Cheryl was assigned to a patient who was on her 2nd day of labor, and 3rd shift of nurses. This patient was complicated by the following facts: paranoid schizophrenic, incarcerated (deputy in attendance), patient was 7 cm, reported by prior shift: "uncooperative" and "combative", requiring handcuffing.
After report Cheryl's initial assessment of the patient included discovering the IV had been pulled out. Replacing the IV was not only a priority, but was challenging and time consuming. Eventually a Medline was placed by the PICC Nurse.
A cesarean section was called for failure to progress. Cheryl notified me that she wanted to talk to me outside the room prior to my interviewing the patient for cesarean. We met in the hallway just outside the room. Cheryl explained the patient's mental and emotional status. Cheryl explained that over the course of the day both she and the deputy had not only gained the patient’s trust, but also her cooperation. Cheryl explained the best plan of care for the OR would require some staffing adjustments. She wanted to ensure the patient would have both Cheryl and the deputy closely supportive in physical and visual proximity at all times. We agreed to a plan of care which included the Resource Nurse to attend the cesarean as baby nurse so that Cheryl could remain at the patient's side throughout the cesarean.
With the plan in place, Cheryl accompanied me into the patient's room, introducing me to the patient as a trusted member of the team, all the while reassuring the patient that she (Cheryl) would remain with the patient. The patient was clearly terrified, but Cheryl had total control, explaining everything with clarity at the patient's level of understanding. We transferred the patient to the OR and the patient was completely cooperative during the transfer and for the entire case. Cheryl held the patient in position for the spinal, with the deputy in visual contact. Cheryl remained with the patient in the PACU and participated with transfer and hand off to PP.
Cheryl embraced a difficult assignment with efficiency and compassion. Instead of tackling her assignment with preconceived bias to an "uncooperative and combative" patient, Cheryl took the time to evaluate and focus on the patient as an individual, deserving respect as a fellow human in need of care. Cheryl identified and established effective communication, developed trust, and ensured safe, quality care.
Cheryl essentially did not leave this patient's side for 12 hours. Cheryl made a significant difference for this patient. As a member of the perioperative team during the cesarean, I observed the incredible, trusting relationship in real time. It was powerful. It was beautiful.