The patient stories shared by Melissa Owen, MSN, RN, BSN Coordinator/Lecturer in the College of Nursing, at Kent State University Geauga, illustrate how nurses can truly influence patient care, and the advice she gives to other nurses.
Back many years ago when I was a young nurse, I had decided that I was going to be that nurse who sat at the bedside, held the patient’s hand, listened, and was observant. With those skills, I could advocate for the needs of those for whom I cared.
I worked on a medical-surgical unit and was caring for a patient who had recently had bowel surgery. The patient did okay for the first few days, but then started to decline. I noticed she couldn’t tolerate food or fluids, her abdomen was swollen with ascites, she became weak and lethargic. The surgeon came to see her daily, wrote his note, and moved on. At some point, her husband and daughter were present and ask how their wife and mom was doing and when she could come home. Although family had been present, they had questions that had gone unanswered. I spoke with them and asked if they knew what the patient’s wishes were if her health continued to deteriorate, and if they had ever considered end of life care. The family hadn’t realized that the patient might not make it home. We got the surgeon involved and everyone decided on a DNR order. Over the next few days, family came to visit from out of town and eventually the patient passed on peacefully. As I write this, I can still see her lying in that bed. I had wondered if I did the right thing.
A few months later, my manager came to me with a letter—it was from the patient’s daughter. This letter validated my actions as a new nurse. She wrote that the family was thankful that I had been forthcoming in communication and advocating for her mom. Had I not said anything and left if up to the physicians, her mom may have died abruptly without notice. Family members were able to say goodbye and had a short time to prepare for her passing.
Fast forward 15 years and I faced with a similar situation—different department, different hospital, different state. I was working as a procedural nurse; the patient was intubated and under anesthesia, so I functioned as a circulator. The patient was bleeding internally, and the bleeding could not be stopped. While the interventional team continued to try, they asked if I would go out and update the family. As you can imagine, it’s never easy to let anyone know that progress is not being made. Each time I went to update them, they shared more about their mom and her wants and needs. I then brought this information back to the interventional team. After a few hours, the family asked to have the procedure stopped and the DNR order reinstated. The physician spoke with the family and the procedure was ended. The family did not want her to suffer in the way they had seen their father suffer, when he had passed a few years earlier. The patient was transported back to her room, and passed within a few hours.
Making an impact
Both examples above were difficult for me as a nurse, as nothing prepares you to deliver bad news. Communication led to advocacy—advocating for the patient and family.
If I had to give one piece of advice, it would be twofold—communicate often and advocate early.