Respecting Patient/Family Choice Through Authentic Presence

Kaiser Permanente, Northern California

Caritas in ActionHow Caring Science informs and inspires KP caregivers and affirms our commitment to provide our

patients and their families exceptional care

Caritas Consortium 2013

Respecting Patient/Family Choice through Authentic Presence

Intent to Contribute Statement:It was a Friday, typically my day off. I was asked to reassess one of our home health patients that had a

history of laryngeal CA, late effects of radiation treatment and a more recent CVA. When I arrived at the

house, Mr. L was sitting in his recliner and also present were his paid attendant and his two daughters. I

listened to their concerns about the patient just not being himself. I took his vitals - his respirations were up,

otherwise everything else was normal. It is not my area of expertise to do lung ausculation but it was clear

when I laid my hand on his chest that he was having respiratory issues. I called the physician - it was after

5pm. I called the case manager, Amy, who called 911. I called the MD who asked me my status - when I told

him that I was still in the home with the patient and family and that his respiratory status was compromised,

he immediately engaged. He spoke with the family and explained that this might be the end of Mr. L's life

and to gather the family to say goodbyes, and then he called the ED. Mr. L had expressed that he wanted to

die days before and he was struggling to accept the paramedics during this visit. However, with his family's

urging, he accepted. His oxygen saturation was 80% and he began to do better with oxygen.


With a team of people including myself, the nurse case manager, the ED, the physician, the

paramedics and Apria, we were able to respect the family's wishes for treatment but allow this

gentleman to stay home and not be transferred to the Hospital. He remained home with Apria

placing oxygen only within a few hours. This would not be what I would do with a family member or

myself. If I wanted to pass away, I would hope that a family member would respect that wish.

However, I listened to the family's wishes as well as the patient. I stayed until everything was in

place. I have no doubt that the choices I made in this situation were right for the family, patient and

me professionally.

… Continued


Inspired Contributor(s) 1 : Diane Foti Amy Rizen

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Service Area: GSAA

Medical Center: HAY

Affiliation: Continuum

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Year Shared: 2013

Venue: Caritas Consortium

Format: PowerPoint

ID #: n/a

1 Names as listed in Lotus Notes, otherwise personal e-mails indicated

Keyword TAGs: Identifier

Consortium2013-July, GSAA, Hayward, Podium, Home Health / Hospice

Team, Patients/Families

Descriptor Authentic Listening, Caritas

Consciousness, Storytelling


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Health & Medicine

Respecting Patient/Family Choice Through Authentic Presence