I'm sitting in a control room waiting- white coat wrapped around me. I've been enlisted to participate in a recorded simulation about discussing end of life. Outside a group of student nurses is undergoing a mock change of shift report on a 50 year old gentleman who has been diagnosed with widely metastatic lung cancer. The nursing students are told the patient is waiting for Dr. Phelps to tell him the diagnosis.
That is my cue as I burst from the control room behind them clutching papers, striding briskly across the room white coat flapping. "Ok, lets get this show on the road". I chivvy the students into the simulation hospital room where "Mr. Mitchell" is awaiting his diagnosis. "Mr. Mitchell" is actually Mario, the tech guy with a secret skill. He is also a trained thespian who did the make up and props. Now he lies on the hospital bed, moaning occasionally and coughing into a spit cup with real looking blood tinging the paper lining. His "wife" is Susan our hospice's grief counsellor.
What the students don't know is that this is a set up. It is to help the students understand the strong emotions and concerns about patients getting potentially life ending diagnoses. "Mr. Mitchell" sits on the bedside as I explain to him and wife that his 'pneumonia' is actually widespread cancer. As his newly summoned 'oncologist' I begin to lay out various therapies and discuss the dismal prognosis seemingly oblivious to he and his wife's growing distress. Suddenly I am called out to an 'emergency' and leave the room, leaving the nurses to deal with the family, their disbelief and grief. Although a little artificial, Mario's job is to at least start through the Kubler -Ross's Five stages of grief.
As I noted in my book, when doing a simulation of my own during fellowship how quickly the 'simulation' aspect of the process is forgotten. Along with the nursing faculty member who set this scenario up, I watch from the control room as Mario and 'wife get more and more agitated. When he gets to Denial his full thespian skills come into play as he rages against the unfairness of it all while his 'wife' rubs salt in the wound about how she'd told him he should have quit smoking. By the way, Mario is a very large person that that makes his raging gestures all the more threatening. But I give the students full credit. They hung in there! At turns calming, at turns consoling, at turns explaining what "that doctor" said again.
We let the scene run for about 20 minutes then call it, and do a debrief with faculty, Susan and Mario and myself. At that point it comes out that Mario had himself been in a real life circumstance with a family member much like that we portrayed and complemented the students, saying he wished they'd been there when the he'd done this for real. We talk about the students distress, and coping and how they tended to avoid silence to cover their anxiety. Along with other commentary, Susan points out the gifts of silence and presence that are often needed. She gives them the acronym "WAIT" Why Am I Talking? Susan talks about nursing self care as well. The group is dismissed.
We set up for the next group. The new scene is an impressively made up crash dummy- '30 year old mother of three" with car wreck and a life ending intracerebral hemorrhage. Susan this time is the atheist sister, Mario the husband. This time I am the somewhat callous neurosurgeon delivering the news that the injuries are life ending and there is "nothing to be done." Again my pager summons me to another emergency. Mario and Susan emote and rage as a new group of students struggle to deal with how to calm this family. Then, again the debrief. All of the students in both sections are stress but energized to have this opportunity to learn the emotions of health care in a practice session and feel that it has been stressful but worth it.
Communication is listed as one of the six "Core Competencies" of medicine and dealing with strong emotions can put a significant stress on communication. Preparing these nursing students for dealing with the vagaries and intensity of feelings can do a lot for ensuring the patient feels heard and understood. I salute the nursing staff at Chattanooga State for putting us all thorough this.
Comentarios