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vmbennett

vmbennett

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  1. vmbennett

    The Patient was a Retired Nurse

    The author was being oriented in intensive care units when she was assigned to her exemplary case. This case involved an elderly ventilated lady that was alert and oriented, capable of making her own decisions and facing the end of life decisions. The elderly lady had several comorbidities, including respiratory distress, diabetes, congestive heart failure, and a history of a stroke. The patient knew that if we took the ventilator tube out of her mouth, she would not be able to withstand life very long. She was a retired nurse and understood the ramifications and was prepared for the outcome. Comorbidities The patient’s respiratory distress had developed into acute respiratory distress syndrome (ARDS). Additionally, she had congestive heart failure, which causes fluid to increase around the heart, causing it to pump inefficiently. These symptoms made it harder to extubate this patient. The elderly patient also had diabetes and a history of a stroke. Although her diabetes was being controlled based on an A1C of six, and she had no deficits from a previous stoke, she was ready to see her husband again. The combined symptoms from her disorders and with the blessing of her family, this patient decided to be extubated. The pathophysiology progress of ARDS was explained by palliative care as neutrophil activation due to inflammation, which is significant in the pathogenesis of ARDS. The patient and the family members verbally acknowledged the possibilities of multiple organ failure, pulmonary hypertension, and a high mortality rate. Additionally, palliative care explained that there are no single biomarkers to predict the outcome of ARDS in an elderly patient, but numerous different pathways are involved in the development, which increases the risks for a poor outcome at an advanced age. Although the family members were not agreeable with the patient's decisions and very tearful, they were all respectful. Patient's Journey The journey involved a retired ventilated nurse that was alert and oriented, capable of making her own decisions and facing the end of life decisions. She was writing messages on our communication board and texting with her phone to communicate. She had been in intensive care for several days, and we were unable to wean her from the ventilator during the daily spontaneous breathing trials. She had lost her husband several years earlier from cancer and wanted to be with him. Palliative care had been consulted and met with the patient and the family members. The patient kept her dignity, which included autonomy and control over the daily activities and circumstances. The patient's self-determination allowed her to feel that life still had worth and importance despite the current circumstances. The patient understood the meaning of comfort care and withdrawing care. She knew that if we took the ventilator tube out of her mouth, she would not be able to withstand life very long. She understood the ramifications and was prepared for the outcome. To the author, this was a well-educated elderly lady with independence and dignity. The patient kept her dignity, which included autonomy and control over the daily activities and circumstances. The patient's self-determination allowed her to feel that life still had worth and importance despite the current circumstances. The author observed the elderly lady facing the end of life decisions had identified with her illness, age, and comorbidities. The cause of her death would be by her hand and decisions. The patient would determine the timeline, and the consequences were that she got to meet her husband again. Other consequences the patient thought about was leaving her children and grandchildren, but the patient expressed a weary life and determination to be pain-free again. The treatment the patient chose was comfort care to relieve her suffering. After caring for this patient on many occasions, becoming a confidant to the family members and a friend to the patient, we withdrew care. As an orientee, the author was not fully aware of what comfort care meant. The author was instructed to get pain medications from the Omnicell to administer to the patient. As the author administered the medications, the patient's heart rate and respiratory rate began to diminish. As an orientee, this response was alarming, but as an intensive care nurse, composure was vital. At that moment, the author was confused, irritated, and doubted what she had just done as a nurse. We are taught to do no harm. What had just happened? The author had been listening to the palliative care team for days talk about comfort care and peace, but details had not been explained. The author certainly had not expected to be the one pushing the final medication before the patient's last breath. As the author stood there holding the patient's hand, watching the monitor, passing out tissues to the family, and feeling as though she had done something wrong, the patient took her last breath. It was not a sudden death but a peaceful one. This incident made the author doubt her career choice, her faith, and the intention of the medical field. This situation was the most uncomfortable and spiritually confusing event of the author's life. As the author drove home that evening, tears of forgiveness rolled down her cheeks. The author went to the hospital chaplain and the palliative care team for guidance and clarification. The circumstance was explained as holistic care, focusing on psychosocial, psychological, and spiritual characteristics of care for the patient and family. This experience was the author's first experience watching the role of a palliative care team, experiencing grief for someone that the author had not known very long, watching a person pass away, and witnessing a faithful family lose their mother. The family stated that medical treatment would have prolonged their mother's life without offering substantial benefits. Nursing incorporates numerous characteristics of care, including ethical decision making, supporting families and patients through the death and dying process and pain management. It is challenging to teach curricula on empathy, sympathy, the dying process, different healthcare system policies and practices, and the numerous interpretations of end-of-life progressions. As an orientee, effective communication skills from the leaders could have enhanced the experience, built trust, increased knowledge, and diminished career doubt. Provider's Professional Role A provider’s professional role when dealing with end of life decisions is to listen and discuss the wishes of the patient and family members. It should be routine as providers in a primary care setting to offer a living will/advance directive to every adult patient regardless of their age. Options and choices in the document should be read and explained so that the patient gets a clear understanding. A provider can educate the family and patients on who can sign as a witness, what is involved in decision making, and suggest someone who will respect their wishes. A provider should encourage the patient to discuss this decision with all family members involved before this document is needed. To prevent disagreements during the implementation of living will or advance directive, it is essential to begin the dialogue process concerning the end of life strategies early. A non-crisis situation is an ideal time to have discussions about the end of life. The patient and family members can think clearly, discussing values, and ask questions. When approaching these conversations, the patient should feel safe, heard, and valuable. Autonomy should be given to the patient, and providers must explore cultural aspects and expectations of care with the patient and family. Providing information and education on what to expect, support groups, and discussing needs and expectations with the patient and family are vital. Conclusion Although the retired nurse passed away, a positive outcome was accomplished. The patient kept her dignity, which included autonomy and control over the daily activities and circumstances. Her quality of life was maintained until her last breath, and her family experienced a serene and peaceful passing. The patient's choices displayed her self-determination without external influences from her family, and her stress was limited due to managing and adapting to her illness. This patient demonstrated a journey of courage, love, faithfulness, kindness, and consideration. The retired nurse’s life story will forever be described as the author's epiphany in her nursing career and a hero. This encounter taught the author a deeper meaning of compassion, patient autonomy, understanding, and the true meaning of a hero.
  2. vmbennett

    Toon Caption Contest | Student Nurse Day

    When bae says "we need to talk" and you're trying to think of what you did wrong.
  3. vmbennett

    Toon Caption Contest | Student Nurse Day

    Nursing students caring all the gossip in their minds when they haven't met with their besties in two days.....
  4. vmbennett

    Meme Contest | Nurses Week

    Day 2 of quarantine, and I just found out my wife's favorite color is yellow. Who the crap likes YELLOW???
  5. vmbennett

    Meme Contest | Nurses Week

    I've gone bald from trying to work from home, watch my kids, stay hydrated, not be broke, stay quarantined, find toilet paper, wash my hands and not touch my face!
  6. vmbennett

    Meme Contest | Nurses Week

    Me after I eat all the quarantine snacks in one night.
  7. vmbennett

    Meme Contest | Nurses Week

    To all you numb nuts that are hoarding all the toilet paper, I'm buying up all the toilet plungers..... Check mate!! When you hear the person beside you cough....
  8. vmbennett

    Meme Contest | Nurses Week

    You are required to home school for the rest of the school year.
  9. vmbennett

    Send A Message To The World Contest | Nurses Week

    As nurses, our thoughts are with the many who have been directly affected by the coronavirus, as well as the sorrow and hardship the pandemic is causing, from physical suffering to economic difficulties. In these weeks, the lives of millions of people have suddenly changed. For many, remaining at home has been an opportunity to reflect, to withdraw from the frenetic pace of life, stay with loved ones, and enjoy their company. For many, though, this is also a time of worry about an uncertain future, about jobs that are at risk, and about other consequences of the current crisis. As nurses, as a team, as a family, as a community, we are working actively for the common good to move mountains, to rise up, and to SAVE LIVES.
  10. vmbennett

    Nurse Heroes Caption Contest | Nurses Week

    Save one life and you are a hero. Save one hundred lives and you are a NURSE!
  11. vmbennett

    Nurse Heroes Caption Contest | Nurses Week

    Heroes Living Among US!!
  12. vmbennett

    Nurse Heroes Caption Contest | Nurses Week

    We are Stronger than Fear!
  13. vmbennett

    Funny Things Patients Say Contest | Nurses Week

    It was my first patient with a colostomy. He was this old, grumpy man sitting up in bed. I started taking off his bag and it smelled so bad my eyes were watering. I kept telling myself to think about his feelings and to not let anything show on my face. He looked at me and said, 'God, you've got bad breath!'
  14. vmbennett

    Funny Things Patients Say Contest | Nurses Week

    We were extubating my really sick Whipple patient. He'd gone through a major surgery, and, when we got him off the ventilator, the respiratory therapist gently reminded him he was in hospital. He replied ,'no s---! I once had the daughter of one of my patients march up to the nursing station, slam the vitals chart down on the desk, and yell at me, 'How dare you say my mother stinks!' I'm utterly puzzled by this as no one had said anything of the sort, and I asked the daughter to explain what she meant. She grabs the chart, points to the row of 'BOs' recorded on it, and shouts, 'Here you even had the nerve to write it down! I explained that 'BO' meant 'Bowels Open' not body odor before escaping to the staff room to laugh my head off.
  15. vmbennett

    Funny Things Patients Say Contest | Nurses Week

    “I wasn’t using any illegal drugs. It was just weed!!”
  16. vmbennett

    Share Your COVID-19 Stories Contest | Nurses Week

    The fear of dying alone is nearly universal, a fact of which anyone who has taken care of a critically ill patient is acutely aware. One aspect of the Covid-19 pandemic that has been particularly difficult is that instead of our usual promise that we will do everything we can to keep him alive until you get here, we find ourselves telling families that because of hospital policy, we cannot allow visitors at this time. My patient’s wife arrives at the emergency department at 1:30 a.m., despite having been told she would not be allowed to see her husband. I go to meet her, and we discuss her husband’s continued decline. Unfortunately, in the middle of the conversation, a Code Blue rings from the overhead speaker for a patient in the ICU. I step away and find myself entering her husband’s room, where CPR is already in progress. After 90 minutes of CPR, my patient still has not regained a sustained pulse. One of the nurses in the hallway has been in contact with the wife throughout the process and has informed her of the death; she now has the wife on FaceTime so that she can see her husband. When she recognizes him in the distorted image, she lets out a wail of sorrow. She is saying her final goodbyes when I have to excuse myself from the room: another patient with Covid-19 is deteriorating a few rooms over.
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