Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
I asked people what they genuinely wanted to know from nurses and this was a top request. If you have any interest, you can find my first set of suggestions here.
From a nurse with over a decade of experience working in acute care with adult populations on cardiac telemetry in critical care step-down units… here we go.
What Nurses Wish People Knew About Hospitalization (continued)
Do Not Resuscitate does not mean that we will not provide care if you become critical. While there are studies that show a DNR status may have influenced the intensity of care that doctors may have wanted to provide, those studies were in the past. Hospitals began huge campaigns in order to remind their staff that “DNR” did not mean that the patient did not want any care at all and did not want to be prevented from a catastrophic decline. It did the job and most hospitals do not treat DNR patients any differently than patients that are Full Code, with regard to transferring to ICU if necessary and providing aggressive treatment. As a matter of fact, there is a large push toward changing the terminology to the preferred acronym “A.N.D.” meaning “Allow Natural Death”. The code simply means that if one stops breathing or one’s heart stops beating we will go in one of two predetermined directions: either CPR or not.
Full Code does not mean that we will get you back or that if we do get you back you will return to your family in a recognizable state. This one makes nurses really sad and it is actually difficult to write this. In a well-controlled hospital environment, the chances that we will successfully resuscitate you are somewhere between 11-30% depending upon medical comorbidities as well as the hospital itself. The chances that you will survive to discharge? Less than that. The chances that you will survive CPR, live to discharge, and have the same quality of life? Smaller. If you are over the age of 60, these chances start to go down. Once over the age of 80? …the odds aren’t great. If you have serious chronic illnesses such as COPD, Heart Failure, Kidney Failure, Liver Failure, or Cancer, the chances shrink even more. We will do everything in our power to help you to survive. Being close to care and receiving immediate care is key. However, CPR is devastating to the body. Even in non-fragile adults, ribs are frequently(normally) broken during compressions and lungs can be punctured by the fragments. This does not mean that we are unwilling to try, but it does mean to be realistic about the limitations of the human body and the limitations of physics. For more on this topic, please see my previous post.
Nurses cannot just give you a pain or anxiety medication “whenever it is available.” It sounds odd, but you have to ask for it. It is PRN for a reason, that reason being that it is only to be used when necessary. If we just gave it to you all of the time, any time it was due, the moment that it was due, you would never have any time off of the medication to discover if it actually was helping. You would never know if you were having less pain or anxiety. You would just be increasing your tolerance or, more likely, just getting altered from the drugs while increasing the chances of adverse effects. We are not trying to be mean, I promise.
We want to fully educate you on your medications…but…. This is a big confession. The administration insists that we educate you on the biggest/most likely side effects of every medication that you receive from us. If you have already been taking the medication at home, you probably already know what those would be. If it is a new medication, we really do not want to scare you with reactions that most people generally do not have, particularly if you are an anxious sort. Some patients will report whatever side effects they were warned about. Itching, sleepiness, lethargy, muscle aches, and more can all be pretty subjective and many of these effects are dose-dependent. Sometimes, they are not even related to the medications we are giving to you at all. Of course, we want you to tell us if you’re having a bad side effect or an allergic reaction! We also want you to be reasonable and to know that most of these effects are also dependent on how long you are taking them. Most of the time, you will not suddenly start having these effects in the hospital.
Google. *sigh* We hate Dr. Google. Dr. Google does not know all. If you googled your symptoms in sequence, I can almost certainly guarantee that one of the results will be Lupus or Cancer. The likelihood that you have either of those is much, much lower than the likelihood that it will be toward the top of your search. While Google can be a good starting place for mystery illnesses (like many chronic ones tend to be), in acute care Google can do more harm than is necessary since it does not include the full picture of the patient. You are unique. No computer program will ever be able to take that into proper consideration.
Keep a medication list with you. This might just be my own personal preference. While many healthcare agencies are becoming more and more linked, not all of them like to provide full access to one another. If you have Kaiser, in particular, this is very important since you are not receiving medications from an outside retail pharmacy. It might not seem important to you, but if you are on antidepressants or anxiety medication, this can have serious repercussions when you go into withdrawal or have side effects from medications we unknowingly give you. It might not seem like a big deal, but withdrawal from these drugs (even smaller doses) can include severe panic, blood pressure, and heart rate changes, as well as hallucinations/psychosis. Trust me, you want people to know what you are taking because many of these effects can be fixed pretty quickly if we restart your medication.
Please, please send any valuables home and TELL US that you are doing it. We do not want to lose your grandma’s wedding ring. That’s it. Really. Please, please, come to your loved one’s hospital and retrieve anything you are uncomfortable with replacing. We try to keep track of everything, but soap is slippery, sheets are plentiful, and sometimes things go missing. More often than not, they’re sent to the laundry company and get mixed up with other hospitals’ linens. We will always do our best to find your shoes/dentures/glasses/jewelry including dumpster diving (if staffing allows). But the less time we spend searching and panicking is more time than we can devote to the care of our patients.
We do not have the best information about your insurance allowances, but the Case Managers do! We try, we really do, but years ago the insurance aspect was pretty well divided from the caregiving aspect. Ethically, it is for the best, since it means that no one will treat anyone any different based on insurance. However, it does mean that I cannot answer your questions about coverage. I’m sorry. Write down your questions so that you do not forget them and then ask your Case Manager. If they cannot answer them, they will often give you your insurance phone number so that you might inquire yourself/for your loved one.
Please fill out those Advanced Directive forms that they keep giving you. No one likes them. I know that I do not. However, I have my copy sitting on my dining table in front of me because I need to complete it, have it notarized, and put it in the filing cabinet. It really, really is important because it guides you through all of the “what if?” scenarios that you might not have thought about. It is revocable and is not permanent. It does guide care. There is nothing to lose by filling it out and you might save your family from having to make a decision that you already (in your mind) made and thought you’d made clear.
Thank you to @garymcvey and @sawatdeeka for the suggestion on healthcare topics! This post started to get exceptionally long, so I am breaking this up into three parts (probably).Published in