Ethical and spiritual discussion response 4
please respond to the discussions with reference
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I currently do not currently work in healthcare, but in the past I worked in long term care and med/surg. In both of these specialties I worked with patients on hospice who died occasionally. My very first shift on my own as an RN I was called in to determine if a hospice patient at our long term care facility had died. I do not think I had even received report yet. I felt completely inadequate and had no idea what the policy was at our facility. Meanwhile I had the family staring at me as I listened to her chest. I immediately realized the importance of my position and the impact I had on them. With all my hospice patients I considered it an honor that the family would let me in on these final moments of their loved ones. It is an important part of life that should be respected.
I did not have any patients die under my care who were not on hospice and expected to die. I have a lot of apprehension for when that happens. I think that would be a harder situation for me to accept and I worry I will feel guilt about not providing the care needed to help them.
Accepting death has gotten easier for me. Many years ago, for my first job, I used to work in the hospital on a Med-Surg unit. I was almost afraid of the surprise and shock of death, I did not want to be the one to find the person dead in bed. When I worked in ICU, I remember at first not wanting to give patients morphine when they were in the dying process, because I did not want to hasten their death and felt guilt. I became detached by watching the monitors instead of the person and the technology became a barrier between the patient and me. When people had resuscitation attempted, it was so messy, traumatic, intense, etc. Sometimes I would be shaky afterwards from the adrenaline rush. I did not mind the “no-codes”. I liked doing the comfort measures, the deep talks with people, the respectful, calm deaths. Most people and families in ICU, don’t do superficial chit chat, but talk “real”, they speak their fears, sorrows, regrets, and joys. You can get to know patients and families extremely quickly because they speak their raw emotions and what is really important to them. Now I work in a special needs school. We generally have 2 children die each year, but these have not happened at school so far. Most of the time, parents find them dead when they go to get them up in the morning. Although each of these deaths is sad, and I mourn over the children, I cannot wish them back. I believe most of them are in a much better place and that they are whole now, how they were meant to be. Whereas on earth they could not talk, walk, communicate, and sometimes hardly move voluntarily, I think now they are running, jumping, and shouting for joy. My students go up to age 26. Recently a Buddhist died. While there is talk that all children go to heaven, I am not sure about a 26-year-old Buddhist. He is older physically than a child, but mentally was aged probably about 9 months.
I have been blessed in not experiencing many deaths in my three years on the job. I am currently working on a cardiac unit and have only had two patients that expire on my shift. One was expected as her vital signs were declining and her intestines were blocked from the cancer that she had recently been diagnosed with. The first death was unexpected at the time because I had not seen any signs except for a change in spirit. He was asking for a hug and kiss the day prior to passing away and I dodged his request on that day. When I came in the next day at first passing and bed-side shift report he told me that I owed him a kiss and hug. When bringing his medication to him he asked again and yielded and gave a kiss on the cheek along with a hug, he died about an hour later. He was a DNR so no heroic measures were performed. It was emotionally hard when the daughter stopped by on her way out of town and arrived just as he expired and yelled “Bring him back.”
Death is harder to deal with if it is totally unexpected such as in a MVA. This is a time when it is easy to ask, “Why God.” Death is never easy to receive for the families left behind. The patient is free from pain, suffering, and worries. The family members must deal with the separation of their loved one. Whether they believe that there will be a reunion after death is according to the worldview that the family holds as truth.
To everything there is a season, and a time to every purpose under the heaven: A time to be born, a time to die; (Ecclesiastes 3: 1.) In the Called to Care page 223 the author held the viewpoint that Jesus struggled with death in the garden, but was it more the fact that he knew that God would have to turn his back on Jesus as he was on the cross? I feel that the threat of separation from God even for that brief of a time deeply disturbed Jesus since he had a perfect relationship with his father (God).
Shelley, J. &. (2006). Called to care: A Christian worldview for nursing. Downers Grove: IVP Academic.
Wellman, J. (2018). PHI-413 V Lecture 4.
Currently, I work at long care term facility and most of the population are elderly residents whose needs cannot be met if they would live in the community. Most of them need different degree of help with activities of daily living as well as specialized nursing care. During my 6 months of working there unfortunately, I witnessed death a few times. My view of death was shaped long ago when me being a kid questioned my parents what death was. Being Christians, they taught me that death is final only for the body, but soul continues to and goes either to heaven or to hell depending on our deeds during the life. In the end, there will be resurrection and no more death. Surely, there is much more to death, dying and afterlife. My experience of death was redefined as I started facing death of the people I knew and took care of. First the most conscious and most painful experience was the death of grandmother who passed away after long battle with disease and whom I love cordially. My feeling of loss was tremendous. At the same time, I understood that her suffering was finally over, and she was in better place now. When I was thinking of her death from position of Christian, I knew it was God’s will and her death was just end of her life on earth and she was with Lord now. The experience of death of residents was a little bit different. First of all, those people were not relatives who you know all your life, but nevertheless, seeing them deteriorating and suffering was still hard. I understand that from Christian point of view God is with them in their suffering. We as nursing personnel tried to ease their suffering by maximizing care and make them as comfortable as possible. Situation with dying in health care facilities are often shaped by presence or absence of DNR, DNI, and DNH orders. Recently, we had to announce code blue on one resident who although was expected to pass away, the family still want him to be resuscitated. It was painful to feel his ribs got broken under compression during CPR, and, honestly, all staff thought our efforts to revive him was hopeless. Then 911 came and took over CPR and little later he was transferred to the hospital still alive. Sadly, he dies few days later in the hospital. This situation made me think more about moral dilemma around the death, whether or not to keep residents full code or DNR and whose decision it should be. I cannot answer that if it easier or harder for me to accept fact of death after what I experienced because every time it’s different people with different stories. One thing I can say for sure, I feel relieved when their suffering ends.
At the hospital where I work, in my unit med-surg, we began having hospice patients six months ago. I’ve cared for many patients at the end of life, but it wasn’t until two weeks ago that one of my patients passed during my shift. It was a really strange feeling when I had to check for the absence of pulse; although it was obvious he had already passed. He didn’t have much family and there was no one at the bedside at the time he expired which made it seem less emotional. I’ve cared for many hospice patients who have families at the beside 24/7, and I have gotten to know their families well. In this way there is more emotional attachment. It is also a strange and sad feeling when you come on to your shift to find that that a particular patient has passed. Even though it is expected that hospice patients die, it is still difficult. Though I haven’t yet had a med-surg patient die unexpectedly.
Although this is all a new experience for me, it hasn’t changed my view of death. It is sad every time I know someone is leaving the earth too soon (it seems they are usually in their 50’s) and their families are feeling this tremendous loss. In this situation we are not only caring for the patient, but also their family. I feel we need to show a lot of respect towards the families, as this is an extremely difficult time. We have patients of various forms of Christianity (Jehovah’s Witness, Catholic), but all tend to show their faith in God by having a cross at the bedside, or visit from a pastor or priest. This sense of faith helps me know they are passing peacefully to a better place.
Working in both transitional care and IR, while I don’t experience death daily, I have been the one to pronounce, several times, on the TCU. In witnessing someone actively dying it humbled and brought me to tears. I wondered what they were thinking or feeling. I reflected on my children and myself, my life. Asked “will my husband be able to care for them adequately? I placed myself there in that person’s state of condition and felt saddened. I visualized my time of demise and it deeply saddened me. I don’t care that I have a happy, fulfilled life. I love it and want to stay. I don’t consider myself obsessed with death, but I think of it every day. Am I prepared, not just on paper but spiritually? I question whether my behavior is pleasing to my Lord. I fear dying especially tragically but no one knows when that time will be or how – until it is. While some may fall ill and think that they Know from what they’ll perish, sometimes death comes so unexpectedly and it doesn’t have anything to do with the terminal ailment. Being a nurse, it is realized very quickly that death is imminent and sits upon all of our doorsteps. Modern technology, biochemistry, biogenetics, whatever the scientific pleasure, cannot cure death. Accepting death is difficult for me but I acknowledge that I am promised this phase in my existence from God and it will be done.