Alex K Gervais
January 2024
Alex K
Gervais
,
RN, BSN, CCRN
9 Mountain ICU - Neuro Trauma
Carilion Roanoke Memorial Hospital
Roanoke
,
VA
United States
Alex Gervais exemplified a cardinal principle of medical ethics: advocating for our patients' autonomy.
During our recent snowstorm, we had a patient who developed complications during the transition to end-of-life comfort care. When nearing preparations for the transition this particular night shift, family members at the bedside began adamantly refusing the care team from proceeding with comfort measures as previously established during the goals-of-care discussions with the medical decision-maker. The patient continued to wail out loud, begging that they were "ready to go" and "ready to meet my Savior." Unfortunately, the designated medical power-of-attorney (MPOA) could not be present at the time of transition.
While we on the care team were distressed, Alex - the patient's primary nurse - stood firm. She de-escalated the situation while contacting the primary on-call physician and searching through the patient's chart for corresponding legal documents. Eventually, Alex was able to coordinate contact with the on-call resident with the patient's MPOA to explain the situation. In turn, the MPOA - initially shocked by the developments – proceeded with the decision to continue honoring their loved one's wishes.
During the transition into comfort measures, bedside family members began refusing care due to misinterpretation of pain and anxiety medication administration despite the patient being in visible distress from terminally weaning cardiopulmonary support. Alex continued further de-escalation with the resident on-call through discussions and family education.
Eventually, Alex was able to transition the patient into full comfort-focused care with studious symptom management during their final hours. The patient passed peacefully at morning change-of-shift, surrounded by family and friends at the bedside.
Alex Gervais exemplified a cardinal principle of medical ethics: advocating for our patients' autonomy. Any one of us could be in that very same situation where our decisions near the end of life may not be carried out. Alex remained steadfast in upholding the MPOA’s decision, which ultimately honored the patient’s wishes. She is a true patient advocate, and I look forward to continuing working with her as a fellow nurse.
While we on the care team were distressed, Alex - the patient's primary nurse - stood firm. She de-escalated the situation while contacting the primary on-call physician and searching through the patient's chart for corresponding legal documents. Eventually, Alex was able to coordinate contact with the on-call resident with the patient's MPOA to explain the situation. In turn, the MPOA - initially shocked by the developments – proceeded with the decision to continue honoring their loved one's wishes.
During the transition into comfort measures, bedside family members began refusing care due to misinterpretation of pain and anxiety medication administration despite the patient being in visible distress from terminally weaning cardiopulmonary support. Alex continued further de-escalation with the resident on-call through discussions and family education.
Eventually, Alex was able to transition the patient into full comfort-focused care with studious symptom management during their final hours. The patient passed peacefully at morning change-of-shift, surrounded by family and friends at the bedside.
Alex Gervais exemplified a cardinal principle of medical ethics: advocating for our patients' autonomy. Any one of us could be in that very same situation where our decisions near the end of life may not be carried out. Alex remained steadfast in upholding the MPOA’s decision, which ultimately honored the patient’s wishes. She is a true patient advocate, and I look forward to continuing working with her as a fellow nurse.