Utica College Nurse Practice in ICU Discussion Responses

Post A

Describe your experience completing or reviewing your own advance directive.

It was a little strange filling out my own advance directive at 24 years old. Being a nurse in the ICU, I realize emergencies can happen at any age, but you typically see them more in the older population. However, it was good to be able to put in writing exactly what you want to happen if you are in a position where you cannot physically tell anyone.

2. Describe what it was like to assist someone else filling out or reviewing their advance directive.

I helped a coworker fill out her advanced directive. I ask patients about their advance directives frequently, so it was not hard to talk someone else through it. This coworker already had an idea of how she wants things to be handled, so it was not hard to assist her filling it out.

3. Explain some of the issues or concerns the person you talked to had in relation to the developmental stages (e.g. worries about children or elderly parents).

The coworker who I assisted is a single mother of 3 minors, so her biggest concern was who would take care of her children. Even though the oldest turns 18 this year, she would not expect her to take over care of her 2 siblings in regard to housing, food, etc..

4. What was the most interesting aspect of the assignment. Be specific and give details about the experience (not details about the advance directive choices).

It was interesting being on the other side of these questions. In ICU, we see families desperately trying to keep their loved ones alive, but where is the line drawn? For example, we had an 80 year old who threw a clot in her brainstem. She could not move or talk, her reflexes were absent, and her quality of life was diminished. She did not have an advanced directive, so her daughter made her healthcare decisions. Her daughter did not want to lose her, so she went through a tracheostomy, a peg tube placement, and could not get off the vent so she was transferred to a long term acute care (LTAC) facility. Months later at her facility, she coded and was brought back with awful sacral ulcers. She died with every rib cracked and in pain. I would never want that life. So for me, it is important to make it clear to family and have a physical copy that I would not want life sustaining measured in scenarios similar to that one. This assignment made me think about my preferences for end of life.

5. What do you think is the biggest barrier to getting people to complete an advance directive?

Barriers for writing advanced directives include not wanting to discuss death, lack of knowledge or resources, not discussing it with a medical professional, not wanting to burden others, or not thinking it is needed at this time (Harvard Medicine, 2019).

6. Did you gain any insight to the process that will change how you approach patients to discuss advance directives in the future?

I gained insight from the process of filling out my own advance directive. I realize that it can be an emotional topic to discuss, but it is important especially in the hospital. It is something that needs to be talked about, so I will use empathy but be direct when bringing up the topic.

Harvard Medicine. (2019, July 18). When Someone You Love Won’t Create an Advance Directive. https://www.health.harvard.edu/staying-healthy/when-someone-you-love-wont-create-an-advance-directive

Post B .

Describe your experience completing or reviewing your own advance directive.

Completing my own advanced directive was a little bit difficult as I started with the designation of a health care surrogate as I’ve recently gotten out of a long term relationship and am a bit estranged with my family, but ended up choosing my baby sister as she is a nurse practitioner with extensive critical care experience. As I went through the living will, a million scenarios ran through my mind that could cause things that could range from my inability to communicate my needs to a terminal condition. It pretty much comes down to what I believe my family would need if there was no chance of meaningful recovery to give them time to say goodbye, but I personally would not want any life sustaining measures if that got to be the case and work on organ donation as soon as possible.

2. Describe what it was like to assist someone else filling out or reviewing their advance directive.

Working in the critical care unit, I try to be proactive as possible to get copies of advanced directives or establish one if the patient is unstable to make sure that their own wishes are respected and used as a guideline for our plan of care. Recently, I had a gentleman who came to our unit from the floor for increased oxygen demand and was in extreme respiratory distress. I asked him about his willingness for intubation and life sustaining measures such as enteral nutrition being he would not be able to eat and how he wanted us to handle it if his condition worsened further. It was very difficult as he was very emotional and frightened, so I gave him some time and called his family explaining he wasn’t really able to talk since he was on such high oxygen support with the bipap- but that hearing their voices and input would provide support at this time. They wanted everything done as long as possible, but after he got off the phone he declined surgical intervention.

3. Explain some of the issues or concerns the person you talked to had in relation to the developmental stages (e.g. worries about children or elderly parents).

This gentleman was 58 years old with 2 children and grandchildren out of the house and one still living at home. His mentality was that he had lived his life as much as he could and that his family would be ok without him.

4. What was the most interesting aspect of the assignment? Be specific and give details about the experience (not details about the advance directive choices).

The most interesting aspect of the assignment is looking at the challenges of the developmental stages one is in and the questions they may be asking themselves in their current place in life which may influence their advanced directive decisions and who their health care surrogate would be.

5. What do you think is the biggest barrier to getting people to complete an advance directive?

I believe the biggest barrier to getting people to complete their advanced directive is their emotional and mental strength to face the idea of death and dying. An article from Gale University states that a major barrier to advanced directive action is often one’s own issues with personal identity (Tonelli, 1996).

6. Did you gain any insight to the process that will change how you approach patients to discuss advance directives in the future?

I believe that approach should be as sensitive as possible while being sure to provide as much information to the patient about potential risks and complications of their condition. I believe that educating the patient about their options gives them a sense of control over their own health care which will help them be more emotionally able to handle the advanced direction action and who they would choose as a healthcare surrogate.

Reference

Tonelli, M. R. (1996). Pulling the plug on living wills: a critical analysis of advance directives. Chest, 110(3), 816+.