Family Issues

On my last prac I encountered quite a few situations in which the families of patients had conflicting views about their management. I was on a respiratory medical ward and one 87 year old patient was admitted with end stage type 2 respiratory failure, secondary to COPD. I had assessed her but at the time there was no role for physiotherapy, so was just keeping an eye on her in case her condition changed. When the patient was first admitted she was extremely confused, and wasnt communicating with staff at all. Her family had brought her in after noticing a deterioration in her condition over the last few weeks. The patient was not for resucitation.

The medical staff had put her on bipap, however, she was not tolerating it well. She would become extremely agitated and try to pull the mask off herself. At times the only way the bipap could be kept on was when there were family members there who would restrain the patients arms so she could not pull it off. During periods when she was not on bipap she was also agitated and after a couple of hours off it, she would be gasping for air. The daughters of the patient seemed to be divided by how they thought their mother should be managed. Medical staff had enformed them that the only thing keeping her alive was the bipap but after a one week trial it hadnt seemed to make any improvements in her condition. They expressed that sedating the patient to keep the bipap on was a cruel measure. One daughter wanted to continue with the bipap and the other daughter wanted to end the bipap due to the fact that her mother really wasnt tolerating the bipap and she hadnt made any sort of recovery.

After extensive family meetings it was finally decided that the bipap would not be continued, and only comfort measures would be used. I can imagine that this would have been an extremely difficult decision to make but at the end of the day I think they have done what is in the best interest of the patient.