14 l Nursing2013CriticalCare l Volume 8, Number 4 www.nursingcriticalcare.com S SM, who has been living with systemic lupus erythe- matosus (SLE) for almost 20 years, is admitted to the hospital with a high fever of unknown origin. She was diagnosed with primary pulmonary diffuse large B-cell lymphoma a few months ago. The lymphoma was believed to be the result of the underlying dis- ease process of SLE, as well as the immunosuppres- sant therapy used to treat it. SM appeared to be responding well to treatment for lymphoma, and she seemed to be on the road to recovery. Her high fever was a mystery to all of her care providers. Her part- ner, AE, and three of their closest friends remained with SM day and night. All came together when the pulmonologist recommended a lung biopsy and explained what to expect. The prognosis wasn’t good. After the procedure, SM was admitted to the ICU. When her partner and their friends arrived, they encountered a volunteer stationed by the door to strictly enforce the very limited visiting hours. Their friend KT, a nurse with ICU experience, explained to the nurse in charge of the unit why it was so important for AE and the close friends (who were SM’s family of choice), to remain with SM. The charge nurse indicated she would allow SM’s “family” to remain during her shift, but that this would need to be renegotiated with each charge nurse. SM’s con- dition deteriorated. As each shift changed, the nurses gradually understood the intense connections among members of SM’s chosen family. When it became clear that SM wouldn’t survive without “the breath- ing tube” (which she had clearly conveyed she didn’t want), her chosen family gathered with AE and the physicians to honor SM’s advance directive and extubate her. Death was imminent. The nurses became increasingly supportive of the ways in which SM’s family of women created a home in the ICU. Her family remained with her throughout the remaining few days of SM’s life. Respecting family After a somewhat rocky start, SM’s family of choice was respected by the nursing staff, and allowed to By Michele J. Eliason, PhD; Jeanne DeJoseph, PhD; Suzanne Dibble, DNC; and Peggy Chinn, PhD Reaching out to Reaching out to lesbian, lesbian, gay, gay, bisexual, bisexual, transgender, transgender, queer, queer, and questioning patients and questioning patients Expand your culturally appropriate nursing care to include LGBTQ patients. IMAGE BY THINKSTOCK © Copyright © 2013 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.