I would like to recognize Julie Wright, one of the charge nurses on South 5. On Tuesday, there was a patient who had undergone a partial thoracotomy the day before. Tuesday morning, the patient's heart rhythm went from sinus rhythm to atrial fibrillation with a rapid ventricular rate in the 180's. Julie immediately went to the room to see the patient. The patient's oxygen demand had increased, and Julie changed her from a nasal cannula to a nonrebreather mask. The patient's nurse worked to contact the surgery team. The surgeon (Dr. S.) called the unit and asked Julie if the patient needed to be moved to ICU. Julie explained the patient's condition and suggested that yes, the patient needed to be moved immediately. A few minutes later, Dr. S arrived on the unit and asked to speak to the patient's daughter outside the room. Dr. S, his nurse practitioner, Julie, and the patient's daughter stood in the hall while Dr. S clarified that the patient wanted to be a full code. The daughter explained that she wanted her Mother to be a DNR due to her terminal cancer diagnosis and that she did not want anything done to prolong her mother's life. Julie then asked if her Mother wanted to be a DNR. The daughter replied that it didn't matter because she was the medical power of attorney for her mother. Julie then explained that it is still the patient's right to determine her own code status because she was completely alert and oriented.
This moment of patient advocation by Julie prompted everyone to move inside the room where Dr. S discussed the issue of code status with the patient. The patient confirmed that she no longer wanted to be a full code and that she did not want to be intubated or to receive compressions. Julie immediately got a DNR form for Dr. S to fill out with the patient and asked Dr. S if he would like her to call the palliative team. He said yes and asked if the patient should remain on South 5. Julie said yes and assured him that the patient would be well cared for.
Julie called and spoke with T with the palliative team and explained the patient's condition and the urgency of the situation. T arrived on the floor within five minutes to speak with the family and ordered comfort measures. The patient's nurse worked to start the medication to slow the patient's heart rate down and provide some relief. Julie notified the family that they could have five people at the bedside. The patient's heart rate responded to the medication and she was able to feel more comfortable.
The entire South 5 team worked together to ensure justice and integrity for this patient. The patient was able to be discharged home the next morning with hospice so that she could spend her final moments at home with her family. Julie did an amazing job advocating for this patient and leading as the charge nurse. Sometimes our duty to our patients is not healing them, but ensuring that they are respected, cared for, and that the final days of their lives are spent with integrity.