Toni was shocked by the blunt way a doctor brought up the subject of DNAR with a patient. Her research helped her understand the lack of compassion she witnessed.
During a placement on a rehabilitation ward I was asked to look after Joan*, a 72 year old lady who was suffering from terminal lung cancer.
The cancer had spread into her spine and she was having difficulty walking. Her sole reason for being on the ward was to improve her mobility with the physiotherapy team before returning home.
Joan was clearly nervous clutching her husband Geoff’s hand as two doctors approached her room. The senior doctor introduced both himself and his colleague briefly and turned to walk out of the room.
“The senior doctor introduced both himself and his colleague briefly and turned to walk out of the room”
I began setting up a nebuliser for Joan as the senior doctor returned and asked, as if in afterthought, “Have you considered a DNAR”? Joan looked at Geoff and asked, “What‘s that”?
I thought this may take some time so I placed the oxygen bottle I was going to use to power the nebuliser back into its stand but the doctor quickly retorted, “A DNAR is a procedure where if anything should happen to you, you would not be resuscitated”.
Joan lay there bemused staring at her husband as the doctor turned to walk out of the room again muttering, “I will leave this with you; you don’t have to decide right away”.
I stood there absolutely astounded by what I had just witnessed as Joan started to sob asking me, “Am I going to die? Is there something you aren’t telling me”?
“I stood there absolutely astounded by what I had just witnessed”
With a lump in my throat and a sinking sensation in my stomach I felt it was now my responsibility to reassure Joan. As I handed Joan and Geoff a box of tissues, I explained exactly what a DNAR was and assured her she was in hospital for rehabilitation and not to die.
I felt angry that the doctor had put me, a student nurse, in such an uncomfortable position. Later that night Geoff made a formal complaint regarding the doctor’s lack of compassion.
There are lots of attempts to justify the absence of compassion in healthcare settings, such as staff shortages and lack of resources, yet Dr Quallington, head of University of Worcester’s institute of health and society, believes that every doctor, nurse or health professional should intrinsically possess the right attitude towards patient care (Stubbins, 2013).
“Later that night Geoff made a formal complaint regarding the doctor’s lack of compassion”
Whereas Dr Anna Smajdor disputes the need for compassion, stating that a bedpan can be emptied without caring for the person who filled it and food can be provided for a person without caring for the person who eats it (Borland, 2013). An alarming statement I found coming from a health professional.
Being in hospital can be a frightening experience. Reassurance from another human being shows that they care and are able to identify and empathise with what a patient is experiencing, particularly important regarding sensitive issues such as DNAR.
Growing pressure to meet overwhelming needs can often lead to professionals, such as the doctor in this case, falling victim to compassion fatigue (Lombardo and Eyre, 2011).
“Reassurance from another human being shows that they care and are able to identify and empathise with what a patient is experiencing”
Had the doctor stayed with the patient and her husband and answered their collective queries regarding the DNAR order, he could have saved himself the shame of having to deal with a formal complaint and also reaped the benefits of facing his own emotional vulnerability.
By leaving the room the consultant left a student nurse alone to deal with the distress and anger of a patient and her husband. If more emotional support was available to health professionals maybe fewer complaints would transpire from situations like these.
*Names have been changed to protect confidentiality
Toni Lodge is a student nurse studying at Sheffield Hallam University
Have you ever been in a similar situation?
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