A couple of months ago I was looking after a patient whom had been suffering from an incident during surgery which had resulted in him being completely bed bound and far off of his baseline. Previously, even though the patient was well into his nineties, he was completely mobile self caring and sound of mind, he had no previous medical history of server or life threatening illnesses and was regularly active with his family. Unfortunately, due to this incident the patient became nil by mouth and was frequently given total parenteral nutrition (TPN) and so due to his sudden inactive life style he started to regularly become drowsy. During this time a couple of family members of the patient had started visiting, all of whom we hadn’t seen before- baring in mind this patient had been on our ward for the last two months. On one night shift, these relatives had asked me to have a word with them, when I entered the room they asked me if their uncle ‘had’ to be on these medications and if we could stop and palliate him.
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To which I replied, questioning their reasoning for this request and if they had spoken to there uncle and if it was what he wanted. The nieces where in shock by my reply and as a response walked over to the patient and started asking negatively phrased questions such as, ‘You’ve had enough haven’t you, we should stop this shouldn’t we?’ Rather than asking direct questions. The patient, however very drowsy, replied saying he wanted to continue his medication. The nieces then looked horrified and suggested the patient did not have capacity. Given my time working and caring for this man I knew he had capacity and that he wanted to continue his medication, which I continued to convey to his nieces.FeelingsDuring this conversation, I felt really uncomfortable and under pressure.
Not only because it was two relatives conveying to me an upsetting situation but because I distinctly knew it was unjustified. The patient was a kind and loving man whom didn’t deserve this level of treatment so I felt it imperative to stand up and support this man but felt very poorly supported myself to do so.After this conversation however, I had felt very angry and concerned for this mans wellbeing, it had angered me that the nieces would make such a prompt decision between themselves without consulting with the patient first- and then to expect his health care professional to abide to their decision. I was also feeling greatly confused as to why they wanted his medication to stop and most likely result in him dying. I also felt restricted, I wanted to query there decision and explain to them how inappropriate there behaviour was to this situation, however, I felt this may have then been my emotions getting the better of me within a professional conversation so instead I maintained my silence in this regard. Evaluation I felt from this experience I was able to support and stand up for my patients decision even though it was against his own family members.
I feel as though I had protect and supported his wellbeing and his individual opinion. I supported my patient for factual and ethical reasons rather than for personal beliefs. However, reflecting back I feel as though I hadn’t conveyed my reasoning as strongly as I had liked. I had explained to the family that we couldn’t take the patient off of his medication because the patient had objected and he did have capacity. I wish I had exclaimed further that from the care I had been regularly giving to their uncle I had seen his happiness and contentment and that he wanted to continue with his medication, so there was no reason for us to believe he would want to be taken off of his medication. Analysis From this however, I did support my patients decision and encouraged him to state his opinion rather than have it undermined. Given the situation of the patient including his age, health situation and quality of life, one may have suggested to stop his medication, however this was not what the patient had wanted.
The nieces decision however, I couldn’t make any sense of, given this situation you find relatives wishing to prolong and help the lives of their ill family member. To pursue medication costs and therapies to make them better whatever the age so long as they’re still conscious and have capacity. Sadly, once this man had passed away, many weeks on, we were able to determine why the nieces wanted his medication to be stopped. ConclusionIn conclusion, looking back at this conversation, I do wish I had acquired another member of staff to help me with this conversation, as I felt I could’ve passed my opinion off more adequately. Furthermore, I reflect back on this conversation and I wish I had communicated and engaged more with the patient within this conversation, although the patient was drowsy I feel he still had the capacity and understanding to be more involved in the conversation. Finally, even though after this conversation I reported it to the nurse in charge of the happenings I wish I had done further written evidence, knowing what I know now about the reasons behind the nieces decision, I feel if I had done a written report it may have supported our case further.
Action planIf this situation was to arise again I feel I could confidently make a written report either in doctors notes or within EPR, so not only all staff involved with the patient would know, but that we would have written evidence encase it was needed for following events. I would also ensure that another member of staff accompany me while conversing with them, as from this previous situation I had felt slightly under pressure during the conversation, so having additional staff would potentially make me feel more supported and less uncomfortable. Furthermore, I was happy I was able to maintain my professionalism and not become too emotionally involved within the conversation, but on the other hand I do feel if this situation was to come about again, that I should’ve explained the inappropriateness of this and that the question should’ve been rephrased.