Critical Nursing I Recently Witnessed

Critical Nursing

I recently witnessed a medical decision that will weigh heavily upon my psyche for a long time. Having learned to critically ponder, analyze and think about such scenarios really has no effective bearing until undergoing a situation such as the one just past. The experience involved a woman in her early 50's who spent the greatest part of the last 18 months in the hospital. Her maladies stemmed from diabetes, and included such illnesses as gastoparesis, uncontrolled blood sugar levels, high blood pressure, osteoporosis, broken wrist, broken hip, daily peritoneal dialysis (after a failed regime of hemodialysis), heart attacks, blood clots, peritonitis, and a number of staph infections.

This lady was taken off all forms of dialysis due to the number of infections contracted, at that time she was told that her kidneys seemed to have enough residual strength left to carry on for a while, but that her numbers would be monitored closely and if they began to deteriorate, she would once again be placed on dialysis. During the following month her numbers remained fairly steady and she was allowed to go home. Shortly thereafter she slipped and fell, breaking her hip. After surgery to repair the hip, her numbers began to fall once again. The nephrologist informed her and her family that she would have to begin dialysis treatments once again; after much discussion she made the decision to forgo such treatments. Even after being told that she would likely die, she stilled refused the doctor's recommendations. After failing to change her decision, the doctor expedited her release from the hospital. Shortly thereafter she passed away.

One recent study determined that graduates from Masters Nursing programs "make statistically significant gains in critical thinking" (Drennan, 2010, p. 423) and I can hope that it is true because what I found was that one nurse who was working with the patient (after the doctor had left the room) told the woman that she had made the right choice, and that sometimes doctors were the last ones to let go. One statement she made bore the entire gist of the scenario 'doctors are so sure that they can save lives, they don't like it when they are not given the chance to do so'. Yet in thinking about this situation, one could say that is true of most professionals. However, the question still remains as to whether this was the correct decision, and more importantly for this paper is the question; "was the nurse correct in attempting to fortify the lady's choice?" Should nurses be comforters; compassionate and caring, especially when a difficult scenario such as this one is present? Initially, I assumed the patient's family might not agree with her decision, or that the doctor might order her back on dialysis against her wishes. I also assumed that the nurse I was observing would likely support the doctor and try to talk the patient into changing her mind. My assumptions were incorrect. Later I took the time to reflect upon my reaction to the situation.

After thinking through the entire situation, it is my belief that she did make the right choice, she no longer wished to live a life tied to a machine, wheeled about in a chair and unable to enjoy even the smallest of pleasures. As a nurse, my approach would be to comfort the patient, understanding and giving support to the family and friends who are attempting to support the patient. The patient is experiencing enough trauma, and should be fully supported in making whatever decision is best for that particular individual.