Examplars
Critical nursing incidents where you made the difference
Helen Calabretto
School of Nursing, University of South Australia, SA
PP: 131 - 133
Article Text
The privilege of caring for the dying client
Sandi Mackey RN BNsg
On completion of my general nursing training, I worked on an oncology ward at a large Sydney hospital. I found there were only two possible responses when working with people faced with death- to either close oneself off to the client's experience and one's own emotions, or to share of oneself in a reciprocal relationship. Without being aware of it at the time I chose the latter, and this being involved with the person not just the client in my care, has become a significant feature of my nursing practice.
One particular client remains in my memory from that time because he helped me experience the value of such involvement. John was 17 years old when admitted to our unit via a Brisbane hospital where treatment of his cancer had been discontinued. His parents had refused to accept that nothing more could be done to treat their son. They sought out further options and John was admitted to our ward for more chemotherapy.
He was paralysed from the waist down, extremely frail and emaciated, with deep pressure sores on his sacrum, hip and heel. He was the youngest of a large, close knit, very religious family, and his parents could not reconcile their deep faith and belief in their own and their son's goodness of mind, body and spirit, with the suffering they were enduring. They believed that John would eventually get better, despite the obvious seriousness of his condition and, by accepting John for treatment, our unit offered them hope.
Because of his physical condition, John required a great deal of nursing care-hourly turns, help with feeding, dressing, moving, bathing. This constant physical interaction provided the time and opportunity to interact with him more personally. His patient, smiling acceptance of his suffering was remarkable. He was only three years younger than me and he made me feel my own mortality-this could have been me. I asked myself 'Why him and not me? How would I have managed?' I know I could not have endured what he did with such grace. As I got to know John and his family, I came to realise that he was patient and smiling for his family. He knew he was dying and he was waiting for them to come to terms with this, without losing their faith, before letting go. I ached for his parents, for their pain, the questioning of their lifelong beliefs. I talked with them, cried with them and felt their 'Why? Why? Why?'
I felt the purity of John's spirit and his capacity to give to others through his suffering. I felt privileged to care for him, as he taught me that while I could not make him better, that which I gave him through my care was enough. Finally, after some months, his parents were able to see the reality of John's condition and to accept his need to die. I sat with them as their remarkable son counselled them in preparation for their loss, as he told them, and us, when to expect him to die.
I believe nurses are a privileged group in so far as the nature of our interaction with clients is intimate, one-to-one and based on need. Our clients need our assistance and skill during a physically and emotionally vulnerable experience. This revelation of vulnerability by our clients provides us with the opportunity to experience and examine our own vulnerability - if we are prepared to involve our personal, not just professional, selves in our interactions with them.
I know I was enriched as a person and as a nurse by my involvement with John and his family, and I believe I helped to make the experience of his dying more bearable for them because of my preparedness to involve myself and expose my own vulnerability.
Families - An important part of client care
Jackie Pearse RGON RM AdvDipNsg
Dunedin, New Zealand
It was an afternoon in early November when Mrs Smith (not her real name) was admitted with a small sub-arachnoid haemorrhage. She was accompanied by her husband, who initially seemed fragile and poorly equipped to cope with her hospitalization. I remember her main concern was that she had baked a Christmas cake for each of her three daughters and was worried about getting them iced in time. Her husband and I reassured her that Christmas was weeks away and she would be home by then. The neurology ward was a temporary placement for me as I was awaiting a midwifery position and my evenings were spent frantically reading texts to fill the many chasms in my knowledge. I felt I had to do this not only for me so I could practice competently, but also to share relevant information with my clients and their families.
Mrs Smith initially seemed to have very little residual effect from her initial 'bleed' but two days later she suffered another more major episode and lapsed into a coma. Her three daughters arrived en masse and all of a sudden I found I had five clients. As I came to know these women over the ensuing weeks, I found they had very specific needs and it is these that I would like to share with you.
Anne had been a nurse-she had left to get married. At least that was the official version. I had been confused at how she seemed so ill at ease and almost seemed trapped within the ward and asked her how she felt about being in a hospital again. It all came out. She hated hospitals and nursing and was terrified of dealing with sick people. Her training had been a nightmare and her marriage the only means she could see of escaping it. The present situation was made worse for her because she had never told anyone and her father and sisters expected her to take the lead and 'know' what to do. Once I realised the cause of her distress I was able to suggest Anne take breaks and gave her 'permission' to leave. Her relief was amazing.
Bella's problem was completely different. She had several children, lived miles away and was a farmer's wife. November is a particularly busy time on the farm, and with her children's and her own social activities. She was literally feeling 'torn' between being with her mother and father and being with her own family. I reminded her that her mother was a farmer's wife (albeit retired) and would understand the constraints upon her and that she should visit when possible. Bella also needed to feel that it was acceptable to go home knowing we would call the moment there was any change.
Cath was different again. She hung back was but was also there. One day she showed me a photograph. 'I don't want you to think Mum always looked like she does now. She was a real lady and very particular about her appearance. This is my real Mum'. On one occasion she broke down. She and her mother had not related well for years and Cath had never told her how sorry she was about that. I guess I realised that she needed to do something to atone. Atonement is deeply embedded in our collective subconscious. I recruited Cath. She began to help me with sponging, bed changing, massaging and hairbrushing. She loved her mother with every touch and I know her mother knew it was her and heard her apology.
As for Mr Smith, he was a gem. He turned out to be a very wise, strong, sensitive husband and father who taught me much about love and life. His daughters had shared my concerns as to whether he would cope, but he surpassed our expectations.
Twenty-two days after the initial admission, Mrs Smith died. A final bleed. Her family were all there and I remember asking them when they went to leave if they would just wait for 15 minutes. They accepted the proverbial 'cuppa' and granted me the time. It's an age-old, largely unapplauded task that we do, in laying out those who die in our care. To me it has always been the final privilege. I took away the machines and tubes and monitors-all the physical accoutrements of our technological caring. It was a relief for me to be with Mrs Smith. I talked to her about her family while I washed and combed her hair, made up her face and changed her gown. The only flowers I could cadge were three red roses, but it turned out later they were her favourite flowers.
After placing the roses in her hands, I asked her family if they would like to come in and say goodbye before they left. They were a bit mystified, but when they saw her, they just cried. Anne turned and embraced me. The others softly stroked Mrs Smith's hair or held her hand. Cath just stood and looked at her mother. Then a slow smile came over her face. 'Jackie' she said, 'you've given us our Mum back.' It felt so good. I'd nursed well.
eContent Home
