Journal

Today I opened my mailslot for the first time since May and discovered a paper I had written for Ethics class last October.

It's not like I haven't been around dying people before. I was in the room when an elderly resident I cared for at the nursing home stopped gasping for air and passed away. I heard her last breath and called the nurse. I have dealt with the deaths of residents that I've been close to. I've gotten teary eyed during post-mortem cares. But nothing compared to the wrenching sobs of a nurse I observed on the clinical floor last week. Her patient was coding. The young girl's heard had stopped and she wasn't breathing. And the nurse was an emotional wreck. I've thought about the implications of developing relationships with clients before, working at a nursing home for four years it's difficult not to form bonds with residents you've taken care of for seemingly forever. but when does a nurse-client relationship go too far? How do you stop yourself from becoming emotionally attached?

I've been wrestling with a lot of quesitons in my head for the past week. That fateful day on the pediatric floor will forever be engrained in my mind. Maybe it's because I'd never seen CPR being performed in real life before. Movies are one thing. When you're standing in the hall, watching trauma teams run through to try to save a life, your whole perspective changes. the doctor on the phone, running fingers through her hair. The resident frantically flipping through the pages of his palm-sized medical dictionary. Hysterical screams from the mouth of Mom, slumped helpless in the hallway. Nurses doing compressions on a small lifeless body, bending into the softness of the mattress. The hissing sound of the ambu-bag and oxygen trying in vain to bring a breath of life. Yells of "All clear!" and requests for medications, vital signs, IV access. This isn't the peaceful, expected death of an elderly client on hospice who's lived a full life. This client still has her whole life ahead of her. I was scared. I was in awe. Life is but a split second from death.

As I write this journal I fell a thousand questions peeling through my mind. Ethical issues that we've discussed in class raised their ugly heads when I wasn't expecting them. Where do nurses draw the line between compassionate care and develpoing too personal a relationship with client and family? How do we keep events confidential? Whose responsiblilty is it for not preparint the mother who walks into a room where her young daughter has been attached to tubes and machines and is lying bare from CPR? How does a nurse deal with self-blame and guilt associated with a client's death? One afternoon changes so many lives, mine included. I almost feel horrible saying that a little girl's life draining away left me with an incredible learning experience. But it was. And it did.

A week later I'm in a different portion of my clinical experience, a pediatric clinic across town. And what are the nurses talking about? The trauma situation I witnessed. I sit quietly, not saying a word. I want to scream. I was there. I know what went on. But going through my head?....how do all these nurses know about this? How do they know these details? THey don't even work at the hospital! They weren't there! What ever happened to confidentiality?

Nurses are called to fill the role of caregiver, teacher, advocate, and a multiple amount of other roles as well. Along with these roles comes the responsiblity to fulfill them. As nurses we are responsible for providing quality care for our clients. Included in this care is effective communication, trust, and confidentiality. Nurses provide care for the physical needs of his/her clients but also must provide emotional and spiritual care to the client and their family as well. families trust health care professionals to do their utmost best for their sick loved one. Whe I see and hear health care workers talking about confidential situations in areas that are inappropriate, I feel that we have broken that trust. Providing emotional care to clients and their families means the nurse is probably going to become involved emotionally as well, but in order to keep his/her integrity and professional stuatus, the nurse must make sure not to relate too personally. Not that we cannot be personable and friendly with our clients, but that we must maintain the thought that we are there to help in the healing process, not be best friends.

As a student nurse I am glad that I can use the situation I witnessed on clinical to evaluate my own personal ethical standards. It is easy to say now that I will never lose control of my emotions or break confidentiality by telling a story. And I hope I never will. but in the future I will remember this sad clinical day, remember the issues that came about, look for these issues and more in my own practice, and follow ethical standards that I have set up for myself.