reflective journal

					My reflective journal is about a patient in ICU that had end stage liver disease. This patient
had been in ICU for a few days, was ventilated and on high dose inotropes. The patient was
very jaundice. It was the general opinion of the nurses in the unit that this patient was not
going to survive. A lot of the nurses felt like we were “ventilating a dead body”.

I looked after this patient on night shift. The patient’s renal function was declining. The ICU
registrar came to review and decided that she wanted to commence the patient on dialysis.
I found it difficult to agree with this decision. I was thinking to myself: What is best for this
patient? Just because we have the technology to improve this patient’s renal function,
should we use it? Is it actually going to improve the patient’s outcome? And although I feel a
bit guilty about thinking the last one: Is it worth the financial cost of running the dialysis
machine?

The Code of Ethics for Nurses in Australia (2008) says that as nurses we need to advocate for
our patients and do all that we can to preserve their dignity. When the ICU reg said that she
wanted to start dialysis me and another nurse both questioned her decision. We felt like
this patient was going to die very soon and that the patient should be left to rest peacefully.

I feel that sometimes doctors may keep initiating technological interventions to try to
improve the patient’s outcome even when it is very unlikely that the patient will survive.
Browning (2010) sums this up very well:

       “With all of its many obvious advantages, the advent of life-support technology has
       brought with it the potential hazard of prolonging life perhaps inappropriately.”

Don’t get me wrong, I do believe in doing everything we can to save a patient. But when it is
fairly clear that the patient is not going to survive shouldn’t we just leave the patient to die
painlessly and peacefully?

I am sure that I will be in this sort of situation again many times in my nursing career. And I
will probably do the same thing. And if the doctor does want to continue with the
intervention then it is my job to keep the patient comfortable and calm.
References

Australian Nursing and Midwifery Council (2008). Code of Ethics for Nurses in Australia.
ANMC, Canberra. Retrieved from the ANMC website:
http://www.nursingmidwiferyboard.gov.au/

Browning, A. (2010). Life Support Technology and the Dying Experience. Dimensions of
Critical Care Nursing, 29(5), 230-237.

				
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