Nurses pronouncing death
In "Your Final Assessment: of Death" (Issues in Nursing, February 2011),* I learned that only a few states permit RNs to pronounce death in all settings. I work in Texas, a state that's allowed RNs to pronounce patients' death for nearly 20 years. I can't imagine a family member losing a loved one and having to wait hours for a physician to pronounce death.
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Under the policy at my hospital, the house supervisor, who's an RN, and charge nurses in the CCU can pronounce death for patients on hospice or with a do-not-resuscitate order. Allowing nurses to make the final determination of death for their patients shows compassion and respect for patients and their families.
-JEANNINE JENNINGS, RN
Clearing up COPD questions
I was surprised that oxygen therapy was considered a nonpharmacologic treatment in "Smoking Out the Dangers of COPD" (April 2011).* I thought oxygen is always considered a medication, and that for this reason, unlicensed staff aren't allowed to adjust flow rates. Have I missed something?
The article says that a prescription for oxygen must specify liters/minute, but the delivery device isn't specified. Should nurses choose what device to use? We need accurate information because not every facility has the assistance of a respiratory therapist or technician.
-REGINA G. COTTRELL, MN-ED, BS, RN
Brenda L. Smith, MSN, RN, CMSRN, and Frederick J. Tasota, MSN, RN, respond: Thank you for your inquiry. Our characterization of oxygen is based on the Global Initiative for Chronic Obstructive Lung Disease 2009 guidelines, which describe oxygen therapy as "one of the principal nonpharmacologic treatments for Stage IV: Very Severe COPD."1 The healthcare provider's prescription for oxygen therapy should include the flow rate, duration of therapy, and delivery device. Nurses shouldn't choose the delivery device except in an emergency. Even then, nurses should consult a healthcare provider or respiratory therapist as soon as possible for further direction.