By the nature of the work, health care is a team sport. This feels especially true for nurses in the ICU. I witness the team sport across both ICUs on a daily basis and could provide many examples. But for the purposes of this DAISY Team Award nomination, it is my honor to share one story of extraordinary culturally compassionate care.
These nurses, Laura, Amanda, Val, Josie, Mo, Nick, and Alaina, and I'm sure others recently cared for a young patient after emergent open-heart surgery to repair his aorta. Prior to surgery his heart stopped twice and required CPR and ACLS to revive him. While the surgery was successful in fixing the aortic aneurysm, there was concern his brain may have suffered a lack of blood flow for too long.
Laura was his nurse right out of surgery and the one who called the Organ Donation referral line because this patient met the clinical indications. The referral call is not something that changes the treatment plan but allows for that team to locate a record of patient wishes regarding donation - whether on the registry or driver's license.
It wasn't until the next day, clinical suspicions were confirmed. The head CT showed a very large anoxic injury and additional imaging was diagnostic of brain death. Amanda navigated the language barrier utilizing the "face to face" video interpreter option that offered the closest language for the unique dialect spoken by the family so, in the family meeting, they could understand the diagnosis of brain death.
The team approached the known and unknown beliefs and discussion surrounding death in the Tibetan culture in a very thoughtful and respectful manner. Without making broad generalized assumptions about another culture's values and beliefs, they worked to meet this family's needs at this point in time. This patient had previously indicated wishes to be a donor. So, Amanda facilitated a huddle with the online interpreter and the donation support specialist to explain the context of the conversation that needed to occur.
Most Buddhists believe everything you experience is related to your future life - the last things you experience in this life prepares you for your next life. Actions at the end of life are to help an individual prepare for a good life. It's believed that it can take many days for consciousness to leave the body so a surgery, such as organ recovery, at the end of death could be a traumatic event.
While the donation conversation had some hiccups, for example, not every organ has a translation to Tibetan (for example, the pancreas was not able to be translated) the family understood the options and ultimately decided to honor the patient's wishes.
The great length at which this team went to support the wishes to pursue organ donation and uphold the spiritual care of the patient, family, and Buddhist community. At each handoff, the primary nurses would (Amanda, Nick, Josie, and Val) passed along in detail the spiritual and culturally focused needs of his care.
Chaplin Pema was instrumental in uniting the nursing care to the spiritual care needed. She encouraged and instructed the primary nurses, Amanda, Josie, Val, and Nick, to keep virtuous thoughts while in the presence of the patient, speaking softly and minimally disturbing his body. An image of Buddha and electric candles were also placed in the room.
There was extensive coordination in the arrival of community clergy and elders to begin their prayers. The night shift, Val and Mo, ensured the room was prepared to welcome the elders and demonstrate respect. Mo was in charge that night and tracked down a late-night bakery that could provide plain sugar cookies, appropriate for the modified comfort care. Alaina rummaged through the cafeteria in the middle of the night in search of the "premium" tea. Val ensured the hot water was fresh and everything was in place early that morning.
Prior to going to the OR, community leaders and members came on sight to begin praying for his death day. Faith leaders accompanied the team to the doors of the OR as part of the honor walk.
Two elders brought packages of herbs wrapped in white fabric blessed by Tibetan monks that were handed off to Lynn, the surgical recovery coordinator, for the purpose of using these wraps in place of removed organs to maintain the wholeness of the body. Normally a body after organ donation is cleansed and prepared for the funeral home. It was the family's wish that the patient be washed fully at the end of the operation. They wouldn't want the funeral home to disturb the body more after his death day. Lynn took additional time to respect this spiritual request that was believed to support the patient's peaceful transition into the next life.
Outside of the OR, prayers continued until it was felt his consciousness had fully left his body. During the flag ceremony, Chaplin Pema continued to support the spiritual/faith needs by bringing a white scarf, a kotta which is a blessing exchange, for the mother to raise with the donate life flag.