Caring for a Pregnant Patient With a New Diagnosis of Cardiac Angiosarcoma

Abstract

The use of Jean Watson's theory of human caring science provided a framework for reflecting on the care of patient who had a complex diagnosis. A 34-year-old gravida 1 para 0 woman was admitted at 31-weeks gestation with shortness of breath. She was found to have a pulmonary embolism for which she was admitted for anticoagulation therapy. The imaging revealed a cardiac mass, which was found to be a cardiac angiosarcoma with pulmonary metastases, a life-limiting diagnosis. The patient was treated in the cardiac unit; for 6 weeks, obstetric nurses assessed and completed daily fetal nonstress tests. Multidisciplinary meetings were held among cardiology, oncology, and obstetrics to discuss treatment and birth planning. Many nurses developed a relationship with the family. The patient’s goal was to have a vaginal birth and to breastfeed her baby. To achieve her goals, she was induced at 36 4/7 weeks; however, she needed a cesarean because of nonreassuring fetal heart tracing. The cesarean surgery went smoothly, and the patient accomplished skin-to-skin contact with her newborn and attempted to breastfeed at birth. She was transferred to the surgical intensive care unit for immediate postoperative care. She was ultimately discharged home on Day 5 from the mother–baby unit, with continued treatment for her cancer. Her male newborn weighed 1,975 g and had stable Apgar scores, although he remained in the NICU for hypoglycemia and thermoregulation. He was discharged to home on day of life 22. Caring for patients with complex diagnoses is common in our institution, but caring for this family impacted nursing staff in a different way. Although the patient received a serious diagnosis, it was the relationship with the family that impacted the nurses. When a patient receives terminal diagnosis while she is, instead, expecting to celebrate a new life, it affects everyone involved. Through the use of Watson’s theory of human caring, the nurses involved with this patient shared clinical narratives of how being present and caring for self and others are integral to nursing care. Their stories helped others to process the experience, recover, heal, and identify opportunities for future practice. Strategies could include journaling, sharing their stories, multidisciplinary debriefing, and validation that caring for the care team is as important as caring for the patients.