A couple weeks into acute care, I had a patient who I had no idea what to do with. Among a long list of diagnoses and a complex significant health history, I was a bit overwhelmed with the case.
She had been admitted to the hospital for a GI bleed, but it was not her first. In three months, she had suffered 7 GI bleeds and had to have an EGD procedure each time, where they go in and laser the lesions in her intestines to stop the bleeding. The doctors call her case that of a "watermelon stomach." The first thing I thought was, 'well why does this keep happening?' How can we make it stop? My patient had anemia and a very low hematocrit in junction with Congestive Heart Failure and a history of AFib, a pacemaker, and an artificial mitral valve. Clearly, she had significant cardiovascular health problems and because of that, she was taking Warfarin. She needed to take an anti-coagulant regularly to prevent blood clotting and increased cardiac output.
Because of the blood thinner, the lesions in her intestines were more apt to bleeding when they might have otherwise been able to heal and be fine. I listened to the doctor speak with my patient about her choices and how she wanted to spend the rest of her life, as she was an 86 year old. Simply, she could cease taking the anti-coagulant which might solve her recurrent GI bleeds, but she'd be at an increased risk for clotting or possibly having a stroke. On the other hand, she could continue with the Warfarin but have a possibility of bleeding out from the GI bleeds.
After the doctor would leave her room, the patient would look to me and ask me what I thought she should do. I never gave her a straight answer, because I myself had no idea which route to take. I believe I have a strong sense in critical thinking and I have been successful when determining the priorities of my patients and other general situations, but how does critical thinking allow us to choose our way to die? I mean, inevitably, this woman is going to die and it's rather a choice she has been given on how she would like to pass away. How do we as nurses use critical thinking to make a decision like that? The textbook just doesn't hold answers for things like this.
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About Me
- SeahawkGirl81
- I'm a 21 year old nursing student, pretty much living in the junior nursing classroom and finding out most of my friends now are textbooks.
2 comments:
You are right about that, Ashley! The textbooks only take us so far!
Even if it was because you didn't know what was the best course for your patient, when I read about you not telling her what you thought she should do I thought about what we learned about therapeutic communication and how it is not appropriate for the nurse to give his or her personal opinion. It sounds like the lady was well informed and understood her situation and I think you did a great job of providing support while allowing her to make the decision for herself. In this situation, I think that is a foundational role of the nurse- to provide emotional support and education while remaining neutral. I think the hardest part for me would come if I had a patient who chose what I saw as the worst of two options (such as a patient who decided to abort a pregnancy or something like that) and I had to provide support for the patient regardless of the decision.
In any event, well done.
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