I wonder if the facility is upfront about that policy when people sign on to live there.

I also wonder how the event has affected other residents - especially but not limited to any who might have witnessed it.

[Votive]

[ 04. March 2013, 06:23: Message edited by: churchgeek ]

Posted by Doublethink (# 1984) on :

I think if you are gong to have that policy - you have to do it by having only residents who have *chosen* to sign a DNR.

That said I can see good reason for having a DNR if you are 87 and already not able to live independently. CPR will probably break you ribs, this is likely to lead to medical complications if you are old and frail. There is a fair chance you have collapsed due to stroke or heart attack and if you survive therefore; there is a high chance it will be with an increased level of disability or only for a short period, in hospital, full of tubes.

Posted by Boogie (# 13538) on :

My Mum is in a home now and they write up an end of life plan, with the resident or (in the case of advanced dementia, as my Mum has) their relatives. Doctors, district nurses etc all sign up too. It is not an easy meeting to attend - but important to be sure that we are all on the same sad page.

A DNR is essential as broken bones in an already dying patient will simply prolong their agony.

I feel for this nurse - she was put in an impossible situation.

[Votive]

[ 04. March 2013, 07:07: Message edited by: Boogie ]

Posted by Enoch (# 14322) on :

What does CPR stand for please? The linked article doesn't say either. And does DNR stand for 'do not resuscitate' or something else?

Posted by Doublethink (# 1984) on :

Cardio-pulminary resuscitation and yes, DNR is do not resuscitate.

[Slightly amazed you haven't come across CPR before.]

[ 04. March 2013, 07:17: Message edited by: Doublethink ]

Posted by Hawk (# 14289) on :

CPR doesn't work like in the movies. It almost never actually restarts the heart, and then only in young, otherwise healthy patients, who have healthy hearts and there's something else causing the heart failure. CPR causes a lot of damage, especially to the elderly, as well as great distress. It's only designed to massage the heart muscles slightly and force the blood to move a bit to delay tissue death before the heart can be restarted by drugs, or sometimes by defibrillation. Defib also only works on certain specific heart rythmns, and in most cases of end-of-life organ failure, it would have as little effect as CPR.

IMO, in the link, it sounds like the old lady was dying of significant problems. CPR can't fix that. It would only have hurt her, with no appreciable benefit. Either the dispatcher didn't know what she was talking about, or had watched too many movies. The professional expert in this case was the nurse on the scene, not the dispatcher on the phone who may or may not have had any relevent medical trianing beyond general first aid.

In a general emergency, when a dispatcher is on the phone with a non-medical person, it is appropriate to get that perosn to do whatever general first aid can be done, whether it helps or not, until a trained medical person can arrive and diagnose the situation properly. In this case the nurse was already on the scene and the dispatcher had no right to try and overule her medical assessment of the situation. The nurse did the right thing, even though it sounds like she communicated it poorly to the dispatcher, citing policy rather than medical benefit. This story is only valuable as a reflection of poor communication, not poor treatment. There was a disconnect between a phone operator's view of medical benefit, and a medical professional's view.

Posted by lilBuddha (# 14333) on :

Hawk,

From the articles I've read to this point, the nurse made no medical assessment. It appears the opposite, that she was refusing to do so. She was following facility policy which is to call emergency personnel and wait.
IIRC, there are several levels of nursing. Hers is not mentioned.

Posted by Hawk (# 14289) on :

quote:
Originally posted by lilBuddha:
Hawk,

From the articles I've read to this point, the nurse made no medical assessment. It appears the opposite, that she was refusing to do so. She was following facility policy which is to call emergency personnel and wait.

That is a medical assessment. She judged the situation and assessed that the correct policy to follow in that situation was to call 911 and wait with the patient. The policy for that facility (and likely for most places that deal with similar situations) was not to do CPR abitrarily on elderly patients. This is for sound medical reasons. The director of the facility, the woman's daughter (also a nurse), in fact everyone actually involved in the situation, supported the nurse's assessment that this procedure was the correct one for the situation.

The only person who disagreed was the dispatcher for the fire department who wasn't even there. In fact she was just following the fire department's blanket procedure to recommend CPR in all situations, no matter what. This is good advice for the majority of emergency situations where no other medical information is available, but not good advice in this specific sitaution where there was no medical purpose to it. The dispatcher doesn't appear to have realised this, and kept insisting on CPR without any medical assessment of her own, (which she wasn't qualified to give even if she had been on the scene rather than miles away).

You assume that the facility's policy wasn't medically based, but just callous beauracracy. That there weren't sound medical reasons for that policy being there. Nurses don't just make up treatment options on the spot, they follow evidence-based clinical guidelines for each specific situation. I'm not sure why you think these should be discarded and replaced with ad hoc arbitrary treatment just based on what the attending nurse feels like doing.

I understand the article is written in a certain way in order to paint the nurse in a bad light, but surely you can see beyond the rabble-rousing rhetoric they exploit to sell newspapers.

Posted by Zacchaeus (# 14454) on :

quote:
Originally posted by Hawk:
Nurses don't just make up treatment options on the spot, they follow evidence-based clinical guidelines for each specific situation. I'm not sure why you think these should be discarded and replaced with ad hoc arbitrary treatment just based on what the attending nurse feels like doing.

I understand the article is written in a certain way in order to paint the nurse in a bad light, but surely you can see beyond the rabble-rousing rhetoric they exploit to sell newspapers. [/QB]

I think the point is that she didn't make medical assessments based on the specific situation. The facility has a blanket policy of no CPR..

Posted by Zach82 (# 3208) on :

It's probably the official policy of the facility because CPR runs a pretty high chance of killing elderly patients.

Posted by Zacchaeus (# 14454) on :

quote:
Originally posted by Zach82:
It's probably the official policy of the facility because CPR runs a pretty high chance of killing elderly patients.

It maybe for excellent reasons, just same as the emergency services have their policy to reccommend CPR at all times for excellent reasons.

I was just replying to Hawk for what he said about the emergency operator for following a blanket policy.

Neither policies are based on clinical decisions made at the time, just on the most likely best option.

Posted by Jane R (# 331) on :

Zacchaeus, how do you know the nurse on the spot didn't make a clinical decision to follow the nursing home's usual policy? I'd certainly be more inclined to trust the judgment of the health professional who was actually there over that of someone who was several miles away.

Oh, and what Hawk and Doublethink said.

Posted by Amanda B. Reckondwythe (# 5521) on :

I join those who side with the nurse. She acted correctly. Leave it to the media to sensationalize the story.

Posted by Hawk (# 14289) on :

quote:
Originally posted by Zacchaeus:
I was just replying to Hawk for what he said about the emergency operator for following a blanket policy.

Neither policies are based on clinical decisions made at the time, just on the most likely best option.

Maybe both are blanket policies. But one is for all patients in a particular, highly specific circumstance, this facility which evidently cares exclusively for a certain type of patient. I don't know precisely what this facility is, but I would suspect it is akin to a UK palliative care home. In such homes, patients are admitted with the knowledge and understanding that they are dying and the care and the policies relating to that care are designed to keep the patients as comfortable as possible for as long as possible until nature takes its course. Painful and traumatic intervention to forcefully keep patients alive just for its own sake is counter-productive to this approach. From what I've read the DNR policy is communicated oto all patients and their families when they sign up to live at this facility.

As an aside, personally I do think there is an over-reliance in nursing training in the UK on following procedure rather than a full awareness of the rationale and clinical evidence behind each procedure. This has the effect of sometimes building a sense of nurses as functionaries rather than medical professionals, and patients can feel like they are being treated as a series of boxes to be ticked off rather than a whole person. It can lead to nurses labouring to do something difficult for hours, when someone with an understanding of the medicine underneath the policy could see a quick and easy shortcut. Following policy usually won't put patients at risk, just make nurses appear cold and beauracratic, so in a big setting, where you don't have the time or money to train nurses in more detail, it's easier (and safer) just to make them learn and follow the policies by rote, rather than thinking for themselves and maybe getting it wrong. I don't know if this is the case in the OP though.

Posted by Niteowl (# 15841) on :

I do know the State of California does require a DNR, however I don't know if each resident signs and agreement acknowledging that the facility will only call for emergency treatment, but do no extraordinary efforts themselves or if that obviates the need for a DNR. In my sue happy state I also wonder how suits have been filed over damage done to their very elderly loved ones by CPR.

[ 04. March 2013, 14:56: Message edited by: Niteowl ]

Posted by lilBuddha (# 14333) on :

I do not side with the nurse.
I do not side with the dispatcher.
Had I either, this would have been posted in Hell. A simple explanation of the policy should quiet things, if the reasoning for it is as some here speculate.

Posted by Amanda B. Reckondwythe (# 5521) on :

quote:
Originally posted by Hawk:
I don't know precisely what this facility is, but I would suspect it is akin to a UK palliative care home. In such homes, patients are admitted with the knowledge and understanding that they are dying and the care and the policies relating to that care are designed to keep the patients as comfortable as possible for as long as possible until nature takes its course.

I think that's what we call hospice over here.

Posted by Amos (# 44) on :

It's called a hospice in the UK too.

Posted by Lyda*Rose (# 4544) on :

I read some more of the articles on the situation, and I understand from them that the lady in distress was lodged in a part of the facility that was for residents who were fairly independent and did not need complicated care. This is a common framework these days in the US. People will retire to a place where they have the option of cooking or not (dining hall provided), taking part in gentle exercise, classes in different interests, and social activities, and taking a facility van to church or shopping or doctor appointments, etc. If their health starts failing, they are moved to a section with a higher level of care, where more skilled medical practitioners are available. I doubt that she was originally known to be near death.

Posted by claret10 (# 16341) on :

When I was training as a PE teacher and as part of that learning first aid, we were told if we worked over the summer in American kids camps, NEVER to attempt CPR. That the likelihood of getting sued if we caused broken ribs etc was too high to take the risk.

I don't know how much of that was just based on urban myths, it did strike me as strange at the time.

Posted by PaulBC (# 13712) on :

When my late mother was in hospital the doctor who was in charge of doing codes
said he wouldn't do it in mum's case. She had dementia and her heart wasn't 100%.
Thankfully she had a living will and returned to my home to get the document. In it she specified no extra ordinary means to keep her alive. I have the same clause in my will. This covered the hospital.
Did this R.N.over step the mark ? That is a call only she could make and that took courage . I think that end of life desions must be made between the family, MD's & nursing staff and each facility should have
a decided policy. [Votive]

Posted by Doublethink (# 1984) on :

Very strange, based on total bollocks, and totally pointless - because I doubt any functioning human being is going to stand over an injured child, who wasn't already terminally ill, whom they know how to resuscitate saying - well the policy says I shouldn't.

[Crosspost]

[ 04. March 2013, 18:39: Message edited by: Doublethink ]

Posted by Doublethink (# 1984) on :

quote:
Originally posted by Lyda*Rose:
I read some more of the articles on the situation, and I understand from them that the lady in distress was lodged in a part of the facility that was for residents who were fairly independent and did not need complicated care. This is a common framework these days in the US. People will retire to a place where they have the option of cooking or not (dining hall provided), taking part in gentle exercise, classes in different interests, and social activities, and taking a facility van to church or shopping or doctor appointments, etc. If their health starts failing, they are moved to a section with a higher level of care, where more skilled medical practitioners are available. I doubt that she was originally known to be near death.

I take your point - but we don't know what had previously been agreed with this lady and her family. They were presumably aware of the policy.

Fact is however well you are at 87, broken ribs and pierced lungs are a serious health burden on top of whatever else has already laid you low. You have to also lot at the longer term prospects. It takes about two years to fully recover from really major injuries - if you were fit and well to start with. Maybe longer if you're 87, if you live to be 89.

I recall going to dermatology clinic with 96yr old grandmother a couple of years before she died. She tended to get ulcers on her legs and they took ages to heal (by ages I mean a year or more). Bouncy young registrar was talking her into having a rodent ulcer on her leg frozen off - so I asked him whether it would leave a wound and how long it would take to heal. Yes it would leave a wound, and yes it would take some time. What would happen if it wasn't treated, it would become cancerous over time. How long will that take ? About 15 years. She didn't have the procedure done.

Posted by cliffdweller (# 13338) on :

quote:
Originally posted by Amanda B. Reckondwythe:

quote:
Originally posted by Hawk:
I don't know precisely what this facility is, but I would suspect it is akin to a UK palliative care home. In such homes, patients are admitted with the knowledge and understanding that they are dying and the care and the policies relating to that care are designed to keep the patients as comfortable as possible for as long as possible until nature takes its course.
I think that's what we call hospice over here.

I've got quite a bit of experience with this-- my mom died last year after spending several years in an independent living facility, later skilled nursing, and finally, the last few weeks of her life in hospice. I'm in the same state that this happened. But the policy of the Bakersfield facility doesn't fit with our experience at all-- in fact, seems to be contrary to everything we learned just a year ago and a few miles south of where this happened.

fyi: Independent living is not the same as hospice-- in fact, it's not even a nursing home, although some facilities (including my mom's) will have a skilled nursing wing that patients can toggle between as need arises. Independent living is what the term implies-- a home with separate apartments where seniors live independently, but with some additional services e.g. meals, laundry, etc. The idea is that when you need more intensive medical care you are moved to skilled nursing where there is medical staff around 24/7.

The policy described here doesn't fit with my recent experience with my mom at all (again, same State). When my mom was in her final stages and the decision was made for her to go into hospice, we learned that she did not have to be moved, but could stay in the same skilled nursing facility. But-- here's where it deviates from their plan-- the facility insisted that a separate team of hospice nurses from an outside agency take over her care. The local hospital (where she had a brief stay) had a similar arrangement. It was explained to us that every medical facility of this sort had to publish mortality rates; having hospice patients included in those stats would lower their rating, so the administration required this arrangement so their death would occur technically "off site" even though physically she was at the same address. The nurses who had cared for my mom for many years were not even allowed in her room when she was dying, but whenever we stepped out into the hallway, they would come over to ask us what was happening because they loved my mom and were concerned.

It's hard to fit the Bakersfield facility's policy in with our recent experience just a few miles south. However, I will say that we learned that all these levels of care-- independent living, skilled nursing, critical care, hospice-- have very sharply defined legal definitions, rule & boundaries.

Posted by Heavenly Anarchist (# 13313) on :

quote:
Originally posted by claret10:
When I was training as a PE teacher and as part of that learning first aid, we were told if we worked over the summer in American kids camps, NEVER to attempt CPR. That the likelihood of getting sued if we caused broken ribs etc was too high to take the risk.

I don't know how much of that was just based on urban myths, it did strike me as strange at the time.

What's the point of learning CPR if you don't do it? I think this generally is urban myth, i'd have thought that you are far more likely to be sued for not making an effort to preserve life when you have the capability and are in a position of responsibility. When I did my UK nurse training we were told that if you performed first aid outside the workplace you would be judged according to whether your behaviour was reasonable within those circumstances. And, as pointed out, who wouldn't help a child?
I guess I've broken many a rib doing CPR (and I'm tiny!) and never been sued here.

[ 05. March 2013, 07:37: Message edited by: Heavenly Anarchist ]

Posted by Jane R (# 331) on :

My first aid instructor reckoned that if you didn't break any ribs during CPR you weren't pushing hard enough... though he was talking about adults, not children.

Posted by Hawk (# 14289) on :

quote:
Originally posted by claret10:
When I was training as a PE teacher and as part of that learning first aid, we were told if we worked over the summer in American kids camps, NEVER to attempt CPR. That the likelihood of getting sued if we caused broken ribs etc was too high to take the risk.

I don't know how much of that was just based on urban myths, it did strike me as strange at the time.

Probably urban myth (I hope). If you're not a medical professional then the advice in the UK is, if someone is unresponsive and not breathing normally, then ALWAYS do CPR. It is actually most useful when dealing with young, otherwise healthy kids. The danger of broken ribs if you do is unimportant next to the risk of brain damage if you don't. Ribs heal.

Posted by Hawk (# 14289) on :

quote:
Originally posted by cliffdweller:

quote:
Originally posted by Amanda B. Reckondwythe:

quote:
Originally posted by Hawk:
I don't know precisely what this facility is, but I would suspect it is akin to a UK palliative care home. In such homes, patients are admitted with the knowledge and understanding that they are dying and the care and the policies relating to that care are designed to keep the patients as comfortable as possible for as long as possible until nature takes its course.
I think that's what we call hospice over here.
I've got quite a bit of experience with this-- my mom died last year after spending several years in an independent living facility, later skilled nursing, and finally, the last few weeks of her life in hospice. I'm in the same state that this happened. But the policy of the Bakersfield facility doesn't fit with our experience at all-- in fact, seems to be contrary to everything we learned just a year ago and a few miles south of where this happened.

Thank you Cliffdweller. It sounds a very complicated situation between the different arrangements for end-of-life care. The problem with our discussions on this case is that the only information we have is indirect, sensationalist reporting from someone who wasn't there, reporting on the reaction of someone else who wasn't there.

The nurse involved, the facility itself, and the family involved have said nothing (or at least the journo hasn't reported they have). All we have from the people actually involved are vague statements of support. I expect the article doesn't have all the facts, it's perfectly possible they don't even have precisely the right facts.

Posted by cliffdweller (# 13338) on :

quote:
Originally posted by Hawk:
Thank you Cliffdweller. It sounds a very complicated situation between the different arrangements for end-of-life care. The problem with our discussions on this case is that the only information we have is indirect, sensationalist reporting from someone who wasn't there, reporting on the reaction of someone else who wasn't there.

The nurse involved, the facility itself, and the family involved have said nothing (or at least the journo hasn't reported they have). All we have from the people actually involved are vague statements of support. I expect the article doesn't have all the facts, it's perfectly possible they don't even have precisely the right facts.

Yes, exactly. There were a lot of complicated rules, peculiar legal definitions of various levels of care, etc. At the same time, there were also all sorts of financial interests involved with differing agenda (e.g. concerns re facility's mortality rates). It will take a while to clear away all that before what really happened becomes clear.

[ 05. March 2013, 13:48: Message edited by: cliffdweller ]

Posted by HenryT (# 3722) on :

CPR can't kill anyone. Clinical death, defined as no pulse, no breathing, is the starting point. You can't make someone more dead. I've done CPR once, and he stayed dead.

The case seems to me to reflect a great deal of confusion. Once you activate the emergency medical system by calling 911 or 112 or 999, you are a participant. I don't see how you can then refuse to participate in the only effective method for dealing with cardiac arrest. Otherwise why even make the call?

Posted by Lyda*Rose (# 4544) on :

I caught an update on the news: the employee who called 911 wasn't employed as a nurse but as a "resident services director". She's now on leave, although they still said she followed protocol. Maybe they are protecting her from angry mobs. The family of the deceased have no plans to sue. They said she knew the limitations of care at the facility and are sure she is at peace with it all.

quote:
Glenwood Gardens “is an independent living facility, which by law is not licensed to provide medical care to any of its residents,” Finn said in a statement.

Read more: http://ktla.com/2013/03/06/retirement-home-nurse-refuses-to-perform-cpr-on-dying-woman/#ixzz2MuZGZBGz
Read more at http://ktla.com/2013/03/06/retirement-home-nurse-refuses-to-perform-cpr-on-dying-woman/#cCyyWPqH862oIUB2.99

Posted by cliffdweller (# 13338) on :

quote:
Originally posted by HenryT:
CPR can't kill anyone. Clinical death, defined as no pulse, no breathing, is the starting point. You can't make someone more dead. I've done CPR once, and he stayed dead.

The case seems to me to reflect a great deal of confusion. Once you activate the emergency medical system by calling 911 or 112 or 999, you are a participant. I don't see how you can then refuse to participate in the only effective method for dealing with cardiac arrest. Otherwise why even make the call?

Not that I agree with the nurse's decision (or the facility's if that was the problem), but obviously she called 911 to get an ambulance. Again, this is an independent living facility (think apartment building with really good amenities like laundry & meal service), not a nursing home. Some facilities have both levels of care (as my mom's did), apparently this one did not.

Posted by Anyuta (# 14692) on :

quote:
Originally posted by HenryT:
CPR can't kill anyone. Clinical death, defined as no pulse, no breathing, is the starting point. You can't make someone more dead. I've done CPR once, and he stayed dead.

The case seems to me to reflect a great deal of confusion. Once you activate the emergency medical system by calling 911 or 112 or 999, you are a participant. I don't see how you can then refuse to participate in the only effective method for dealing with cardiac arrest. Otherwise why even make the call?

Except that you are also told to call 911 when someone is dead. As in, not revivable. As in, ok, they are gone now..what do I do next? The nurse may very well have simply done what they do at this facility when someone dies. Not "is dying" but "is dead". As you say, that is the starting point for CPR...so it's not really a matter of the nurse refusing to "help" keep this woman from dying, but rather that she didn't choose to revive her from the dead.

What I don't get is why there was no DNRin place, but perhaps no one thought it would be needed, given the facility's policy?

Once an ambulance is on site and they start working to revive someone, they can't stop, even if there is a DNR. I know this because it came up with my father. A number of years ago, he caught a very bad cold. He was very uncomfortable, and it got bad enough that Mom called 911. As they were getting ready to move him, he went into cardiac arrest. They immediately started to revive him. Mom told them he had a DNR, but since they had already started, the were not allowed to stop. He recovered and lived several more years, but his first words when he was able to speak we're "you should have let me go". He said this to my mother, but my sister and I were in the room. Poor mom was in a difficult position...guilt either way!

Posted by Huia (# 3473) on :

Anyuta - how horrible for your mother.

Although Dad decided to have DNR on his file in the care facility apparently if he is in the public hospital they can choose to ignore it.

Posted by cliffdweller (# 13338) on :

quote:
Originally posted by Anyuta:

quote:
Originally posted by HenryT:
CPR can't kill anyone. Clinical death, defined as no pulse, no breathing, is the starting point. You can't make someone more dead. I've done CPR once, and he stayed dead.

The case seems to me to reflect a great deal of confusion. Once you activate the emergency medical system by calling 911 or 112 or 999, you are a participant. I don't see how you can then refuse to participate in the only effective method for dealing with cardiac arrest. Otherwise why even make the call?
What I don't get is why there was no DNRin place, but perhaps no one thought it would be needed, given the facility's policy?

This fact to me is significant. I don't think it was the "not needed" thing. My very similar experience with my mom was such that she couldn't go to the doctor for a routine blood test w/o someone asking if she had a DNR on file, a medical proxy, etc. Again, everything about this case is contrary to my experience w/ my mom, even though it was a similar sort of facility in the same state. Beyond the normal human concerns, on a crass pragmatic level, I'm surprised they weren't concerned about their mortality rates. As we've seen, the usual trend is to the reverse-- to ignore DNRs, rather than to act as if a DNR were in place when it is not.

Since the family is choosing not to sue (also unusual in this litigious state) we'll probably never know, but I suspect there's more going on here than we know.

Posted by Tortuf (# 3784) on :

I have had several folks in facilities run by this company. They generally taker very good care of their residents. And, like most facilities for older people who need a little help, they are not anxious to have one of their residents die in front of their other residents. Everybody "knows" they are going to die soon. The reality of death casts a pall on the place.

In other words the call to 911 was not about saving the woman. The call to 911 was about getting her out of the facility before she died.

Posted by Josephine (# 3899) on :

quote:
Originally posted by claret10:
When I was training as a PE teacher and as part of that learning first aid, we were told if we worked over the summer in American kids camps, NEVER to attempt CPR. That the likelihood of getting sued if we caused broken ribs etc was too high to take the risk.

I don't know how much of that was just based on urban myths, it did strike me as strange at the time.

As far as I know, every state has a "good Samaritan" law that protects people who are administering first aid from liability. The details vary from state to state, as most things do in this country. But saying that "the likelihood of getting sued" is too high to take the risk of performing CPR on a child -- that's just plain wrong.

Posted by Lyda*Rose (# 4544) on :

I think it would be a good idea if when people take CPR training the course should include very specific info on who in what situations Good Samaritan laws apply. If you are not a medical practitioner and one isn't immediately available, does your being on the job mean your employers could be sued? If not, your training might be useless in an on-the-job situation if you felt you could not use your training when, in fact, you could.

Posted by HenryT (# 3722) on :

quote:
Originally posted by Tortuf:

In other words the call to 911 was not about saving the woman. The call to 911 was about getting her out of the facility before she died.

That makes much more sense than anything I've heard.

Posted by Bullfrog. (# 11014) on :

I've worked in a couple places where this kind of conversation is relevant. My impression is that just about anywhere in the US, if you're not otherwise advised (DNR) then you can't be sued or punished for either failure or success whlie administering first aid in good faith. There are some states where not performing first aid is a criminal offense (I think Vermont might be one, but I don't remember at the moment) and this is a fairly recent legislative innovation.

Posted by mdijon (# 8520) on :

quote:
Originally posted by Lyda*Rose:
I think it would be a good idea if when people take CPR training the course should include very specific info on who in what situations Good Samaritan laws apply. If you are not a medical practitioner and one isn't immediately available, does your being on the job mean your employers could be sued? If not, your training might be useless in an on-the-job situation if you felt you could not use your training when, in fact, you could.

I expect the question is impossible to answer generally and definitively.

Of course one can be sued for anything, but assuming that the question is the probability of a successful suing, then I'm pretty sure that one could be sued for doing CPR badly if this could be shown to be associated with poor outcome. I think that one could be sued for not doing CPR if a duty of care could be shown. In the UK one now be charged with assault for performing CPR if an advance directive had been made against it.

I think tortuf probably has guessed the only motive that makes any sense. In which case I think the nurse behaved reprehensibly, since being moved in the last few hours of life does not help achieve either a comfortable or a dignified end. But maybe the nurse had not had enough training to help her understand that.

Posted by lilBuddha (# 14333) on :

I would think, mdijion, that it might also be a case of liability. Moving the treatment/cessation of life determination to the emergency responders and/or hospital.

Posted by mdijon (# 8520) on :

This is all speculation, but if the nurse was resolute in refusing to follow the instruction from the emergency services to start CPR that implies she was sure enough of her standing to not be worried about personal liability.

If anything she increased her personal liability by seeking advice that she didn't follow.

The policy of no CPR comes across clearly and was followed. It isn't clear what the policy is regarding calling emergency services.

The policy ought to be that emergency services are not the first source of help, but that a primary care provider is called for advice in the first instance.

If the care home hasn't got that in place then they are culpable for creating the situation in which the nurse acted. Nurses are generally not trained or empowered to determine which new medical symptoms ought to be treated as potentially reversible and which herald the end of life and are hopeless.

On they other hand they often recognise the distinction through experience and common sense, and that would put them in an impossible situation if they a) knew they were probably looking at an end-of-life scenario but b) didn't have a doctor they could call for input.

[ 14. March 2013, 11:23: Message edited by: mdijon ]

Posted by cliffdweller (# 13338) on :

QUOTE]Originally posted by HenryT:

quote:
Originally posted by Tortuf:

In other words the call to 911 was not about saving the woman. The call to 911 was about getting her out of the facility before she died.

That makes much more sense than anything I've heard. [/QUOTE]

I agree.

Which may have to do with the mortality rates I mentioned earlier. Again, in my experience with my mom, that was THE major driving consideration both for the hospital where my mom was treated and for the skilled nursing home where she lived. When she "entered hospice" (i.e. anticipating an imminent death) they required all sorts of peculiar legal maneuvers (e.g. setting up a room w/in the facility w/ outside staff as if it were a separate facility-within-the-facility) to avoid having a negative impact on that rating. Tortuf's suggestion re the facility's motive to move patients off site as quickly as possible to avoid having a death on site (and thus included in their mortality rate) is the first thing that makes sense to me given my very similar experiences.

[ 15. March 2013, 14:53: Message edited by: cliffdweller ]

Posted by Tortuf (# 3784) on :

I have been thinking about this situation on and off for a while.

It is still the case that homes are not fond of residents dying in the facility. It reminds the other residents too much of their own impending fate.

That does not explain why a nurse would refuse to do CPR.

The clue to the answer lies in the age of the resident in question. She was 87. If you think about the state of the bones forming the ribcage of an 87 year old woman the high probability is a significant osteoporosis.

Do CPR on a person whose bones are likely to fracture and you risk pulmonary puncture, puncture of the pericardium and so on.

Is it better to perform CPR with a high certainty of fractured bones and the problems and pain that come with that on an 87 year old woman, or not do CPR?

Posted by SusanDoris (# 12618) on :

Particular thanks to Hawk for the info in posts, but I have found this is a very interesting thread, as I am quite soon to have open-heart surgery. My sons know that DNR will be clearly on my notes but the CPR info I hadn't realised, so I'll tell them that too. As I am a keep-fit (in order to do the tapdancing!) almost very ancient person, I'm optimistic (of course!) that the op will give me another ten years of same. [Smile]

[ 16. April 2013, 06:16: Message edited by: SusanDoris ]

Posted by Hawk (# 14289) on :

quote:
Originally posted by Tortuf:
Do CPR on a person whose bones are likely to fracture and you risk pulmonary puncture, puncture of the pericardium and so on.

Not really an issue. If you do CPR properly you'll break the ribs of anyone, even if they are 21. It won't puncture anything important though, it'll just really hurt when they wake up.

Posted by Boogie (# 13538) on :

quote:
Originally posted by Hawk:

quote:
Originally posted by Tortuf:
Do CPR on a person whose bones are likely to fracture and you risk pulmonary puncture, puncture of the pericardium and so on.
Not really an issue. If you do CPR properly you'll break the ribs of anyone, even if they are 21. It won't puncture anything important though, it'll just really hurt when they wake up.

A different story entirely when they are in their 90s - it isn't going to just really hurt. It will cause terrible pain and suffering.

I am very thankful that all the residents at my Mum's home who have died in the past 3 years have died peacefully in their beds, most with family round them. (It is a home for the very elderly) It is policy there not to call the emergency services.

Posted by Pine Marten (# 11068) on :

quote:
Originally posted by SusanDoris:
Particular thanks to Hawk for the info in posts, but I have found this is a very interesting thread, as I am quite soon to have open-heart surgery. My sons know that DNR will be clearly on my notes but the CPR info I hadn't realised, so I'll tell them that too. As I am a keep-fit (in order to do the tapdancing!) almost very ancient person, I'm optimistic (of course!) that the op will give me another ten years of same.

I haven't posted on this thread but I have been reading.

All the best for your surgery, SusanDoris, and here's to seeing you fighting fit back on board soon.

Posted by cliffdweller (# 13338) on :

quote:
Originally posted by Boogie:
A different story entirely when they are in their 90s - it isn't going to just really hurt. It will cause terrible pain and suffering.

I am very thankful that all the residents at my Mum's home who have died in the past 3 years have died peacefully in their beds, most with family round them. (It is a home for the very elderly) It is policy there not to call the emergency services.

Presumably not w/o a DNR. Even at 90-- or 100, or 110-- it has to be their choice. It has to. And people are ready to make that choice when they're ready to make that choice. My mom lived with a great deal of pain and suffering for 2 years before she was able to decide to go into hospice. It needed to be her choice-- not mine, not the doctor's, not the nursing home's.

Since you say "mum" rather than "mom" I'm assuming you're not in the US. Given my recent first-hand knowledge of the laws/system in the same state this occurred (see above) I'm fairly certain this was not at all about a "merciful death" or concern for the patient's pain, but most likely (see above) a desire to move the death off-site to avoid negatively impacting their mortality stats.

Posted by SusanDoris (# 12618) on :

PineMarten - Thank you for your good wishes.

Posted by Tortuf (# 3784) on :

In an unhappy coincidence, my deeply demented 82 year old mother in a nursing home for rehab just quit breathing and 911 was called. I am at a loss as to why. Mom has a no code.

She has a no code because she understands that death comes to all, but death with some dignity only comes to the prepared.

Posted by Gwai (# 11076) on :

It may not be a coincidence if the bad publicity around this situation influenced the bad decision.

( [Votive]

)

Posted by Deputy Verger (# 15876) on :

I'm not a nurse. But I was once at the deathbed of a frail old woman who I knew was ready to die. She was in a care-home, a good one. It was shift-change time. Her breathing was laboured. The shift of carers going off all stuck their heads in to say good night, good-bye, whatever. The shift of carers coming on all stuck their heads in to say hello, how is she, etc. I waved them all away. She breathed her last. I opened a window (superstitious, maybe, but it couldn't hurt). I waited, holding her hand, quite a while before calling in anyone to corroborate my feeling that she was gone beyond our sight and hearing, beyond anyone attempting to bring her back. Then I left them to it and went and called her daughter, my friend. Not one person (staff or relative) said I should have called for intervention. I know I did the right thing. This nurse did the right thing. End of.

Posted by cliffdweller (# 13338) on :

quote:
Originally posted by Deputy Verger:
I'm not a nurse. But I was once at the deathbed of a frail old woman who I knew was ready to die. She was in a care-home, a good one. It was shift-change time. Her breathing was laboured. The shift of carers going off all stuck their heads in to say good night, good-bye, whatever. The shift of carers coming on all stuck their heads in to say hello, how is she, etc. I waved them all away. She breathed her last. I opened a window (superstitious, maybe, but it couldn't hurt). I waited, holding her hand, quite a while before calling in anyone to corroborate my feeling that she was gone beyond our sight and hearing, beyond anyone attempting to bring her back. Then I left them to it and went and called her daughter, my friend. Not one person (staff or relative) said I should have called for intervention. I know I did the right thing. This nurse did the right thing. End of.

The circumstances are not exactly comparable, if you've been following the thread. But I am grateful you were able to attend for and care for your friend.

[ 17. April 2013, 05:16: Message edited by: cliffdweller ]

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