This week was the end of the first semester of Year 2, and the End of Life/Palliative Care and Supporting Families and Carers optional modules came to a conclusion. In order to summarise and finalise each module, special activities had been prepared in each of the last lessons.
In the End of Life/Palliative Care module, we went into the high fidelity simulation labs and worked with one of the mannequins – ‘dummies’ – and one of the lecturers. The mannequin was a 43 year old man, ‘Vinnie’, who was dying of cancer. He had been rushed into hospital the night before, and his wife, our lecturer, had been near his bedside ever since. Vinnie was unconscious but apparently comfortable, as he had been given morphine to treat his pain. Our job, as student nurses, was to look after Vinnie and his wife, ‘Jackie’, for the afternoon.
Our group consisted of 20 student nurses and we all formed into ten pairs of two. A pair at a time, we went in to talk to Jackie and to check up on how Vinnie was doing. The rest of us were able to watch each pair as they looked after the couple, through a camera in the classroom. When each pair returned, we were able to discuss each scenario and how Vinnie and Jackie were progressing in their journey. We then decided as a group how the next pair might move on in their discussion with Jackie, and their efforts to keep Vinnie comfortable.
The afternoon was marked by a series of developments, with the first one being Jackie’s reluctance to accept that Vinnie was dying. She then became concerned about the cannula on Vinnie’s arm and how it was looking sore. This was eventually resolved by removing it, as the IV fluids did not need to be connected. The next concern was that Vinnie might be getting dry in and around his mouth from the oxygen mask, and so the mask was temporarily removed. His breathing got worse, and so the mask was put back on. Later however, it was possible to completely remove it, and so then regular mouth care was able to be given. This consisted of a damp sponge-ended ‘lollipop’ stick and some Vaseline applied to his lips.
Jackie went through an emotional rollercoaster of painful acceptance regarding Vinnie’s impending death. It was decided that Vinnie’s brother should be called, as he was living a few hours away in London. A decision was also made to bring in the couple’s two children, but this eventually did not materialise. The question of whether Vinnie had a DNAR (Do not attempt resuscitation) in place was also raised and discussed. Jackie thought that a DNAR was absent, but she had to be told that it was in fact actually recorded on Vinnie’s notes. Through the shock, she was able to accept that it was probably the most dignified course of action for her very poorly and dying husband. Jackie went out for some air, and just after she left, Vinnie’s breathing started to deteriorate. A panic pursued, as it was realised that there was no mobile contact number recorded for Jackie. It was feared that Vinnie would die in her absence, but in fact it was just his breathing that was changing, as he approached just a little nearer to death. Fortunately Jackie soon came back and Vinnie’s breathing pattern changes were explained to her.
Later on, Vinnie started to groan very loudly, and it was realised that he was experiencing breakthrough pain as his morphine wore off, and so it was therefore decided to administer him some more morphine. Vinnie soon settled back down, and further measures were taken to keep him comfortable. Two nurses changed his incontinence pad and cleansed his skin, as a decision had been taken not to use a catheter. Another two nurses washed his hands and face, and gave him some more mouth care. Jackie began to give him mouth care too, and she sat holding his hand and intermittently crying and kissing him. Our lecturer’s acting abilities were extraordinarily realistic! When Vinnie’s breathing finally stopped, the last two nurses (and I was one of them) could do nothing except comfort Jackie at a distance, as she buried her head in Vinnie’s chest. Jackie sobbed, turning away from everyone, and the other lecturer, the ‘clinical nurse specialist’, came in to confirm the death and to tell Jackie that Vinnie had indeed died. It was amazing how realistic the situation seemed, as once we student nurses were in the ‘ward’ environment, it just all felt so real, and we were able to completely forget that we were actually being watched on a camera.
I had secretly been dreading the end of life simulation activity, and many of the other student nurses had felt the same way too. On the day however, it was actually a really valuable learning experience, as things are never usually as bad as what one originally thinks. The learning was not limited to taking part in the simulation; it was actually valuably extended through watching our other student colleagues, and through discussing the scenario progression and outcomes as they emerged in real time. The optional End of Life/Palliative Care module has been exceptionally good, and is one that I have found really valuable as a future potential dementia nurse.
In the Supporting Families and Carers module, we gathered as a whole group and then split down into smaller groups of about five students. Each individual had previously been instructed to bring along a recorded sheet of feedback from a service user’s family member or carer, on our recent placement, which consisted of their comments on our performance as a student nurse. Focussing on this information, we had then been previously told to write a piece of reflective writing on this feedback using a reflective framework model such as Gibbs, Johns, Schön or Kolb. I personally used the Gibbs model, which I feel is quite a simplistic, but functionally useful guide. Reflection is considered to be an essential part of nursing, as it helps a nurse to look closely at what she or he does well or can do better in the future, and why that is so, and how it can be achieved. As a mature student perhaps, I feel that I naturally reflect in my head most of the time, but I am receptive to trying written reflection and want to give it a go. As requested for the session, I had produced a piece of reflective writing for the lesson.
In our small groups, we discussed and shared our prerequisite feedback and reflections, and thus learned from each other’s experiences. Our lecturers then explained about the reflective art that we would be producing that day, via a collage. They showed us examples of art that had been produced in the Brighton area for an exhibition called Sick, which, as the name implies, was connected with health issues and the expression of these through artwork. The examples were very inspiring and we prepared in our groups to create our own expressive contributions, regarding what people like about us as nurses and what makes these people’s experiences good. Collecting a large sheet of paper, some different coloured marker pens, some sequins, furry bobbles and glue, etc. we set to work as a group.
We decided to draw a central family group of a mum, dad, child and baby, all very brightly coloured in. We then recorded lots of captions about what people like about us as nurses. These consisted of examples such as ‘being a good listener’, ‘reading stories to the children’ to ‘cooking eggs or pancakes in the morning’. All of the captions were decorated with bullet point furry bobbles and glittery sequins, and it all looked really bright and busy. When the time duration came to an end, we all felt really satisfied about what we had achieved, and felt that we had suitably summarised the learning journey on the module.
Our other colleagues had produced some lovely expressive collages too, and so after mounting each art piece onto the wall, each group explained the thinking behind their creation to the rest of the class. As a bit of fun, we all marked each other’s work, awarding our favourite a 4, then the next best a 3, a 2 and then a 1. The winning group had a bag of edible goodies, but unfortunately it was not our group! Other examples of artwork included a rollercoaster of emotions and a pair of glittery caring hands. All of the creations were lovely, and the activity made me feel a sense of overall belonging to the group and to our profession as future nurses. It was fun and valuable at the same time.
Afterwards we had a surprise visit from the Head of the School, who was very interested and complimentary about what we had done. The artwork, I believe, is now being displayed and shared within the university. What a great end to the optional modules!