Marsh AACN Excellent Nurse Practitioner Award
Megan E. Carr-Lettieri, MSN, CRNP, BC, CCRN
Hospital of the University of Pennsylvania, Philadelphia, PA
Kia, a 28-year-old single mother of two young children, had developed significant pulmonary emboli, progressive pulmonary hypertension and right heart failure requiring evaluation for transplant on our unit. As time passed, her condition worsened, and she appeared to be seeking medication for
pain that was disproportionate to her physical exams.
During this period, Kia asked me for a favor. Because her children’s father was in prison, she wanted to make certain that her mother would become their legal guardian if she should die. I collaborated with our legal consultants and social worker, who helped her to draft both a living will and power of attorney.
I also offered her my tape recorder so that she could leave messages for her family. When approached about this, she was tearful, but agreed that she would do so. During this same conversation, I had a valuable discussion regarding her pain medication use. She revealed that she was simply trying to hide from the reality of her situation. Together we determined a reasonable weaning strategy so that she could have meaningful interactions with her family during the precious days to come.
Soon after, Kia died peacefully with her mother at her bedside. It was then that I gave the tape to her mother. I don’t think I’ll ever forget the power of that moment. Her mother has since told me that she listens to the tape daily and is grateful for the words her daughter shared with her and her children, who were now in her custody as Kia had wanted.
The lesson I learned from Kia is that our role as clinicians is not merely to provide patients with physical care or technical support, but also to be cognizant of their emotional, social and spiritual needs, even when they may not be vocalized.
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