This issue of JCN has especially poignant articles for me. Many nurses will resonate with the continuing education feature "Advance Directives Education: A Critical Need" (pp. 220-225). I can't imagine a nurse who has not fumbled a bit discussing advance directives (ADs) with a patient or family on admission, or struggled trying to ascertain desires for medical intervention in a life-threatening situation. As required, I ask patients on admission about ADs and if they have a durable power of attorney (DPOA). I'm ashamed to admit I don't know as much as I need to about state laws or how to effectively educate about ADs.
I can say with confidence, however, that ADs make a huge difference. The night my father unexpectedly died, his ADs changed everything. I received a panicked call from hundreds of miles away saying Dad had been taken to the hospital unable to breathe. I called my mother in the emergency room. She said they had restarted Dad's heart several times and were trying to get him to intensive care. The next call with mom was in ICU and she didn't know what to do as Dad needed repeated cardiac defibrillation. Staff members kept asking her whether to keep going or stop cardiopulmonary resuscitation. She was lost. But Mom knew I was my father's DPOA and had discussed his wishes for this kind of situation. She begged me to make this decision with her.
A short discussion with Dad's nurse revealed the futility of his condition. Knowing he did not want extended intervention to keep him alive nor to live in a vegetative state, I explained the situation to Mom. Tearfully but confidently, I gave a "Do Not Resuscitate" directive to Dad's nurse over the phone, then to another nurse as a witness.
As I talked to the second nurse, he said Dad was temporarily in sinus rhythm and, he thought, responding to my mom. I asked the nurse to quickly give my father a critical message-his daughter Kathryn loved him, and I would see him in heaven. The nurse relayed my words and said my father looked at him fully, nodded his head over and over, and appeared to understand as tears rolled from his eyes. Mom stroked Dad's head for another few moments, telling Dad she loved him, as he went into cardiac arrest for the last time.
ADs made all the difference in my father's death. Knowing Dad's wishes helped us know when to stop intervening, gave us confidence to let him go, saved fleeting moments as we said goodbye, and decreased the amount of suffering he experienced. As nurses we need to know enough about ADs to educate and encourage patients, friends, families, and church members to create a Living Will and appoint a DPOA before a healthcare crisis. Making an AD is a tremendous gift people can give to themselves and their families.
Another moving article in this issue is "Nursing Students' Perceptions of Adoption: The Need for Educational Preparation" (pp. 246-251). As an adoptive mother, I can't emphasize enough how helpful it would have been for nurses caring for my children at birth, as they grew up, and for those who care for them now as adults, to appropriately communicate about adoption. From nurses who have asked, "Does she know her real mother?" (I'm a real mother), to ones who stumble over question after question trying to obtain a family history (Why can't they accept we don't know the family history?), I've had many awkward moments with nurses. Nurses in every area of practice are going to encounter birth parents who relinquished a child, adoptees, and adoptive parents. Recognize that birth mothers made an adoption plan for their baby rather than "giving them up," that birth and adoptive parents are both very "real," and that there are issues to approach sensitively with each member of the adoption triad. Knowing how to communicate appropriately is one of the most compassionate gifts you can give us.
I hope you find something in this issue of JCN that resonates with your heart and nursing practice. If you do, write and let us know about it.