Examplars
Critical nursing incidents where you made the difference
Helen Calabretto
School of Nursing, University of South Australia, SA
PP: 026 - 027
Article Text
A difficult death
Wendy Morey RN Gerontic Nsg Cert
Mrs M, a resident in our nursing home was developing terminal cardiac failure. She was a woman who liked plenty of individual attention and had been very creative in her efforts to command this. She displayed a particularly strong will and determination to live life her way and from the history her family shared, this was perfectly in keeping with her character and life before she came to us.
One morning her condition deteriorated rapidly. As her confusion and physical distress increased, so did her mental agitation and our best efforts at symptom control seemed in vain. She became physically unmanageable - throwing her body about and hitting out at the staff and her family.
We found one of the most effective interventions to be a soothing oil-laced bath. Following this, Mrs M finally lay relaxed on the bed. As the atmosphere calmed, I shared in her daughter's grief as she longed for the mother she once knew - the one who always entertained a dozen strangers around the Christmas dinner table, the one who ensured no-one in the neighbourhood ever went hungry. The daughter wished I had known her mother then.
In what I could only describe as the violence of Mrs M's struggle against death and life in her last few hours, these comments reminded me to recognise once again that my nursing interventions were but a small part of a lifetime for Mrs M and yet were no doubt crucial in helping her die in peace, with dignity and pain-free. My Director of Nursing was very supportive on that distressing day; coming on site to work alongside me and to offer encouragement and support. I valued this, as being the only registered nurse on duty can sometimes create a professional loneliness. Having the opportunity to bounce ideas and verbally review the management for the day was helpful in clarifying my own thoughts and subsequent plans for nursing interventions.
Mrs M died the following morning. Two weeks later, the staff who had been caring for her on those two days and any others who were interested, were invited to a debriefing session where we were able to share our feelings, discuss our care and evaluate it in the light of Mrs M's status in that last 48 hours. Most of the staff had not encountered a death of this nature before and our collective comments were, I'm sure, helpful to those who had not been present. The debriefing was very valuable as it gave formal recognition to the fact that a significant event had taken place - a distressing death which needed exploring, understanding and set in perspective. It also reminded me of the special privilege it is for nurses to participate in the defining moments of life and death.
Nurses and health promotion: We really can make a difference
Anne Johnson RN RM PICNC Grad Dip Health Couns M Ed
Several years ago I was working in a paediatric intensive care unit as a registered nurse. The circumstances surrounding the death of a young boy and the grief that his family went though had an incredible impact on me. The young boy died as a result of choking on a piece of raw carrot while in child care. It seemed bizarre that such a healthy food should be responsible for his death. The Coroner's report stated that the little boy should not have been given raw carrot to eat. This is because children up until the age of about 3 years do not have their back teeth (molars) and are not able to grind hard food into small pieces. Young children do, however, have incisors which can bite hard food. This predisposes them to being susceptible to choke on lumps of food that cannot be chewed. This seemed to make such sense, but it appeared that many people did not seem to appreciate the developmental capabilities of young children when giving them food to eat. Even though I had been a paediatric nurse for many years, I had not associated tooth development with the types of food which should be given to children.
Over the following few years, circumstances arose where I came to know the family reasonably well. I watched with a feeling of powerlessness at their attempts to get the message of this issue raised amongst the general public, health professionals and child care workers and make changes to policies and practice in areas which cared for children. The family slowly but surely lobbied various ministers of health and children's services, gaining some coverage in the media, but without any policy or consistent practice changes. My heart went out to them and their need to make others learn from their child's death so that no other children would die from the same cause. Unfortunately, since their child died, two other young children have died in South Australia from choking on age inappropriate food.
The hospital in which I work has identified health promotion as part of its vision statement and there is now a great deal of activity in the area of health promotion. Because of the lobbying by the above mentioned family, our hospital was approached by a government department to take up the issue of developing a health promotion program to raise the public's awareness of safe eating practices for young children. A small group of interested staff from various disciplines came together to work on the development of the program. All of us had been touched in some way by this young boy's death and the grief experienced by his family and wanted to do something to make a difference. We have since obtained a small grant from Foundation SA and have developed a comprehensive program to promote safe eating practices for young children. It has been an intersectoral approach and there has been a great deal of collaboration and cooperation by many people to make this program a success.
Being involved in this process has made me think a lot about my role as a nurse. On reflection, I became aware that if I had seen my role as a nurse more broadly to incorporate health promotion. I would have realised that I was not powerless to make a difference and could have been active in developing this program several years ago. I think as nurses we sometimes place barriers around our role which makes us feel powerless, when in fact we are very powerful and can make an incredible difference not only to the patients and families we care for, but also the health of the public.
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