Friday, August 31, 2018

Lessons Learned from the Other Side of the ICU Bed

Six years ago, we lost an amazing patriarch. As the nurses in the family, and the oldest child/grandchild, my Mom and I flew to Michigan to be there with our grandfather and his wife as difficult decisions were made. Dr. Frank McDonald was a rocket scientist (literally). He was chief scientist on the Voyager spacecraft, which would exceed all expectations as it spent decades looking for the edge of our solar system. He has a wikipedia page which outlines his scientific accomplishments. Grandpa McDonald was the Sun in our McDonald family solar system. He always said he wanted to die at his desk, and he would retire from one job only to go on to the next one. On August 30, 2012, he was giving a scientific lecture to a group of colleagues. He finished his talk and collapsed. On EMS arrival he had agonal respirations and required intubation. Treatment at St. Joseph's Medical Center quickly revealed a massive cerebral hemorrhage (he was on warfarin for atrial fibrillation).

Stepping away from the emotion of losing a beloved family member, there are three very specific things that stuck with me during our experience. Things that I had to appreciate from the family member perspective in order to truly integrate them into my own practice as an Acute Care Nurse Practitioner. I have shared this story often, but as the anniversary passes once again I thought it time to write it down.

1- When delivering unexpected news, provide information in small bits and ensure family members have the information they need to take appropriate next steps. My Mom and I are a high functioning nurse and NP. We eat crisis for breakfast. Our every day at work is often someone else's worst day. On August 30, however, I vividly remember myself walking around in circles, packing a bag without actually accomplishing anything, while talking to the trauma social worker from the St. Joe's Emergency Department. She gave me step by step instructions: "Get a pen and paper. Here is the address of the hospital. Here is the airport you need to fly in to. Here is what to do when you get here." Without her to focus me, I'm not sure how the details would have gotten taken care of.

2- Color-coded scrubs truly are helpful for patients, families, and visitors.
Our hospital was just starting a conversion to color-coded scrubs when I traveled to Michigan (RNs were to wear navy, Nurse Techs a carribean blue, PTs and RTs maroon, etc). There were mixed feelings about this among staff, as it was a big change and seemed to take away some independence and creativity. On the other side of the bed, as a family member, the colored scrubs were incredibly helpful. St. Joe's had fully integrated this into their dress code, and I knew anyone walking in with grey scrubs was a respiratory therapist, anyone in blue an RN, etc. It helped know to whom to direct which questions, and provided a sense of structure. There was also a key to the scrub colors hanging on the wall in the room to clue visitors and patients into the color scheme.

3- A "Comfort Tray" is one of the most thoughtful and underutilized support mechanisms we have for family members in critical care.
After spending a night of very intermittent sleep in the ICU, I awoke to a cart in the corner that held bagels, pastries, coffee, and juice. There have been countless times I have given family members a gentle reminder to take care of themselves and make sure they sleep and eat. To have someone remove the thinking for me and give me the tools I needed to take care of myself without having to leave my grandfather's room was a huge gift. It was a reminder that the staff wasn't just taking care of my grandfather, but us, as well. With the tray was a thoughtful note from the hospital and their palliative care team letting us know they were thinking of us and offering something small to help ease our journey. I had never ordered a comfort tray prior to that experience, but now I do it often. That small gesture meant so much, and allowed us to focus on other things.

While none of us hopes to walk in the shoes of our patients or their families, it is often inevitable. Taking time to reflect on that perspective can help us to further hone our craft and provide even more exemplary, evidence-based, and compassionate care.

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