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An Exploration of End of Life Care in the MICU

An Exploration of End of Life Care in the MICU

Kelsey Rising

Centofanti School of Nursing, Youngstown State University

NURS 4852: Senior Capstone Seminar

Kim Ballone and Randi Heasley

February 20, 2023

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An Exploration of End of Life Care in the MICU

An Exploration of End of Life Care in the MICU

The concept of clinical nursing judgement has been around long before even Florence

Nightingale became a nurse. This skill can be innate or learned, but is essential to the nursing

practice. Without proper nursing judgement underlying symptoms might go undetected, patients’

needs might not get met, and care may become lackluster. I have been grateful for the

opportunity to strengthen my clinical nursing judgement over the last four years, so that I can

avoid any missteps that happen due to lack of clinical judgement.

Over the last four years, in my clinical and work experience, I have encountered many

different patients that have challenged me in many different ways. Experiencing a variety a

diagnoses, patient backgrounds, and demeanor has allowed me to become very adaptable to a

multitude of situations. I believe experience is one of the main ways to develop clinical nursing

judgement. The phrase ‘practice makes perfect’ fits this perfectly.

The definition of clinical nursing judgement to me is the ability of the nurse to adapt to

many situations, anticipate patients needs, and think analytically to provide the best possible care

for each patient. This definition is purposefully vague because I think that each person defines it

a little bit differently. It is a very personal attribute, and each person knows what their strength is

pertaining to clinical judgement.

Over the next few paragraphs, I will discuss a few patients that I believe really helped me

to develop my own clinical nursing judgement. These patients challenged me, and helped me to

grow into the nurse I am today. These situations were complex and made me use my critical

thinking skills. I will also offer some research articles that relate to the patients I present in this

piece.
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An Exploration of End of Life Care in the MICU

One patient that stands out among the rest is one that I took care of during my Complex

Care clinical last semester. I had clinical at St. Elizabeth Youngstown hospital in the MICU unit.

I was the first one to arrive, and my clinical instructor always gave the best, worst, or most

interesting patient on the unit. So I got a patient that allowed me to use my nursing judgement

often! This patient that I was caring for that day was found on the floor after falling and lying

there for days. This patient had extensive wounds on one side of the body that actually attracted

maggots while lying on the floor. In a research article I later read, I found out that maggots are

beneficial to wound healing, as they naturally debride the tissue and eat any potentially

pathogenic bacteria (Yoshida, 2022). They were in severe respiratory distress, on a ventilator,

and had the most IV lines connected to one patient that I had ever seen before. There were so

many that the nurse took the time to use sticker labels and organize all of them. This was an

unusual case because the routine patient care I was used to giving such as wound dressing

changes, suctioning, turns, morning and afternoon medications did not occur. What I was used

to, and how most of my days prior to this one had been organized, went out the window. We

were doing everything we could to keep this patient alive to see their family for one last time.

My day was turned on its head, and I relied on my clinical judgement to get me through. When it

was time to get vitals, but the family had just gathered in the room to reminisce, I had to use my

intuition and judgment to realize that vitals were not a worthy interruption at that time. The

patient had extensive wounds that needing dressing changes and I so badly wanted to be the one

to change them. However, we did not even touch the tape. Doing so could’ve thrown off the

delicate balance the patient was maintaining and throw them into an even worse state. All care

and interventions were focused solely on maintaining the state they were in and nothing more.
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An Exploration of End of Life Care in the MICU

This patient was in such a fragile state that we were touching them as little as possible in an

attempt to not disrupt them and make their symptoms worse.

On top of the fact that they were such a high acuity patient, this case also had a heavy

mental load. They were considered a confidential case due to the nature of how they were found.

Only the police were allowed to say who could have information on this patient because a

criminal charge was being processed to a family member for allowing the patient to remain in

such a state of disrepair. The other family members were estranged and had not seen the patient

for many years. I was able to witness a call to the daughter of the patient who hadn’t seen the

patient in over three years. That phone call was very difficult to sit through, and the nurse on the

patients case had to call a few other people and have the same conversation. In an article I

discovered, the quality of communication given over the phone from nurse to family members

can aid in decision making, assure, comfort, and support the patients family in times of need

(Dees, 2022). This is especially critical when the patient is gravely ill and the family has to step

up to be the decision maker for the patient due to an inability on the patients part. To see their

reaction to seeing their family member in this state was heartbreaking. They had a family

meeting on the day I was caring for the patient and ultimately decided to change the code status

of the patient from Full to DNR-CC. The meeting was held in a private room on the unit and

lasted for over an hour. These meetings are imperative to communicate with family members so

the patients wishes and needs an be fulfilled. In a study I read, it showed that these types of

meetings facilitated less psychological stress, fewer unmet needs, improved quality of life, and

better end-of-life care for the patient (Hudson, 2021). These things are all very important when

dealing with the stressful situation of having a family member in the hospital and then

transitioning into letting them go and anticipatory grief. Later that day, after my clinical day had
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An Exploration of End of Life Care in the MICU

ended, the patient sadly passed away. I grieved that day because I had never taken care of a

patient so sick before, but looking back I am very grateful to have had that experience with the

support of my clinical group and instructor. This day, and many others on the MICU, is what led

me to love intensive care and strengthen my clinical judgement.

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An Exploration of End of Life Care in the MICU

References

 Yoshida, T., Aonuma, H., Otsuka, S., Ichimura, H., Saiki, E., Hashimoto, K., Ote, M.,
Matsumoto, S., Iwadate, K., Miyawaki, T., & Kanuka, H. (2022). A human tissue-based
assay identifies a novel carrion blowfly strain for Maggot debridement therapy. Scientific
Reports, 12(1). https://doi.org/10.1038/s41598-022-16253-9

Hudson, P., Girgis, A., Thomas, K., Philip, J., Currow, D. C., Mitchell, G., Parker, D., Liew, D.,
Brand, C., Le, B., & Moran, J. (2020). Do family meetings for hospitalised palliative care
patients improve outcomes and reduce health care costs? A cluster randomised trial.
Palliative Medicine, 35(1), 188–199. https://doi.org/10.1177/0269216320967282

Dees, M. L., Carpenter, J. S., & Longtin, K. (2022). Communication between registered nurses
and family members of Intensive Care Unit Patients. Critical Care Nurse, 42(6), 25–34.
https://doi.org/10.4037/ccn2022913