International Nurses Day - a nursing student's experience on placement
Sarah Crossland is a 3rd year student nurse (Adult). She is currently on her first placement for her third year in Rehabilitation in a local hospital. Here she shares an emotional experience from her placement.
When I found out my placement, I was keen to follow the journey of a typical acute patient and how they come to rehabilitation, as I felt like I really have much nursing experience with these patients. When I met my practice assessor, she encouraged this and I contacted the clinical educator on ICU who invited me to shadow.
On my arrival, I was introduced to the team and attended the safety huddle. The clinical educator asked me if I would be interested in working with a patient who had a severe traumatic brain injury and was planned to go the theatres to donate his organs, to which I said yes. I met my patient, Tom*, his family and his nurse Jane*. During this time, I got to know Tom from his family, and I learnt more about his life and interests and what was important to him. His daughter was incredibly proud of him and spoke about her memories of her dad, and his sisters reminisced about good times with their brother. I feel like its important to know the patient for who they were, especially as Tom was about to go through something that would end his life but ultimately restart the lives of three more people. When caring for Tom, I spoke to him throughout to preserve his dignity. I told him when I was doing observations and preforming his GCS scores (shining a pen torch in his eyes and asking him to do things).
Tom’s family made a brave decision to donate some of his organs when learning about his terminal prognosis and knew this was Toms wish. The Specialist Nurses-Organ Donations (known as SNODs) spent time with Toms family and explained the process of what would happen, and Jane and I ensured that Toms family could ask us any questions or feel like they could approach us. When the time came to take Tom to theatres, the whole of the ICU stood still and showed their respects to Tom and his family, including all allied health professionals and relatives of other patients. Toms’ sisters wanted to be there when Tom passed, so we made the anaesthetic room as comfortable as possible. When Tom was extubated (disconnected from the ventilator and breathing tube removed), we cleaned his face and put his dentures in. He was given medication to keep him calm and comfortable and we invited his sisters in to hold his hand and talk to him. We put his favourite music on and stayed and comforted both Tom and his sisters.
Watching the process of a planned death seemed very surreal to me. As nurses, we are trained to preserve life, but this process wasn’t about his life. It was about the lives Tom was about to change for the better by passing away. Tom was on the Organ Donation register, which he registered on himself and made his wishes known to his family. His family spoke about how Tom never wanted to live with profound and severe disabilities, and this is what Tom would have wanted. But even knowing this information, I found it strange and hard to not try and improve his oxygen levels or raise his BP and all medical staff watched as Tom actively died. Ten minutes after extubating, Tom went into asystole, which is when his heart stopped beating and the monitor showed a flat line. We told his sisters who broke down and said their goodbyes to Tom. Seeing his final heartbeat on the monitor was strange, and this is the first time that I have seen someone die in front of me.
Throughout my training, I have looked after end of life patients and helped care for deceased patients and I've even looked after loved ones after death. But to see Toms final heartbeat reminded me how precious life really is, and what an amazing thing he was about to do. From this moment, things happened very quickly. His death was checked and certified by an attending ICU doctor, and then he was on the table and being operated on within minutes.
While watching the procedure I noticed the stark differences in this operation compared to the others I have watched and scrubbed into. There was no anaesthetist. There was no one looking at his vital signs. The mood was different, and it was pressured due to the timing constraints and preserving Toms organs. The attention was no longer on Toms care: it was on his liver and kidneys. I observed the surgeons remove and assess Toms organs, while the SNOD’s in the background were ringing and organising for his liver and kidneys to be distributed across the United Kingdom. I saw the work of what happens when a patient dies and donates their organs, which was fascinating but sad at the same time.
When the surgery ended, me and the SNODs offered to perform Toms last offices. Last offices is the last nursing care a patient will ever experience. For me, it was an honour to do final nursing cares on Tom as he had given his life to help give life to three more people. I removed his medical devices, to make him look more like Tom, and ensured his dentures were in place and that he looked like he was sleeping and at peace. We gave him a wash to get rid of the blood and iodine and changed him. Throughout this, we ensured that Tom had dignity and we spoke to him throughout. When it came to wrapping up Tom, we said goodbye and thanked him. I stayed with Tom until it was time for him to be transported to the mortuary, because I know Tom was a social person and enjoyed being in other people’s company.
I have learnt so much from my limited time nursing Tom and helping his family, not just nursing but also personal experiences. It made me reflect as a person about what care I would want if I was ever in Tom's and his family’s position. I am registered as an organ donor and was so before the opt-out scheme was in place. But this has made me think about my families wishes: what if this happened to my sons? Although they are children, what would they want? How would I cope as a family member going through this journey and coming to the decision for my loved one to have a planned death so others could live? I have worked with many patients who have received organs from deceased donors and had their lives transformed. Many of whom are extremely grateful for their donors and their families for making that choice. But the thought had never occurred to me about the donor who had died, and the processes and procedure that patient and their family go through.
As a student nurse, I am compassionate and empathetic. But I really felt for Tom's family and teared up when I saw how upset they were. As someone who has lost two loved ones during my nursing training, I feel very empathetic for loved ones experiencing bereavement and try to give my best care to them. The nursing team on ICU give an incredible amount of support to both families and each other. The SNODs were fantastic and gave support to every professional involved and Tom's family. I feel like I witnessed and participated in excellent nursing care for Tom throughout his care and after death. Jane was extremely caring throughout and made sure I was OK at every possible opportunity and sat with Toms family during the procedure to give them comfort and to help them with their grief.
My experience working with Tom and his family was a privilege, I will always feel honoured that I helped care for Tom and his family. This experience has not only taught me so much about end of life and organ donation nursing, but also more about myself as a person and my family. Tom has made me reflect on the reasons why I wanted to be a nurse. I will never forget Tom; his family and their amazing decision has helped three people live.
* Names have been changed.