Topics arise in bizarre ways sometimes. It’s summer, and a single topic has been brought up at every gathering: death with choice. One of my very good friends is in the process of watching her mother slip away slowly without her choice of care. She sent me an article from the Kansas City Star about the subject which tweaked my interest in how faculty prepares students to deal with this emotionally-charged issue.
There are so many facets to deal with. Is it okay for a client to choose not to “go to the mattresses” like in ‘The Godfather?’ How do you not judge someone who decides that it is okay to go now? When you are learning to be a nurse you learn how NOT to kill clients, not how to let them go. Who wins the argument about “Should we put oxygen on the dying client?” The medical staff? The family? The client? Can a caregiver be the client’s advocate even if that person does not agree with the client’s plan of care? Because the key in that sentence is the client’s plan of care, the nurse will often be the primary advocate. Do we train our nurses to do this part of the job? Do we help them acknowledge the difficulty?
What do you think, and how do you, as faculty, train your students? Why is it that some health care providers feel the need to insert their beliefs in the plans of care for others? Nursing students are working towards learning the correct method of providing care. Do we as faculty point out how important location is in the providing and planning of that that care? In an ICU setting, it is probably not appropriate to not place oxygen on the client; the ICU is an intensive intervention zone. At home, in a hospice bed, or even a medical surgical unit, do we help students critically think through what occurs if we apply that oxygen? What bothers us if we do not use the oxygen? Is there a different intervention, like morphine, that will not increase length of dying but will decrease suffering and help with air hunger breathing patterns?
Think about clinical rotations? Do we place students in a hospice location to talk with clients and families about how and why they made their decision? Do we assign them to the dying client in the acute care unit? Do we involve our students in discussion of appropriate use of resources? I don’t advocate that persons over the age of 80 cannot have ICU interventions, but if a client does not want them, shouldn’t it be their right to decline them? Shouldn’t it at least be a part of discussion in class? Could a new nurse stand up to the ER HCP for a client and advocate if the health care POA is not present? Do we help new nurses learn how to advocate?
How do you help new nurses in your school? I must admit I did not address advocacy well when I was teaching. I modeled advocacy in OB if the opportunity presented itself, but I did not role- play or really discuss it. I have a history of NICU experience, and death was there. I regret that I did not share how I felt the first time I pulled a vent off a baby and sat with the parents. The nurse in me had to watch the monitor. I shut it off every time after that.
We talked to new grads and asked them how they would feel if they were assigned this process for a client or how they were educated on the topic. One nurse was very outspoken, “I will not care for a dying patient. That is not what I want to do. I think [we] should try everything over and over until the patient comes back. Every person deserves all we can provide.” I asked if she had a dead or dying client at all in her clinical. She said “No, in my ER rotation I came close, but my preceptor sent me to take care of another client.” Have faculty served her and others well? Did she miss an excellent opportunity to hear a discussion of how far should we go? What did this client want? Is there a point when it is cruel to continue life saving measures? Do students need to hear these questions? Can they with their limited experiences understand them? That is a real question.
A new grad in another part of the country gave us a quote on her educational exposure. “There was [only] a chapter in a text book! I really don’t think it’s something [faculty can] teach; [students] have to experience [it]. [A dying patient] is a strange thing, and you never forget the first one; you can’t teach emotion.”
Questions, questions questions. Is nursing care shifting toward advocacy? Will this type of care be more common in the future? My crystal ball says, “Yes!” Reimbursement changes and discussions on quality vs. quantity continue and will impact this care. As limited resource allocation is debated, this will become a primary care responsibility for the newest graduate nurses. Will they be ready?
What do you think?
