Facing Our Own Judgments - Dealing With A Situation We Disagree With

[maybug, ADN, BSN, RN]

I work PRN at a hospice house. I was taking care of a patient that had been with us for 2 months and was very well known to the full-time staff, yet I had only taken care of her on 3 occasions. There had been several issues with the family due to cultural differences but the times I had taken care of her she was alone and resting. Until Thanksgiving.

One of her sons called me into her room and very politely asked to have her transferred to the hospital to pursue life-saving measures. I was a bit taken aback as this was not a situation I had encountered yet. I maintained composure and professionally educated the son on his mother's condition (poorly responsive, no PO intake for days, weak pulses) and the limited resources the hospital would be able to provide, only delaying the inevitable. He relayed this to another family member on the phone who was adamant this was what they wanted. I spoke with the HCPOA who also confirmed this request, and followed policy by making the medical director and clinical supervisor aware and then calling EMS. The son signed the revocation form. When EMS came to transport the patient, they tried to educate the son as well to no avail. Her failing body was transferred to a stretcher and taken out of the hospice house. The entire interaction from beginning to end lasted only an hour.

I know that my direct interaction with the family was professional and without judgment, but afterwards with my co-workers, I was angry and judgmental. And I carried that mindset with me home and for the rest of the night. I judged their decisions. I assumed they were uneducated on their mother's condition and prognosis. That they were being selfish and causing their loved one to suffer more. As a nurse, I assumed I knew best. I've seen countless people pass away at the hospice house. I've educated and re-educated family members who are grieving too badly to understand. Some are more accepting than others. Some just can't let go. But when they are too distracted, too tired, and too afraid to face reality, it is not my place to judge.

The next morning as I was driving to my full-time job I prayed and reflected on my thoughts and actions. I felt ashamed of my lack of compassion and empathy. Why didn't I place myself in their shoes? Why did I feel the need to speak my bitterness and judgment on a situation I had no real knowledge about? Why was I carrying a burden that had nothing to do with me?

As healthcare workers sometimes all we can do is educate. Patients most of the time actually won't do as they are instructed. They are often noncompliant with their treatments. It can be frustrating for us. But it is not our disease. Ultimately it is not our decision and it is not our life. It is easy for us to vent to our co-workers (and sometimes necessary) but it is not our place to judge. We end up carrying that negativity with us whether we realize it or not.

The next time you are involved in a situation that is ethically controversial, that goes against your knowledge, that is testing your patience and that you may disagree with, take a deep breath. Try and take an understanding approach from the patient's or family member's point of view. We do not know their entire life story, their family dynamics, or their thought process. It is our job to educate, listen, advocate, and support. It is not our place to judge.

[OnceMorewithFeeling]

"The next morning as I was driving to my full-time job I prayed and reflected on my thoughts and actions. I felt ashamed of my lack of compassion and empathy. Why didn't I place myself in their shoes? Why did I feel the need to speak my bitterness and judgment on a situation I had no real knowledge about? Why was I carrying a burden that had nothing to do with me?"

Thank you for this post, and thank you especially for the specific part I've quoted above.

You have summed up, better than I ever could have, where I am struggling in my nursing practice.

It is meaningful for me to hear that someone else is struggling in the same way, and has found resolution.

[maybug, ADN, BSN, RN]

Thank you for your response. It is humbling to admit that despite the education and experience we have, that does not take the place of compassion.