There are often challenges regarding the capacity of patients who suffer traumatic accidents resulting in spinal cord injuries to make their own medical decisions. Often, it feels from a nursing perspective that patients are assumed to not have capacity. In these situations, nurses have the ability to have a meaningful impact on patients and ensuring they are active participants in their care. It takes a very special person to tirelessly advocate for patients the way Carolyn Arnold does. I have witnessed Carolyn continuously advocate for patients with spinal cord injuries and their voices to be heard on multiple occasions.

One patient she cared for, she spent over 1 hour with a communication board, working to have a patient spell out what he was trying to say. She would start at A, moving through the alphabet, waiting for a signal from the patient on the correct letter, then start over again for the next letter. Once she learned this strategy was effective for the patient, she informed the physician team to help have his wishes clarified and expressed. She knew this would take an extended period of time but found pride in giving the patient a voice and platform for communication that he previously did not have.

She additionally cared for another spinal cord injury patient who was communicating with nurses and was able to interact with the care team throughout his stay. The family shared the patient was confused with the physician team, resulting in him not being included in decisions. The patient and his family were facing very complex medical decisions during his stay on the unit. We watched Carolyn advocate passionately for the patient over several days with many different members of the care team including nurses, physicians from various disciplines, and family members.

Carolyn noted the physicians were not speaking to the patient directly regarding goals of care. She took action to advocate for the patient to be included. Carolyn worked with the physicians and facilitated multiple conversations with different teams, expressing her concern that his needs and wants were not being met. Her commitment and dedication to having the patient involved in the family meetings allowed the patient to be an active participant in his care. Through these conversations, she sought out clarification and provided education to many members of the care team. Ultimately, the patient was able to make his own choice to pursue comfort measures. Without the advocating that Carolyn did over several days, I am not sure we would have achieved the same outcome.

At one point, Carolyn began to question whether or not this was a fight worth fighting after feeling she wasn’t making the progress as quickly as she would have liked. She continued to advocate and will always go above and beyond for her patients. Her determination, even when not being the primary nurse, ultimately was able to give the patient the ability to express and carry out his final wishes. Carolyn is such a strong patient advocate and continues to go above and beyond for her patients.