Guest Post by Lynn Visser RN, BSN, CEN
As I think back to nursing school, I clearly remember being told “Be a patient advocate!” I always held that message close to my heart, though found as a New Graduate Nurse being a patient advocate was something that was easier said than done. I started working in a busy Emergency Department (ED) straight out of school. I clearly remember wanting to be a patient advocate but was so busy starting the intravenous lines, providing the pain medications, and titrating the vasoactive drips, that truly focusing on “being an advocate” seemed nearly impossible. As the years pass, I have certainly gained experiences making me a better patient advocate and more confident in my abilities.
Recently I cared for a frail 81-year-old woman in the ED who was ready to take her last breaths. The ED physician met with the family and they all agreed comfort care was the best route for this woman. The physician was eager to admit the patient to the hospital floor as it was a typical busy night, gurneys lined the walls, and we needed the bed for other incoming patients. The ED physician called for an admitting physician, but as usual, this took time. In the meantime, the family had gathered; all six of this woman’s children, including their husbands, wives, and many of her grandchildren. They were all present at the bedside, packed like sardines into the 10 by 13 foot room. The patient’s husband approached me and said, “We’re ready to take the oxygen off and let her go.” I recognized the tremendous strength it took the family to make this final decision and knew transferring the woman to the floor meant a change in continuity of care. I relayed this information to the ED physician who encouraged me to transfer the patient to the floor before taking further action. I professionally explained it was in the best interest of all for the woman to stay in our department and advocated for some intravenous morphine sulfate. As the matriarch of this family took her last breaths, it was important to me she experienced no pain. I gave the medication and removed the oxygen.
We really don’t withdraw support in the ED often, as the length of time it takes a patient to expire is often unpredictable. On this particular day though, I saw the family gathered together, holding hands, praying, and coming to peace with their decision. There was no way I was going to disrupt the dignity and grace of the woman’s final moments on this earth all out of convenience for me, the ED physician, or even the next patient waiting. After death was declared, the family lingered. I told them to take all the time they needed.
As the family was preparing to leave, one woman leaned over, gave me a hug, and said “I am an Oncology Nurse, but today you let me be a daughter, sister, mother, wife, and friend. Thank you for being our advocate.” There are times when being an advocate means more than anything to a patient and their family. In moments such as this one, there is nothing more important than the presence of a nurse who will do just that!