I recently received a note from a nurse who was saddened by feeling she was unable to facilitate a good death for a patient. Her challenge lay in being a stranger to the patient and family. While she did not “know” the patient, she intuitively knew the patient was actively dying. The patient was not in distress so the physicians were focused on other patients who were in immediate need of attention.
So if a nurse believes a patient is dying, but she is a stranger to the family, what “should” she do? No one wants to cause the family harm by suggesting a patient is dying when they are not, and certainly nurses don’t want to say or do anything that is contradictory to what a physician has told a family. However, we have an obligation to dying patients as much as to those whose lives can be saved by our expert interventions. When a nurse’s clinical judgment suggests a patient is dying, that is a time to speak up to physicians and families.
Acknowledge the difficult conversation, the desire to do no harm, then take a deep breath and express your concern. Perhaps your concern is that the patient will die and family will not be present; maybe you fear upsetting the family needlessly because the patient is not dying.
Take a risk – first with the physicians. If their attention is divided due to other patients’ needs, ask permission to gently assess the family’s acceptance of their loved one’s situation. Ask about their preferences and values if their loved one should die – not the same as the DNR talk. Having this conversation helps lay the groundwork for the DNR talk.
I wonder if people rate nurses as most trusted (see recent Gallup poll results on the Internet) because they have to believe they are trustworthy, given how vulnerable people are when they are in our care?
Earn the trust of patients and families by caring enough to have a difficult conversation at a crucial time. Don’t be afraid to ask about values and preferences surrounding death. The only way to facilitate a good death for a patient is to explore with the patient or family their preferences for end-of-life care.
Lucia Wocial
Great Nursing Positions Available in Indiana at Clarian.
So if a nurse believes a patient is dying, but she is a stranger to the family, what “should” she do? No one wants to cause the family harm by suggesting a patient is dying when they are not, and certainly nurses don’t want to say or do anything that is contradictory to what a physician has told a family. However, we have an obligation to dying patients as much as to those whose lives can be saved by our expert interventions. When a nurse’s clinical judgment suggests a patient is dying, that is a time to speak up to physicians and families.
Acknowledge the difficult conversation, the desire to do no harm, then take a deep breath and express your concern. Perhaps your concern is that the patient will die and family will not be present; maybe you fear upsetting the family needlessly because the patient is not dying.
Take a risk – first with the physicians. If their attention is divided due to other patients’ needs, ask permission to gently assess the family’s acceptance of their loved one’s situation. Ask about their preferences and values if their loved one should die – not the same as the DNR talk. Having this conversation helps lay the groundwork for the DNR talk.
I wonder if people rate nurses as most trusted (see recent Gallup poll results on the Internet) because they have to believe they are trustworthy, given how vulnerable people are when they are in our care?
Earn the trust of patients and families by caring enough to have a difficult conversation at a crucial time. Don’t be afraid to ask about values and preferences surrounding death. The only way to facilitate a good death for a patient is to explore with the patient or family their preferences for end-of-life care.
Lucia Wocial
Great Nursing Positions Available in Indiana at Clarian.
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