The Rapid Response Team was called to assist with a patient experiencing shortness of breath and decreased oxygen saturations. Upon arrival, RRT was informed the patient’s prognosis was grave. The patient’s plan was to discharge the next day with home hospice however, at this point the patient’s resuscitation status remained full interventions.

Ali, the Clinical Coordinator, explained there had been a lot of care discussion with family, and the wife remained resistant to a DNR status while in the hospital. As RRT arrived, Ali gave us a brief synopsis of the patient’s condition, prognosis, and plan. Present at the bedside were the patient’s wife, daughter, primary nurse, respiratory therapist, 2 RRT nurses, a resident, an intern, a medical student, and Ali.

At the time of the RRT, the patient was in some moderate respiratory distress. Due to the patient’s presentation and increasing oxygen requirements, I recommended an ICU consult. Ali suggested to the resident that they discuss code status with the family, and he agreed. At this point, there were less team members in the room (myself, Ali, resident, intern, and family). The resident started to talk with the patient and family about his poor prognosis and explained about a ventilator. Ali immediately noticed the family and patient were overwhelmed and did not understand what was being said to them. Calmly and politely, she took the patient's hand and talked directly to him with simple and clear words. She included the wife and daughter, pausing for questions and understanding. Her explanations and willingness to use direct and effective communication led the patient and family to make a decision for a DNR code status. Her ability to explain about reducing pain and making the patient comfortable in a caring and tender manner meant that this patient transitioned appropriately to comfort care. Her assessment of the learning needs of all involved was invaluable to the outcome for this patient and his family.