Author: Pamela M. Ironside, PhD, RN, FAAN
Title: Associate Professor
Institution: Indiana University School of Nursing
Integrate understanding of multiple dimensions of patient-centered care:
Patient/family preferences, values
Physical comfort and emotional support
Describe how diverse cultural, ethnic and social backgrounds function as sources of patient, family, and community values.
Recognize personally held attitudes about working with patients from different ethnic, cultural and social backgrounds
Appreciate the role of the nurse in relief of all types and sources of pain or suffering
Provide patient-centered care with sensitivity and respect for the diversity of human experience
Act with integrity, consistency and respect for differing views
I have worked in the NICU for a long time and had begun to feel really comfortable with my clinical skills and with the other members of the team. The unit was busy as usual; only two empty spots and we were, of course, hoping they stayed empty. Then the call came from a birthing center in town that they were transferring a fetal demise to us. The lay midwife described the infant as limp and cyanotic, apgar of 1. We admitted the baby and the parents were at the bedside. This infant was the couple’s first baby. The mother carried the infant to full term without complications and had chosen home birth because they wanted to protect their infant from all the “bad bugs” in the hospital. Given what we were seeing, we suspected the infant suffered an anoxic event. Over the next few days these parents kept a vigil at their infant’s side and it was becoming increasingly apparent that a decision about either continuing treatment or withdrawing treatment was rapidly approaching.
While we certainly felt sorry for this family, losing a child is never easy, it was difficult to connect with them because we were so busy and they were really different. I mean, they both had dreadlocks, tattoos and multiple piercings—you know, the hippie type. They were Buddhists and no one had any clue what the Buddhist rituals were around death and dying. When I found some time I thought I should probably call somebody, but who? As I approached the patient and mother I was determined to make some kind of connection with this woman so we could start the discussions about withdrawing life support. As I began speaking, you know, the usual, “my name is Kia and I’m going to be taking care of your child today,” the mother looked at me with these huge, glossy eyes and began telling me about how guilty she felt that she had killed her baby.
“We thought we were doing what we could to protect our child and we did just the opposite!” She was wracked with grief and clearly in no state to be making important decisions. She told me, “I see people talking to me, but I can’t hear what they are saying. It’s like my whole world has just fallen in on me.”
When I left the room, I approached the attending physician to share my concerns about the mother’s ability to participate in these discussions and suggested a care conference for us to discuss the child’s status, the mother’s current state and a possible timeline for making this decision. Her response was, “we don’t usually do that here.
We refer patients back to the healthcare facility where the event took place.”
You determine the best approach is to convene a care conference so that all interested parties can discuss the situation.
Writing assignment: In one page make your case for convening a care conference.
read more at Include consideration
read more at of the following:
What are the 3 most pressing issues facing those providing care for this family?
Who read more at would you argue should be involved in this conference and why?
Identify the unique perspective (and overlapping contributions or common
areas of concern) each would bring to the case.
Who would NOT be included in the conference at this point and why?
What is the meaning and significance of this to you as the assigned
nurse? To the family?
After you have made your case consider, “If it were my baby, I would want the nurse to…..”
Although this is a written assignment, it is very helpful to discuss
students’ reflections in a classroom or post-clinical setting. Together
with students, you may consider any issues that come up including (but
not limited to):
How do the characteristics of the parents and their birthing decisions influence students’ thinking about the case conference?
How do students anticipate attending to the differences in beliefs,
values, religion, etc in light of the gravity of the decisions facing
this couple? Where do they seek help for dealing with this situation?
Are the routines and timelines for handing such situations adaptable
to the parents’ experience of grief? If students argue for urgency, what
influences that perspective? If students do not see urgency, what
influences that perspective?
You can evaluate the written work and/or the students’ participation
in discussion. The limit on the length of their written assignment will
require students to take and support a particular approach concisely but
thoughtfully and will allow you to respond to student work quickly. In
most cases, a pass/fail approach to marking would be appropriate. I have
found it helpful to return to student responses later in the semester
and ask them to reflect on how their perspective of the situation has
changed, how they would respond to the situation now, and what questions
still remain for them.