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Caring for a dying patient

An celebration that was meaningful to me as a nurse happened during my clinical time at St. Michael’s Medical center. The function was my first experience with encountering a dying individual. During that change, my patient’s doctor broke the poor news and announced that they didn’t give my patient any more chemotherapy or curative treatment and suggested to transfer him to palliative good care. Since it was the first time I encountered this devastating situation, I did not learn how to manage it correctly as a nurse by adopting nursing interventions.

The other persons who were involved in the event were my sufferer and his wife, his daughter in law, my clinical instructor, and the oncologist. During the first moment of the week, the patient was merely being admitted to the hospital and therefore there were few documents about him in his patient binder. I contacted my patient, measured his vital indicators and finished my original assessment and nursing actions. While I was looking after my patient, we commenced talking and I found out he originated from the same city as me and he merely lived two blocks from my old house. We started to speak about the changes in the neighborhood we used in which to stay, the same restaurants both of us liked to go to, and the famous department store we liked that were closed down. My individual and I mentioned nearly every street name inside our neighborhood by the finish of our chat. I quickly built a close connection with my patient through the first day of the shift and felt my sufferer was exactly like an old friend from home. During the second moment of the shift, while I was charting, the oncologist arrived to my patient’s space and had a 15 minute ending up in my individual and his wife and his child in regulation. Once I done charting, I went back to my patient’s place. The first thing I saw was my patient’s wife hiding in the washroom crying and the individual looked sad while lying on the bed listlessly. The child in law was looking at the individual with tears in her eyes. I brought the child in law beyond your room and asked what occurred. She explained the same oncologist who took care of the patient four years ago just broke the undesirable news and announced there is very little they could carry out for my patient today and advised to transfer my patient to palliative care. As well, my patient agreed to go to palliative care following the girl interpreted what the oncologist advised. Once I observed this undesirable news I felt very sad and my mind just could not focus on anything at that time. I thought my patient’s condition did not seem as bad as various other patients I had seen and I thought my patient would have soon recovered and gone residence. I simply could not believe the bad news. I was so occupied by my extreme emotion that I did so not know exactly what to do in that scenario despite my intuition showing me I should adopt active listening skills and present my empathy to my person and his relatives. I tried my best to hold back my tears and be there with the patient and the spouse and children and listen to them. I thought my patient, his wife, and his daughter must feel sad about the bad news plus they will need to have felt unready to handle the change.

In my perspective, the decision of entering palliative care recommended by the oncologist included ethical, cultural, spiritual, and financial considerations. According to CNA’s code of ethics, nurses and different health care professional must be granted a clients informed consent before shifting the patient from an over-all medicine unit to palliative care as a way to protect the patient’s right to autonomy. The right to autonomy signifies that a patient with total understanding and capacity has the right to make choices predicated on what they think is most beneficial for them ( Potter & Perry, 2009). The patient’s Chinese cultural background likewise played a role in this event. From what I read from the patient’s kardex, and what the patient’s daughter in legislation explained, my patient was only partially informed by his family members about the condition of his illness (prognosis and diagnosis). This is because in Chinese culture, the family can often be reluctant to discuss a sickness condition with the afflicted relative because they believe talking about such issues may bring about hopelessness or wishing loss of life upon the patient. Family members may hide the information regarding a sickness or pretend as though nothing were wrong (Kemp & Change, 2002). In conditions of economic consideration in this function, I assume that it is not the very best idea to continue spending extra money and further resources on extreme and expensive treatment of my patient’s incurable disease, especially if it causes unnecessary pain and suffering to a patient. In this case I think palliative care would be a better option. Furthermore, I believe I will possess remained accountable to my sufferer by dealing with the thoughts and adopting therapeutic communication when I initially heard the bad information. This belief comes from knowing it is important for nurses to follow CNO’s methods during practice.

The key problem of the event was my ineffective coping skills when a patient is dying because of my inexperience in comparable situations. If I have a similar situation arise during upcoming clinical practice, I am going to know that effective coping strategies could be applied to handle the problem and improve my overall performance of clinical practice.

Shorter and Stayt completed a report on an ICU nurses’ experience of grief and their coping mechanism whenever a patients dies. This research gave me insights on how to handle caring of a dying affected individual (Shorter and Stayt,2009).

Nurses reported that deaths are often predicted in the ICU, therefore being ready for the death of an individual can produced the dying encounter less traumatic and invite the nurses to remain in control. Also, being in charge of the dying situation can reduce the feeling of guilt after a patient’s death. For instance, one nurse liked to make the patient comfortable, remove monitoring, stop needless drugs, and keep the paperwork updated. When you are organized and in charge, the nurse was able to provide good nursing health care and donate to a tranquil death for the individual and for that reason negative feeling about the patient death is minimized Also, critical treatment nurses reported that their emotional a reaction to a patient’s death could be balanced out when they provided physical relaxation to a patient and respected their wishes (Shorter and Stayt,2009).

Secondly, nurses reported that they often "struck a chord" when spending caring of a dying sufferer. For instance, a nurse will think about a dying individual lying on the bed as her individual sister and look it difficult

to view her die at a young get older. Nurses in ICU care for their dying patient with compassion and empathy which allows patients and nurses to develop a personal bond. This may lead to positive or negative implications (Shorter and Stayt,2009).

Lastly, nurses in the analysis reported that they think extra grief after the patients die if they have developed a relationship with the patients and their families. Although developing a close bond with individuals could cause nurses to suffer even more emotionally after a death, nurses believe a relationship with patient is essential to be able to provide good nursing health care.

In the study, ICU nurses reported they possess adopted countless coping mechanism when looking after dying patients including formal and informal support, the normalization of loss of life, and emotional disassociation (Shorter and Stayt,2009).

Firstly, nurses in the study favored informal support over formal support. In informal support, nurses put great emphasis on their relationships with each other and the informal support this provided. They reported that the informal support allowed them to talk about grief experiences with colleagues which brought them better together with the feelings of being a close-knit team. Many suggested that other persons who was not in the same situation wouldn testmyprep.com‘t normally understand what these were going through. On the other hand , nurses found it really is more difficult to open up and discuss their knowledge about dying and death through a formal support establishing such as for example de-briefing and clinical supervision (Shorter and Stayt,2009).

The second coping device is normalization of loss of life. Nurses in ICU find death so often and will consider death as a standard process of life and part of their daily job. Due to the frequent exposure to loss of life, nurses in ICU can normalize loss of life which enables them to cope with the problem (Shorter and Stayt,2009).

The last coping device of the ICU nurses is certainly emotional dissociation. The nurses attempted to distance their emotion from their patient. For example, a nurse reported she actually is able to activate and off her function mode quickly. Nurses in the analysis agree that they have to include control over their emotion normally they will not be able to continue their practice (Shorter and Stayt,2009).

In another review, Barnett and Copper explore what aspects of looking after a dying patient trigger anxiety in first time nursing learners. The authors provided five recommendations to support nursing students while taking care of dying patients such as ( Barnett & Copper, 2005) :

(a) Reputation that the panic experienced by the nursing college student in this situation is normal.

(b) Focus on the emotional aspects of care and not the practical aspects

(c) Discuss end-of-existence ethical decision making such as do not resuscitate orders

(d) The involvement of knowledgeable registered nurses so college students realize their feelings are typical and not only because of their inexperience

(e) Make learners aware that they may well not always be in a position to solve the problems for an individual but there is worth in other aspects of care such www.testmyprep.com as listening to individuals and comforting them.

Moreover, the authors suggest that there surely is a have to integrate formal coaching and clinical practice together to teach nursing students about dying and death encounters. Placement at palliative good care facilitates will be useful for nurses to consolidate their knowledge and expertise ( Barnett & Copper, 2005).

My thinking has change after analyzing the main element issue. I used to believe experienced nurses do not have emotional issues when looking after a dying patient, but now I understand both scholar nurses and experienced nurses can suffer from emotional distress when working with a dying sufferer or a patient’s loss of life. Also, it really is completely natural for college student nurses to think anxious while caring for a dying affected individual and I really do not have to blame myself too harshly for certainly not handling my first come across with a dying individual properly.

In my perspective, I’d preserve the action of being there with the individual and hearing him and his relatives. With this action, I am showing I respect and look after my sufferer and his family. A very important factor I would change is that I’d not only try to manage my distress by itself. Since I was emotionally bothered by the situation, I would get formal and informal support to reduce my negative feeling about this event. For example, I could book an appointment with the counselor at university or I could talk to my clinical group member about my grief. This might likewise ensure my well-appearing and donate to my practice as students nurse.

If a similar situation arises again in my practice, I’ll adopt the coping mechanism the ICU nurses employ and think about death as a standard and inevitable procedure for life, and that loss of life is also a regular element of a nurse’s daily do the job. Also, I will try to make a curtain of psychological security by compartmentalizing my emotions from my patient. I really believe this allows me to not be influenced as greatly when looking after a dying patient so that I could remain professional and offer for my patient’s necessities. Instead of avoiding interaction with my patient, I will provide therapeutic connection to the patient and their members of the family. For example, the patient or the spouse and children may request "what should we perform?", and in such circumstances I will be cautions in providing suggestions. As a nurse, I should focus on support and clarification of issues important to the patient and their family. Likewise, it is important to understand the patient’s perspective about his clinical state by asking "what is your understanding of your condition?" Also, I think by saying "I have to find out about your wishes which means that your care guideline can follow them". To show my empathy I could say "I understand it must be hard for you" or "My apologies about your loss". In addition, I will supply the chaplain contact details at St. Michael’s Hospital to my person and his family in order that they can gain spiritual support and professional consoling from the chaplain workforce.

In terms of recommendations, I really believe most of the nursing college students have not had exposure to the experience of caring for a dying patient or a patient’s loss of life and therefore I think our school should give a nursing excellence semester for nursing learners which focuses on sharing the tactics of how to manage a dying person or a patient’s death. It would also be useful for students to learn about end of life nursing care module on their own, for instance, the Canadian Hospice Palliative Good care Association website provides very well of information for health care professionals, the family health care givers and the patients about palliative care and end of existence issues in Canada. In addition, we learn therapeutic connection skills from the text books, however, students are lacking the real life connection with how to communicate with a dying person and his members of the family. Therefore a simulation lab where students can practice their interaction skills will be helpful.

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