Reflecting on my second year placement at a hyper acute stroke unit HASU as a student. At HASU I was able to observe how the stroke pathway was conducting. The main focus of my reflection is caring for a palliative patient who sadly passed away. 

This patient was admitted 1 weeks ago with a suspected TIA however he was discharged as he was able to pass his swallow assessment and could mobilise with his frame well, he was medically fit to go home.This was good news for him and his family who were eager to have him home. A few days later he was admitted back into HASU after having a stroke with left side weakness. Although I wasn’t able to interact with him before he was discharged, I was happy for him and his family and wished them well. Seeing that he had deteriorated a lot since his last visit made me more compassionate towards him.

At first he was in the ward with all the other patients, but after his NEWS score was continuously 9+ and due to the nature of his stroke medical intervention was of no use, it was decided by the doctor that the patient would be on palliative care and be moved into the sideroom for a dignified death. This was something that was,understandably, strongly disagreed by the family who wanted there to be medical intervention for their father no matter what. Although the doctors had already explained why that wasn’t possible, me and my supervisor were tasked with reiterating the fact that the patient sadly could not have any more medical intervention other than keeping him pain free and allowing him to have a peaceful and dignified death. For the family’s sake we slowly stopped monitoring the patient NEWS score although the family insisted. For me this was really hard as the nurse asked me to remove his monitoring as it wasnt not needed any more. Although I was able to take his ECG leads off, I was met with disapproval and questions. I kept my composure and with compassion I explained to the family that we had to remove the monitoring as the patient was declining. However, they negotiated with us to keep the SpO2 probe on and I left it on.

The Patient passed away the following few hours with his family present. I felt really sad for the family who were in tears, we gave the family some space and let them grieve. After this I was able to start the bereavement process, I got the death certificate and asked the doctor to sign it. I also got the bereavement pack for the family. me and my supervisor were able to  do the patient’s last offices and wash him. I made sure to maintain dignity and show compassion towards him. After doing all our checks we were able to wrap him in the white sheets which were requested by his family and placed him into the body bag. I found this really hard as this was the first time i had done the last office, i was emotional.

Throughout this experience I learnt that compassion isn’t hyper focused only on the patient, but it extends toward the family as well. In a way we have to vigalinat about their feelings and be mindful/aware of what we say and how we say it. I also learnt that it is important to still speak to the patient when they pass away as if they were alive and treat them with dignity, respect and compassion. I now make sure to be compassionate and respectful towards any patient’s family member regardless of the situation. This adheres to prioritising people in the NMC code. Not only did we treat the patient with kindness, respect, compassion and dignity, we listened to the family and responded to their preferences.