Objective Data
On April 28, 2016, I cared for a terminally ill patient, S.G., along with a group of nurses. The 84-year-old Caucasian female was admitted for heart failure and failure to thrive. She had a medical history of myocardial infarction, hypertension, and renal insufficiency, had not eaten since two days, and had gained 3 pounds in one week. Although alert to time, S.G. showed decreased consciousness. Her blood pressure was hypotensive (96/56), heart rate was tachycardia (120 beats/minute), and the respiratory rate was tachypnea (24/minute). Physical assessment revealed cold-to-touch lower extremities, crackles over all the lobes, and hypoactive bowel sound over all the quadrants. Laboratory tests indicated high creatinine (3.0) levels, low glomerular filtration rate (=20), and low ejection fraction (20%) (Pagana & Pagana, 2012). The patient did not respond to 16 milligrams Lasix and 3 liters of oxygen, and was full code. Her declining physical and physiological functions indicated that she was nearing the end of life (Ignatavicius, 2016).
When the patient experienced pain and shortness of breath, I raised the head of her bed and tried to calm her down by assuring her of my presence. When her anxiety increased, I called the physician and suggested that pain medication be administered. Looking at her deteriorating health and unresponsiveness to treatments, the doctor, nurses, palliative nurse, and other interdisciplinary teams advised palliative care. Since S.G. had told me that her daughter would take decisions on her behalf, I contacted the latter to discuss regarding palliative care. I explained to S.G.’s daughter why palliative care was required and informed her about morphine, a WHO-recommended, minimal adverse effect-causing pain management medication (Kuebler, 2014).
Reflective Data
I have no prior experience in providing palliative and end-of-life care that I could compare with the simulation experience. Caring for S.G. gave me an insight into the end-of-life care process. I learnt how to talk to the patient and her family about palliative care without making them anxious. During simulation, I was unable to explain to the patient about palliative care and assuage her fear of dying. I consider every human death as belittling and the simulation only reminded me of the untimely demise of my 21-year-old older brother 20 years ago. This experience has made me sensitive when talking about death. However, the simulation helped me converse smoothly about the end-of-life care process with the patient and her family.
Interpretative Data
Palliative care aims at providing relief from pain and quality symptom management for terminally ill patients and their families (Rome et al., 2011). During simulation, I learnt how to involve the patient and her family in the end-of-life care process so that it reflected their personal, cultural, and religious values. People who are nearing their end are entitled to accessible and high-quality care and respectful relationships with their nurses (Sherwen, 2011).
Decision Data
The end-of-life simulation helped me understand palliative and end-of-life care planning. During simulation, I could not identify the patient’s religious and cultural preferences. I asked the patient about the DNR document and other care-related issues, which only increased her anxiety. In the future, I will not talk about DNR until the physician makes a decision. I will practice SBAR therapeutic communication and will participate in interdisciplinary palliative and end-of-life care planning processes to reinforce the experience I gained from this simulation.
References
Ignatavisius, W. (2016). Medical-surgical nursing: Patient-centered collaborative care (8th ed.). St. Louis, MO: Elsevier Inc.
Kuebler, K. M. (2014). Using morphine in end-of-life care. Nursing, 44(4), 69. doi:10.1097/01.NURSE.0000444548.72595.ac
Pagana, K. D., & Pagana, T. J. (2012). Mosby’s manual of diagnostic and laboratory test reference. (11th ed.). St. Louis, MO: Elsevier Mosby.
Rome, R. B., Luminais, H. H., Bourgeois, D. A., & Blais, C. M. (2011). The role of palliative care at the end of life. The Ochsner Journal, 11(4), 348- 352.
Sherwen, E. (2011). Good practice guide supports end of life care. Primary Health Care, 21(9), 7-8.
