NR 305 Discussion Reflection on End of Life Care

Sample Answer for NR 305 Discussion Reflection on End of Life Care Included After Question

Purpose

The purpose of this reflection is for learners to apply this week’s lesson on assessment at end of life to past practice experiences, and to consider how knowledge gained this week might shape future practice.

Directions

  • Reflection is an activity that involves your deep thought into your own experiences related to the concepts of the week. Answers should be detailed. In reflections students:
    • Demonstrate understanding of concepts for the week
    • Engage in meaningful dialogue with classmates and/or instructor
    • Express opinions clearly and logically, in a professional manner
  • Use the rubric on this page as you compose your answers.
  • Scholarly sources are NOT required for this reflection
  • Best Practices include:
    • Participation early in the week is encouraged to stimulate meaningful discussion among classmates and instructor.
    • Enter the reflection often during the week to read and learn from posts.
    • Select different classmates for your reply each week.

 Reflection

Share with your classmates a time when you cared for a patient at the end of their life. This may be a time when you assisted the patient (or their support system) with decisions related to end of life care; or a time when you were present for the death of a patient.

  • What were your observations related to this experience?
  • Do you believe it was a peaceful death?
  • What went well?
  • Can you think of anything that could have made the experience better for the patient and/or family?

A Sample Answer For the Assignment: NR 305 Discussion Reflection on End of Life Care

Title: NR 305 Discussion Reflection on End of Life Care

End of life care is one of the most special fields a nurse can give her patients. I have lost both parents and for my mother I was the hospice nurse. But my interest in end-of-life care I wish to discuss generates from the many years I worked in L&D. L&D is supposed to be the happy unit, but that is not always the case. I have experienced probably the worst grieving that of a child. Having a new mother and father who have waited 9 months to meet this bundle of joy be born knowing this wanted baby would not live long after birth can be a devastating blow to new parents and the nurse.

As a labor nurse this is the hardest task to do. But thankfully there are training sessions that prepare L&D nurses when an infant death is inevitable. Many of you have probably seen the purple leaf on doors. I spent many conferences learning what to say, when not to speak, who to notify, and making sure everything is done when the time comes in a professional, respectful, empathic, while meeting the cultural and religious needs of the parents. 

 Post birth bonding is allowed at any time for the parents and family. In many cases parents did not want to hold the child at first, so we would take the child out of the room giving them time alone to grieve. At this time, we will bathe, and put baby powder on the baby, take one ID band of the child and set aside, cut a lock of hair, footprint the infant, wrap the infant in warm blankets, and then take pictures. Next, we would put the lock of hair, the bracelet, pictures, the hat, and footprints, and a toy bear in a beautiful memory box. Time heals wounded and broken hearts, many parents will not take the memory box home, but these boxes are stored forever, and many call years later, parents can open the box when they are ready.  

The hospital where I worked as a L&D nurse was a catholic hospital so pastoral care was readily available and always came daily to speak with the parents regarding religious practices and who they would like us to notify. The hospital was affiliated with a funeral home who would take care of all arrangements for the parents, and every discipline would get involved to make sure the family was taken care of. A more private setting was provided. A private elevator was used for discharge. From the phone operators to security every discipline had a part in the care of these grieving families and did so with empathy, and respect. 

End of life is so hard at any age or stage of life. But the first time you have to be the nurse coding a newborn or sitting with the family watching their baby breathe its last is something you will never forget. Knowing the families background, religion, cultural needs, and having the best interdisciplinary team can make this devastating time at least one where the parents know that they are not alone and have people there to help them through this most difficulty time of their lives.

A couple of weeks ago I had a patient who came from home, she was probably in her 80s or late 70s I don’t recall her age. They brought her due to altered mental status; her urine smelled like ammonia.  The nurse who gave me the report told me that they were unable to receive a full history for her as she was not able to speak.  I cared for her on the second day of her being admitted. So, on that day I called the internist Dr and asked her about the plan for this patient. The patient came late the night before, So the Dr told me, they would go according to all her lab results as her history was limited in the chart.

Her urine was positive, and she was on antibiotics, but she was not in fluid, her blood pressure was extremely high, and I was given PRN hydralazine for that. I told Dr, that this patient only responded to pain stimuli, she did not open her eyes, her pupils were not reactive to light, she was not following commands, and she was not able to swallow her secretions, I asked for a suctioning order, I set up suctioning in the room, and I also ask Dr to put her NPO. So, I received an NPO order, and I put the sign on the door.  The Dr ordered a bunch of tests for her. In the middle of the day, someone called and identified himself as the patient’s son, his name was in the chart, I had tried to reach him earlier, but he did not answer. He was asking about the updates.  

I asked him about any past medical histories as well as medications she was taking at home and inquired about the patient’s baseline at home. He told me that she was able to speak and that is not her baseline and said that he will be coming to the hospital shortly. The patient was full code, she was on heart monitoring.  As a nurse, I could tell that she was in her last moment just by the result of my assessment. Her vital signs were not low, but she was not looking good at all. So, the son came, and I spoke to him, he looked very devastated, I listened to him more than I talked to him, and at that moment, it felt like he became one of my patients as well, he needed someone to listen to him, he was asking me multiple times if the mother ever opened her eyes for me, I told him no.

He gave me the name that she preferred to call by, and I told him that I would try to call her by that. I took good care of her; I turned and repositioned her every two hours. I gave her a bed bath; I washed her face and suctioned her mouth. I changed her multiple times during my shift because her urine was very strong. She was running a fever, so I gave her a PRN acetaminophen suppository, I administered her IV antibiotic as prescribed, my shift ended, and I gave a report to the next shift. The following day, I got assigned again to her, I contacted the Dr, and I told her the patient was NPO and she had not eaten for three days, would she consider putting her on any fluid? She gave me an order for N/S 75 m/hr.

The patient showed no signs of getting better, she was on oxygen N/C 4L, and her saturation was good, I believe that the reason she stayed on the med surge floor and was not transferred to ICU, she did not show any respiratory distress, but she was declining. That day, the son called again and asked if his mother had opened her eyes. In the middle of the day, the charge nurse informed me that the patient was going to hospice the next day, and the family decided to change her code status to DNR/DNI.  I wasn’t surprised at all, because she was not doing well. Since then, I have never heard anything about her. That is the only patient I took care of as a new RN in that stage of life, but as an LPN, I’ve taken care of a lot of dying patients. For that particular patient, I felt like I did great. I advocated for her by asking Dr to put her NPO and start her on fluid, and I was very supportive of the son as well as in this stage, family is very important in patient care as well. I think I did wonderfully.