“One man in his life plays many parts.” William Shakespeare
Dividing life into stages — from infancy and childhood to young adult and elderly — I’ve realized that, if we’re lucky, we all will play many roles throughout our lifetimes.
But jumping from infancy to old age isn’t an option. And there is no place this is more evident than in the Cardiovascular Pediatric Intensive Care Unit (CVPICU), where I worked for 15 years.
The division of life into stages helped me understand and apply the nursing process.
I learned early on that assessing, diagnosing, planning, implementing, and evaluating needs in order to guide nursing interventions will vary at each stage in the life cycle.
Jacob
Jacob was born with Tetralogy of Fallot, a congenital and complicated heart condition.
He went directly from the birthing room to the surgery suite, and finally to the CVPICU.
When I met Jacob, he was two days old and in critical condition. And I was his nurse.
Assessing the family’s needs
In addition to the physical critical care needs of this baby boy, nursing care required that assessing Jacob’s needs also meant assessing the needs of his parents and his grandparents.
Jacob’s mother and father were 18 and 19 years old, respectively. They were unmarried and living at home with his mother’s parents (Jacob’s grandparents).
Gathering information about the psychological, physiological, sociological, and spiritual status of these three generations was challenging but necessary.
Access to the grandparents was limited. Information from the parents was incomplete.
I never quite felt I had enough data, regardless; I was continually re-evaluating their needs by monitoring for signs of change, directing, educating, and instructing.
Diagnosing, planning, implementing
Making an educated judgment regarding their needs focused on two things: 1) assisting the parents and grandparents in understanding the care Jacob was receiving in the CVPICU and, 2) guiding them in forming realistic expectations for Jacob’s care and outcome.
In addition, there was the ongoing intensive care being provided to Jacob that was difficult for the family to observe, let alone understand at times.
Weeks without progress melted into months without hope. Each day was focused on stabilizing and maintaining Jacob’s current condition while supporting the parents and grandparents psychologically and socially.
After several months in the CVPICU, Jacob had yet to be held by his family and they were beginning to weaken as a result of it.
Part of the nursing care was coordinating a team of counselors, social workers, and hospital support staff to assist Jacob and his family.
Implementing these objectives involved providing educational information about Jacob’s condition in the form of published literature and ongoing discussion in the form of online information to assist in supporting patients and their families.
Ongoing evaluation
Throughout Jacob’s time in the CVPICU, there was ongoing evaluation of his condition and the responses of his family.
Throughout the months I took care of Jacob, this process repeated itself over and over. As new concerns surfaced for the parents and grandparents, assessment renewed each diagnosis opening fresh planning and implementation of care.
Eventually, one of the most important days of Jacob’s life came – the day his mother would hold him for the first time.
Unfortunately, that was also the last day of his short life.
The nursing process repeats
For this young mother and her baby, the nursing process once again unfolded around them unseen and unknown just as it had every day throughout Jacob’s life.
But on this day, as I placed Jacob into his mother’s arms, I couldn’t help but see clearly how the support and care we provide as nurses are truly circular in content.
Assessing and planning, the implementing and re-evaluating all function together on so many levels — right up to the very end.
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Cheers,
