AACN News—September 1998—Loving, Human Touch Helps Family Cope With Loss
Vol. 15, No. 9, SEPTEMBER 1998
RN, BSN, CCRN,
is a staff nurse in the cardiac surgery ICU at the Medical College of Virginia Hospitals, Richmond. She received the 1998 Excellence in Caring Practices award, which is part of AACN’s Circle of Excellence recognition program. Presented here are excerpts from the exemplar submitted by Lelis-Grice in connection with her award. For more information about the Circle of Excellence award program, call (800) 899-AACN (2226).
By Debbie Lelis-Grice
I have frequently heard the sigh of deep pain, grief, and suffering in my more than 10 years as a critical care nurse. I have experienced the uneasy feelings of fear and uncertainty and have witnessed unbearable agony and death. We are blessed with advanced technology and scientific therapies to save lives, prevent complications, and “cure” diseases, though the outcome is inevitable for some patients. Although emotional involvement with a family is painful, I experience a tremendous sense of accomplishment in providing comfort and support to family and friends when a loved one dies. I am willing to leave my “comfort zone” and risk emotional discomfort to provide meaningful care to a family. It is the loving human touch—the essence of the art of nursing—that can help a family faced with death begin to cope with their loss and suffering.
I became Mrs. D’s associate nurse 3 weeks after she was admitted. Although there were endless tasks to perform, my focus was to anticipate the patient’s and family’s needs. I tried to empower them by providing choices and honoring their preferences.
Mr. D wanted to be with his wife at all times, and I encouraged him to assist with turning and repositioning, bathing, changing linens, suctioning, changing dressings, and notifying me to assess IV pumps and equipment alarms. Her two sons were
also encouraged to participate in their mother’s care.
My consistent observation was that Mr. and Mrs. D were united by their faith and love for each other. This faith held the family together. Mrs. D was fighting for her life because she cared for her family. She responded to her husband’s presence, his voice, and his loving touch, even though being touched was painful for her. Her spirit was alive and fighting, despite her physical and emotional suffering.
Mr. D kept a daily journal of every event including Mrs. D’s vital signs and weight. He looked for trends indicating improvement. However, after 4 months, Mrs. D’s condition continued to worsen. There was little room for medical intervention, but she remained mentally alert. Like her husband, she was always encouraging, but the hope for recovery became bleaker each day.
There were no complaints or signs of anger, bitterness, or impatience from Mr. D and his sons. They remained calm and appreciative of the care being given and the emotional support they received from the staff.
Mr. D requested a family conference. The surgeon, pulmonologist, physical therapist, nutritionist, respiratory therapist, chaplain, transplant coordinator, social worker, primary nurse, and three associate nurses attended. The meeting took place on my day off, but I wanted to be there to collaborate with my peers and other disciplines and to support the family and healthcare team. The pulmonologist gave the overall report.
Mrs. D. had repeated multisystem organ failure, which included many complications. Every body system was affected or compromised. Although she remained neurologically intact, her prognosis was very poor. Mr. D responded calmly, thanking everyone for the care that had been given to his wife. He said, “God has a purpose and a reason. We are not there yet, so I am not going to make any decision. I believe that God will heal her by miracle and that she will be able to walk out of the hospital.”
After the conference, I stayed to talk to Mr. D and his friend from church. In an effort to identify his religious and spiritual beliefs, I asked how he felt about certain treatments. I felt that this could help him to consciously incorporate these beliefs into his decision-making process. In addition, it would show my respect for him and that I saw him as a unique individual and would establish a caring atmosphere. I offered him words of comfort and insights on dying. By recognizing his relationship with God, I felt I could offer comfort and encouragement, and suggested we pray together.
We held hands and bowed our heads as he expressed his requests, thoughts, and feelings. This type of shared prayer can be one of the deepest forms of human communication. I expressed to God what Mr. D had told me as well as what I had observed. This act of praying showed him that he could then talk more freely about his fears, and he was reassured about my awareness and concern for his needs. I was aware that part of Mr. D, part of her two sons, and a part of her parents would die when Mrs. D passed away. I realized that tremendous emotional support would be needed in the coming weeks. The next week, Mr. D recognized that it was time to begin letting go.
Within a week, Mrs. D’s condition severely deteriorated. The pulmonary specialist determined that no further medical interventions could be offered. Mr. D decided to request “do-not-resuscitate” status for his wife. She was given morphine sulfate for pain.
On my day off, Mrs. D’s condition had deteriorated. I had developed a close relationship with the family and wanted to be there to convey my full support. When I arrived, Mr. D gave me a hug and thanked me for coming. He said, “She is now ready.” He invited me to meet his pastor and friends, who were in the waiting room. He told them, “This is Debbie, my special nurse who prayed for me.” The pastor said, “We heard good things about you.” I responded, “Thank you for your loving care. The support and encouragement you have given to them have shown a real example of love and service. This may be the appointed time for Mrs. D. We can only claim the promises of God.”
After a moment of silence, the pastor said a word of prayer. He included a personal prayer for me to be a continuous blessing to my patients.
Mr. D, one of his sons, and I went to Mrs. D’s room. I encouraged them to continue care, which included suctioning, wiping her face, and repositioning pillows. Mr. D let me know when she needed more IV pain reliever and sedation. My goal was to facilitate a comfortable and dignified death. I encouraged unlimited visits from the family members and friends so that Mrs. D could receive their comfort and support. They sang hymns and worship songs and played her favorite music.
After speaking with the pulmonary specialist, Mr. D asked that the ventilator be removed. He then asked to be left alone with his wife and son. After 15 minutes, he opened the door and we returned. The doctor disconnected the tubing and turned off the ventilator. I dimmed the cardiac monitor so that we could focus on Mrs. D. Mr. D continued to request pain control medicine for Mrs. D. when he thought she was in pain. I sat and listened as Mr. D and his son expressed their grief and talked about their happy memories of Mrs. D.
Mr. D reached his other son and new daughter-in-law by telephone. I suggested that he hold the phone to Mrs. D’s ear, even though her eyes were closed. Her son spoke to her and tears rolled from underneath her closed eyelids and down the side of her face.
Mrs. D’s blood pressure steadily dropped. The monitor showed an agonal rhythm and agonal breathing. We held hands with each other and with Mrs. D to say goodbye. She took her last breath. We all cried. Then I said to Mr. D, “She is no longer in pain. She is already comforted in the arms of God.”
I could not hide my emotions, but I knew that showing how I felt did not make me less professional. After a few minutes, I left the room to give the family time to be with Mrs. D. and hold her.
Her other associate nurses and I attended her funeral service, not only to support the family but to support each other. I donated to the hospital’s Love Lights in her name at the end of the year. It is the loving human touch—the essence of the art of nursing—that can help a family faced with death begin to cope with their loss and suffering.