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Learning
new skills
I
have pretty good skills but I realize that I sometimes cut
the patient off because I'm too busy and needing to get to
the next patient. If you give patients opportunities to speak
without interruption you can learn a lot about their problems…
Since going through this unit, I've really tried to be a better
listener and really listen to what the patient tells me. I've
also learned to be more conscious about asking open-ended
questions, to get more information than straight forward yes/no
questions.
I
want to share with you how helpful this EOL class has been.
We had a 29 y old woman die this week. I was able to call
on techniques I'd learned from the class' grief unit to help
me with the patient, the family, and my co-workers. The youth
of this patient; the fact that she had only been diagnosed
this spring and they were unable to come up with a definitive
diagnosis; the reality of the recent deaths of both of her
grandparents to cancer also; the difficulty the physician
had; her spiritual and physical suffering, all combined to
make this death one of the most difficult I have seen. I set
up a grieving session (debriefing) for staff. I want you to
know how very useful this class was for me.
Health care providers need to know principles and strategies
for helping grievers and need to understand and assess their
own personal experiences with death, dying, grief and loss.
They need to be present physically, as well as emotionally
for those who are grieving, be supportive, listen nonjudgmentally
with permissiveness and acceptance etc...
Assessment is crucial in everything you do. You must assess
before appropriate action can be taken. With pain, communication
is crucial. Pain can be a perception, so it is important to
try to understand what the patient is feeling. It takes continuous
encounters to assess the patient's pain to ensure that it
is adequately controlled, yet not over-medicated, as side
effects can become limiting to therapy. It is important for
all health care professionals to be able to effectively collect
the appropriate information in order to provide the best quality
of care.
Personal reflections
This
week my son was home from college and my daughter had a new
baby. I took a serious look at what I want for EOL care …This
has been a great unit. Not only did my husband and I decide
to finish our living wills but I also plan to talk seriously
with my 98 year old grandma this week and let her know that
it is okay for her to die. She seems to be hanging on to life
for the rest of us, and I realize that we have never told
her that she is free to do what is best for her. She is so
used to taking care of the rest of us but is now so very tired.
It will be hard but my nursing instinct tells me she needs
to be freed to go.
I found the questions about my religion made me feel uneasy
inside. I believe in God, angels, prayer and the after life.
I am not afraid to die, but am fearful for my loved ones'
pain after my death.
I want to be cremated and no funeral-not even a wake. I believe
when you're dead your dead. I hope my husband and children,
who feel the same way, are able to say their goodbyes at the
time, not days later. I really don't care about having an
obituary or eulogy. When I first discussed my decisions with
my husband, he freaked out and thought I was hiding some illness
and was dying. What a drama king! I had to show him my assignment
(learning activity) to calm him down. It made him sad to discuss
my death and my wishes. We have been best friends for 23 years
now. I have had a living will for several years but he would
never listen to me completely. Now he should be better prepared
in the event of my death.
The cost of health care infuriates me. I am ashamed of the
fact that so many people don't have any health care coverage
and I feel guilty that my family has great insurance while
others have none and will never have any.
Acceptance of pain or a poor prognosis is very hard. It is
not something we should expect our patients to accept. It
is an unfortunate thing that illness occurs and for the most
part, people don't try to bring it on themselves. That is
one thing I would wonder, Why me??
Touching Experiences
It
was truly heartwarming to see a family on my unit pull together
and put aside their personal differences to support their
mother at the time of her death. Her family was scattered
across several states and all had jobs and previous commitments,
yet they all gathered to support their mom. It was a touching
experience to see these adult children caring for their mother,
telling stories, reminiscing, singing their favorite Irish
songs and praying the rosary. I have not had the experience
of losing a parent; I can only hope that when the time comes
I can be as strong and supportive to my parents as Florence's
children were to her in her final days.
Insight
about nursing role
Hardest
for me is not knowing what to say when the prognosis is poor
or death is near. I force myself to go to visitations at funeral
homes. I don't like the helpless feeling. I'm always taking
care of things for everyone, but in this situation there is
nothing I can do or say to make it better. I need to remember
that my simple presence probably means more than anything
I could say.
I
have thoroughly enjoyed this class and have come away with
enhanced insight for caring for my patients. I have always
said that we as nurses need to be comfortable with our own
mortality before we can care for those who are dying.
It
is ironic that everything you have learned in nursing school
can't prepare you for end-of-life situations. It seems as
though you have to just set everything you have learned aside
and act on instinct.
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