Katherine
McNichols
August 2012
Katherine
McNichols
,
BSN, RN
Float Pool
Advocate Good Samaritan Hospital
Downers Grove
,
IL
United States
Katie cared for a patient who was admitted with a subacute myocardial infarction and heart failure. The patient, prior to admission, was independent, splitting her time between Hawaii, where she lived with her son, and the Chicago area, where she lived with a friend. In report, Katie was told the patient lacked motivation and was unable to ambulate or sit in a chair safely. It was also reported to Katie that the patient was now requiring assistance with all activities of daily living. Katie noted on her assessment that the patient had poor eye contact and was withdrawn, conversing only with much encouragement. The patient informed Katie she was too weak to get up to use a commode and told physical therapy she was too tired to walk.
Katie gently encouraged the patient throughout the morning. In the afternoon, she was finally able to persuade the patient to ambulate with Katie's and the PCA's assistance. The patient was able to walk 20 feet but then needed to rest. Katie helped her to sit in a chair by the window.
Once she had accomplished this, it was as though she had a breakthrough. She became engaged and initiated conversation. She confided in Katie that she loved Hawaii and was afraid of dying and never making it back.
Over the next few days, Katie encouraged the patient to verbalize her feelings and talked to her about balancing rest and activity. The patient showed improvement each time she ambulated. Katie helped the patient recognized each small improvement. She provided extensive education, not only to the patient, but also to her son. She used their daily ambulation sessions to reinforce her teaching. By the time she was ready for discharge, the patient was able to ambulate 150 feet without fatigue and able to sit in the chair for all of her meals.
Katie's persistence with a patient who was initially disengaged in her plan of care allowed her to make a difference in this patient's outcome. The patient who was initially withdrawn was able, by discharge, to acknowledge her progress towards recovery and focus on what she could still do independently.
Katie gently encouraged the patient throughout the morning. In the afternoon, she was finally able to persuade the patient to ambulate with Katie's and the PCA's assistance. The patient was able to walk 20 feet but then needed to rest. Katie helped her to sit in a chair by the window.
Once she had accomplished this, it was as though she had a breakthrough. She became engaged and initiated conversation. She confided in Katie that she loved Hawaii and was afraid of dying and never making it back.
Over the next few days, Katie encouraged the patient to verbalize her feelings and talked to her about balancing rest and activity. The patient showed improvement each time she ambulated. Katie helped the patient recognized each small improvement. She provided extensive education, not only to the patient, but also to her son. She used their daily ambulation sessions to reinforce her teaching. By the time she was ready for discharge, the patient was able to ambulate 150 feet without fatigue and able to sit in the chair for all of her meals.
Katie's persistence with a patient who was initially disengaged in her plan of care allowed her to make a difference in this patient's outcome. The patient who was initially withdrawn was able, by discharge, to acknowledge her progress towards recovery and focus on what she could still do independently.