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End-of-life care



A mobile career offers numerous opportunities to impact your patients' lives, as well as occasions to help them prepare for their deaths.

As a critical care nurse, you observe people, young and old, at some of the most vulnerable times in their lives. Not only do you respond to their healthcare needs—which are typically complex and serious—but you may also find yourself attending to their emotional, spiritual, and familial requirements.

When your charges have positive outcomes, you watch them set out on their journeys back to health. But, unfortunately, recovering from a disease or condition is not a guarantee, and there are times when your patients will die or require end-of-life (EOL) care. In fact, research shows that one in five deaths in the U.S. occur while the person is in the intensive care unit (ICU) or shortly after being discharged from ICU.

Death is an element of life, not to mention an element of your career as a critical care clinician. For individuals battling highly acute illnesses—such as terminal cancer, heart disease, or the effects of a neurological trauma—facing the end of their lives becomes a reality. These circumstances command empathy, understanding, and professionalism. Have you ever wondered how other critical care travelers put their varied experiences from the road into practice when delivering palliative care? Here, three mobile clinicians share their stories of practicing EOL nursing.

Respecting wishes

Becoming a nurse had been a lifelong dream for Susan Sabatula, RN, a traveler with The Right Solutions, headquartered in Springdale, Arkansas. After working in restaurant management for a while, she decided it was time to pursue her goal and enrolled in nursing school. It was during this period that Susan discovered a passion for critical care. "I found that I really enjoy high acuity situations," she explains. "They are the ultimate in nursing, as well as a challenge, because no two are ever the same."

Since 1999, Susan has practiced primarily on critical care units, with subspecialties in oncology and cardiology. "I have also done some medical/surgical and adult psychiatric nursing," she notes. "But, I prefer working in critical care."

Two years ago, Susan decided to put her clinical skills to the test as a nurse traveler. "I am single, do not have any children, and just thought the timing was right." To date, she has been assigned to facilities in North Carolina, Virginia, Connecticut, and Oregon. Her current contract with Suburban Hospital in Bethesda, Maryland—where she is scheduled for the 7:00 a.m. to 7:00 p.m. shift, 3 days a week—will conclude in June.

While the clinical aspect is often standard from one facility to another, the emotional component of EOL cases is far more dependent on the individuals. "You are providing palliative care by controlling their pain and making sure patients are as comfortable as possible," says Susan. "But quality end-of-life care entails a broader spectrum than just the clinical. This happens to be a very sentimental time and patients and their relatives tend to experience all the stages of grieving, from denial to anger and depression...and hopefully, they reach acceptance. My role is to get them through the stages."

Often, oncology patients have already traversed some of these phases. They may have been dealing with the disease for months or years, and therefore, had time to cope with the illness, its treatment regimen, and the final outcome. While the majority of us do not have a living will or advanced directive in place (only 24% of Americans have taken this step, according to the National Hospice Foundation), many cancer patients have taken control by securing Do Not Resuscitate (DNR) or Do Not Intubate (DNI) orders that instruct medical personnel on steps to take—or not to take—if their conditions deteriorate.

"However, just because someone has a DNR, it does not mean you treat them differently," states Susan. "You still have a certain scope of care to complete. But, it helps to know exactly what they want. They are aware that they are dying and have had time to accept it. Many oncology patients are actually ready to go."


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