Shortly after Rosie arrived in the emergency department, she was ready to return home. At age 89, she appeared to be a well-put-together woman and was aware of her surroundings and medical conditions. Before arriving in the ED, Rosie was experiencing difficulty breathing and alerted her daughter, Tara. With her mother having congestive heart failure and hypertension, Tara called 911 and drove to Rose’s assisted-living residence.
After a brief evaluation, the paramedics were not convinced that Rosie was short of breath. Tara was torn between listening to her mother’s request to go to the ED and appreciating what the paramedics were saying. Tara was a nurse for 10 years and Rosie had also been a nurse. There was a lot of expertise in Rosie’s room, but no definitive strategy for how to reconcile this dilemma. Tara erred on the side of her mother’s wishes and encouraged the paramedics to transported Rosie to the ED.
Having the ability to think for herself is fundamental to Oprah’s success in life. It’s what attracts others to want what she’s achieved through her own merits. Oprah’s followers often become political candidates and leaders themselves. Her recent stump speech for Stacey Abrams, candidate for governor of Georgia, encouraged voters to stop listening to the outside noise and to begin reflecting on personal values.
Stacey and Oprah pointed out to the audiences, “You get a vote – and you get a vote – and you get a vote.” In the democratic process, decisions are made based on the majority of votes. Patients have the right to make their own medical decisions, but most patients prefer the doctor determines what’s in their best interest. This often leaves family caregivers out of the voting process.
Medical experts, family caregivers and patients each get a vote in the decision-making process. In the care of Rosie, Tara regretted her decision to listen to her mother instead of her better judgment. She knew her mother suffered from anxiety and this fear factor influenced her decisions. She also knew that her mother was not long for this world and her end-of-life journey needed safeguarding. A trip to the ED might mean Rosie could die in the hospital. Was this part of Rosie’s advance care plan?
Talking about personal feelings is “Oprah’s stuff.” This is what connects Oprah to family caregivers like Tara. But talking and doing are two different approaches. Oprah says what’s she’s going to do and follows through. Many patients tend to say one thing and do another. NPR (National Public Radio) recently reported that only one out of two patients take their medication as directed. As a family caregiver do you take your lead from Oprah or your loved one?
The following “Oprah steps” are how family caregivers might think for themselves:
- Ask Questions
The point of asking questions is to appear undecided and open-minded. Family caregivers often confront no-win situations and realize that doing the same thing over and over again becomes self-defeating. By asking questions, you accept not knowing everything and show your interest in learning something. It’s also another opportunity to practice your listening skills.
Tara didn’t understand why her mother felt short of breath, but she neglected to ask her mother more questions and explore her personal feelings? Was Rosie upset about something or did she overexert herself? How was this episode similar or different to her previous bouts with congestive heart failure or panic attacks? If Tara agreed to stay with her, could the paramedics be dismissed?
- Assimilate Information
Many medical decisions are confusing and emotionally disturbing. You might be prone to pull back from this situation rather than putting the pieces together and figuring it out for yourself. Most family caregivers feel unprepared to make medical decisions, especially for loved ones. They prefer not to take responsibility, yet likely wish to control the situation because it affects them in them in the long run.
Rosie’s vital signs were normal and her lungs sounded clear. Rosie was of sound mind, but was prone to anxiety. What’s the worst that could happen at this point? The paramedics might need to be called back or Rosie could die. Tara did not anticipate her mother wishing to leave the ED as soon as she arrived. The humiliation of this back-and-forth decision was perhaps the most detrimental to Rosie’s self-esteem.
- Act Purposefully
Family caregivers generally have the mission to either prolong life or prioritize quality of life. The deciding factor is based on stress reduction for both caregiver and patient. Having a mutual purpose and agreement at the outset of a chronic or terminal illness allows the dynamic duo of the patient-caregiver to speak with one voice. Trips to the ED tend to prolong life while remaining at home promotes quality of life.
Thinking for yourself often means relying on home remedies. Since there’s no quality of life in hospitals, Tara might have reminded her mother that remaining at home was in their best interest. Not surprising, Rosie was not receiving home-based palliative care. This added cushion of support might have made Rosie feel more comfortable at home. The palliative care nurse might have cast a reassuring vote for Tara to not have her mother transported to the ED.
The platform of “strategic aging” support shared decision-making among patients, family caregivers and medical experts. The three factors to consider before their votes are cast include:
- Prioritize quality of life (patient’s vote)
- Manage chronic illness (physician’s vote)
- Appreciate palliative care (caregiver’s vote)
Major elections occur in November which is also deemed National Family Caregivers Month and National Palliative Care Month. Family caregivers need to remember that they have a vote in the care of their loved ones and palliative care nurses can lend support in withholding or withdrawing this care. As a family caregiver, strive to think for yourself aside from the noise of others amid stressful situations. Honor your personal values and profound commitments with the likes of Oprah’s inspiration and integrity.