End-of-Life Care Part 3

Case Study: End-of-Life Care Part 3

When Mr. and Mrs. Johnson’s children arrive at the hospital, Mrs. Johnson says she was thinking that it may not be the best thing for Mr. Johnson to continue on life support because it seems that it may only be prolonging his suffering. It took the cardiac arrest situation for her to finally realize that her husband will never recover. The family asks to speak to the healthcare team about removing Mr. Johnson from life support. The social worker, hospitalist, nurse, and respiratory therapist (RT) are available to meet with the family. They explain what to expect once Mr. Johnson is removed from life support, and that the family can arrange for it to be done whenever they want. Mrs. Johnson says she would like their pastor present. Arrangements are made to remove Mr. Johnson from the ventilator later that afternoon. Mrs. Johnson asks the nurse if she will be the one who will remove the life support. The nurse has never done this before and is uncomfortable. She says, “I will be present if you want me to be there with you.” The nurse then privately discusses the situation with the respiratory therapist. She has never removed someone from life support and is uncomfortable doing so for the first time in this situation. The RT says removing life support is part of RT training, and he has done so in a number of cases. He suggests that he remove Mr. Johnson from the ventilator while explaining what he is doing to the family, and the nurse can observe and offer support. Afterward, he and the nurse can meet and discuss the process so the nurse can learn. The hospitalist will be present when Mr. Johnson’s life support is terminated, and he can also be available to talk with the nurse and RT afterward.

Discussion Questions

1. How did the team members respect each other’s roles, responsibilities, and expertise in Mr. Johnson’s case?
2. Using this case, give examples of how team members worked together with each other and the Johnson family.
3. The nurse in this case study demonstrated how interprofessional collaboration can help professionals maintain competence within their scope of practice. Can you think of other ways in which the various professionals could collaborate to learn from one another?

1. The team members in Mr. Johnson’s case demonstrated respect for each other’s roles, responsibilities, and expertise in the following ways:
   • The nurse acknowledged her discomfort and limitations in removing life support and sought guidance from the respiratory therapist, who had the appropriate training and experience in this area.
   • The respiratory therapist recognized the nurse’s desire to be present and offer support to the family, and he offered to perform the procedure while explaining it to the family and allowing the nurse to observe and learn.
   • The hospitalist, although not directly involved in the procedure, made himself available to provide support, guidance, and communication with the nurse and respiratory therapist.
2. Examples of how team members worked together with each other and the Johnson family include:
   • The social worker, hospitalist, nurse, and respiratory therapist collaborated to meet with the family and provide them with information about what to expect when removing Mr. Johnson from life support. This ensured that the family was well-informed and had the opportunity to make an informed decision.
   • The team respected the family’s request to have their pastor present during the process, showing sensitivity to the family’s emotional and spiritual needs.
   • The nurse and respiratory therapist collaborated to create a plan for removing life support, with the respiratory therapist taking the lead in the procedure, while the nurse offered emotional support to the family.
   • The hospitalist’s presence ensured that there was a physician available to address any medical concerns or questions that might arise during the process.
3. Interprofessional collaboration can offer various opportunities for professionals to learn from each other in situations like this:
   • Regular interprofessional meetings or debriefings can be scheduled to discuss cases and share experiences. In this case, the nurse and respiratory therapist can meet afterward to review the procedure and discuss any challenges or questions.
   • Cross-training or shadowing opportunities can be arranged where nurses can observe respiratory therapists performing life support removal procedures, and vice versa, to enhance their skills and comfort levels.
   • Simulation training or workshops involving multiple healthcare disciplines can be conducted to simulate end-of-life care scenarios, allowing professionals to practice and learn together in a controlled environment.
   • Developing guidelines or protocols that outline the roles and responsibilities of each team member in end-of-life care can ensure clarity and consistency in practice.

Overall, effective interprofessional collaboration fosters a culture of continuous learning and improvement, benefiting both the professionals and the patients and families they serve.