Reflection #1 - Emotional Experience

 

During my placement of being a nursing student on the palliative unit at PRHC, I had a very powerful experience with a patient I had been assigned. During this experience, I had been assigned a patient with a prostate cancer that had metastasized, which was causing him to be in unbelievable pain. I had developed a great rapport with this individual and his wife this week, and they were always happy to welcome me into their room whenever I was on the unit. The next week, I went to visit the same patient and he remembered who I was from the week before, and I had stayed and talked with them for a few minutes at the beginning of shift. After break, I came back, and the patient could not remember who I was. This patient was very confused, and started to shake uncontrollable in his hands and feet. His skin started to become very sweaty and pale. Eventually he started to become very vague and confused with his surroundings. This patient started yelling out negative statements repeatedly. His wife started getting pretty worried, and started asking me what is wrong, and can you help him. The wife and I talked about it, and assumed it was the pain medications being administered through the CADD pump that was affecting him. We believed that the medication was too much for him and that we needed to decrease the frequency of the dose. In this situation, I felt a loss of what to do and that the pressure was on me. I realized in this situation, that the wife had put a significant amount of trust into myself, when she started asking me questions like “will he be okay.” I took the patients vitals, and then reported all the subjective and objective data I had just witnessed to the primary nurse. This situation made me feel very emotional, especially to witness someone suffer this much due to the pain from their Dx. I became loss of words and I did not want to say the wrong thing to the wife, especially since I knew she was very worried about her husband’s well-being.

 

Looking back on the experience, which happened less than a week ago, I advocated for the patient to get the pain medication less frequently, since myself and the wife believed that the pain medication was too much for the patient. Instead of the patient being able to administer the medication to himself every 15 minutes for pain, it was changed to every 20 minutes. I followed up with the patient the next day, and he was back to himself, and in great spirits again. This communicates to me that the frequency of the medication was the cause of his unusual behaviour the day before, and that the wife and I had the right judgement.

 

Elaborating back to the experience, I realized in that moment, that I had developed a very strong relationship with the wife, and she seemed to have a significant amount of trust in me as a nursing student. She seemed to belief in me, and my ability to care for her husband in his current condition. Occasionally, I doubt my competency, but this situation made me believe that I should really give myself more recognition. I know I am a compassionate, selfless and cheerful person, which I believe positions myself at an advantage to be able to connect to families and patients easier. This situation also made me realize, the level of initiative I have gained. This initiative allowed me to automatically act on the situation for my patient’s best interest, which was to grab the vitals machine to take his vitals. Checking vitals is important when a patient has a sudden change in physical well-being. When I told the nurse about the patient’s condition, she told me to take the vitals machine to get vitals done, I think she was in astonishment that I had said I already completed the vitals.

 

 I realized that I have become more independent as a nursing student on this floor and also more comfortable in my ability to handle stressful situations. I realized from this year to last year, that I have shown a lot more initiative and that I am more confident than ever as a nursing student. This situation makes myself understand that I have the capability of developing a strong relationship with a patient as well as the family. This is beneficial and important for the future as I will be engaging with many families and patients through my course as a future nurse. The ability for a nurse to engage with a family quickly is important as you need their trust, and they also need your support as well. 

 

I do not believe I could have done anything differently in this situation. I handled the situation with confidence, as well as showed initiative to my primary nurse, which is shown by taking the vitals. I can say, no matter how emotional the situation is, always do the best you can do as a nurse by providing support and using your best judgement. I am excited to learn more and be a part of many experiences during the courses of the semester. Also, to be able to engage and make a positive mark on my future patients that I will have the pleasure of taking part in their care.

 

Reflection #2 - Death and Dying Process

 

During my placement of being a nursing student on the palliative unit at PRHC, I have had many important experiences. One experience that has influenced me was doing post-mortem care on a patient. I would not say this has been a positive experience, but I have learned a lot about myself from it.

 

In this situation, a patient on the floor had passed away from their chronic condition, and our group finally got the opportunity to observe the process of post-mortem care. We all got into the room, and I found it to be a very emotional moment. Even though I did not know him, I was still overwhelmed with the situation and did not know how I was going to handle it. The nurse started explaining the process of post-mortem care, giving us step by step instructions. I stared at the body the entire time, hoping I would get comfortable with the whole idea. I knew I was finally at the moment, and that it was my day to challenge my emotions. I wanted to get involved, so, I volunteered whenever the nurse asked the students to do something. This moment is slightly unclear to me, but I found myself holding his hand, which was my turning point emotionally. The feeling of my heart sinking, nervousness, and tears all started to happen. This patient's hand was partially cold to the touch and felt heavy. The reason why this process is so challenging for me is due to a personal reason that someone very close to me passed away in 2014. I was very young and had not experienced this before. I feel as if this situation was not fair for someone at my age to experience, especially since I was an optimal point in my life with graduating high school, getting into nursing school, and going to prom. At the viewing, I grabbed their hand to say my final goodbyes, and it was freezing to touch. This situation gave me flashbacks of my personal experience, which made me feel very nauseous, uncomfortable, and have a feeling of sadness.

 

I had a hard time overcoming the idea that there is basically “no functions occurring inside that body anymore,” which makes me feel very upset. I get feelings like I wish there were more time families to say goodbye, and how or why was the patient was ‘chosen’ to have this chronic illness. I feel like there is never enough time prepare for this situation because nurses are too busy caring for their patients. I know that by being a part of this experience, I was going outside of my comfort zone as I am not comfortable with the death process.

 

In the beginning, I chose to do palliative care because I wanted to become more comfortable with death and the dying process, and hopefully, become stronger as an individual and as a future nurse. In this situation, I started to reconsider my choice of doing palliative, and that maybe this discipline is not for me. I realized that I should probably choose a discipline of nursing that is less revolved around death and the dying process. In the beginning, I knew that by choosing nursing I was going to be stuck with the reality of death as well. I understand that death always needs to consider as it is not going to go away. 

 

Even though this situation has made me realize this, I also realized that I have a passion for caring for people in their last weeks or even days of life. I get the feeling that I am very fortunate in being able to provide comfort care to ensure they are at peace with their end-of-life. Additionally, I feel honored to be able to be there and to provide my support towards their families and friends. I consider myself a very caring, selfless, and compassionate individual who has helped myself to succeed in this placement thus far. I know that I am not tough with death and I realize that I may never be comfortable with it. This situation is very complicated and challenging to be prepared for as I would never expect it to happen. In my reality, it's not something I see everyday, and therefore, I do not consider it as a part of my daily life. I know I am young, and that there is so much to know and learn, but I think this process will get easier with exposure to it. I have talked to many nurses about death and dying, and most of them said the same thing, that “it will never be easy in the beginning, and probably will never be easy at all.” In the moment, it’s a stressful and emotional period, but I feel a sense of ease and relief as I know patients are not suffering anymore from their illness.

 

In conclusion, I believe it just takes being exposed to a situation to make you realize that it may not be your passion. I know that with palliative care, I enjoy and feel a sense of reward being able to care for patients in their end of life, but I also believe that I am less stressed when I don’t have to be a part of the dying process. This experience was very important for my future decisions about the discipline I should be pursuing in nursing.