End of Life Care (EoL) in the Paediatric Critical Care Unit (PICU)

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To demonstrate my learning in clinical practice, I have also chosen to submit my agenda from earlier on in the term regarding a patient who I have had the privilege of caring for throughout my time on the CCCU. When I originally created my learning plan, this was not a case that I envisioned I would have an opportunity to be indirectly apart of, however being able to see how the healthcare team and ethicists worked as a team was interesting to see. In this case, the healthcare team worked as a unit to ensure the needs of both the family and patient were met and both were supported throughout the process. Having a background in ethics, it was interesting to see the beginning stages of how ‘best interests’ , ‘defining quality of life’ and ‘uncertainty for the care/patient’s health trajectory’ were determined and the process in which the unit managers advocated to can host multiple one-to-one meetings with the ethicists and nurses on the patients’ core team to share their feelings and feel involved in the process, particularly with how morally distressing it was for all involved. 

At some point in the career of a nurse a morally distressing situation will arise. An example of this will be the recent news reports of nurses and physicians on the frontline in Italy having to ration healthcare resources and ventilators on patients who are deemed to have the ‘best chance of survival’ rather than on other factors such as ‘first come first serve’. Being able to understand the topic of moral distress and the ethics being quality of life and how decisions are sometimes made is so important to understand and having the opportunity research this topic I feel slightly more aware of the resources and tools out there that are used daily when making tough decisions. Unfortunately, the reality is morally distressing situations will continue to increase as technology helps to prolong people’s lives (ex. ventilators). This will further beg the question of determining quality of life and whether we should be prolonging people’s lives artificially when we face bed and resource shortages in our system. As a nurse understanding this topic is vital to reducing that stress and will hopefully allow me to be resourceful in helping others facing these situations while on a unit. What went well was the process of finding information and having the opportunity to present this information in a creative and engaging way. For me, visuals play an important part in being able to understand information without the sensation of feeling overwhelmed by large amounts of information or writing. In a society where people are often in a rush I find it important to use these opportunities to be creative in hopes that one day I might be able to use the information on my unit or allow others to learn from it should the topic be relevant to them. Additionally, I enjoyed the process of researching this topic and found that the information was relatively easy to access and I had the opportunity to see the intitial stages of the ethics process unfold on my unit, which was evident from the agenda that has been submitted in addition to the infographic.  For the process of the learning plan I would say it differed significantly from my previous opportunities to fulfill all aspects of my learning plan with the disruption to the term and having our placements cut abruptly. In my case, I wish I had arranged to meet with the ethicist earlier on in the process, while I was directed to the resources they used it would have been nice to perhaps sat through an ethical case (particularly the one on my floor) and examine the process more closely. However, with the events currently unfolding it was not possible to do so and likely would not be able to be done until after SickKids and McMaster would have granted me the opportunity to return.