In her role as an educator, Chrystal is responsible for providing educational programs based on the ICU’s Educational Needs Assessment and conducting annual competencies. She has conducted focus groups with our preceptors and newer nurses to help us refine our orientation program to better meet their needs. Chrystal also provides precepting to our newly graduated nurses. Her approachable demeanor and sense of humor allow the new nurses to feel at ease and ask questions. She assures that there is multiple avenues for our staff to receive education and has set up a monthly educational series, “back to critical care basics” that is videotaped in 30 min segments and is available as a webinar on the ICU website.
Chrystal’s sense of commitment and follow through to any task is commendable. She demonstrates true professionalism, by coming in on her own time to attend committee meetings and complete projects. She is fundamental in supporting evidence-based practice changes that are initiated in the ICU, by providing education and role modeling the appropriate practice with her peers. Chrystal has demonstrated leadership skills as the chair of our Patient and Family Centered Care committee. In that role, she is responsible for monitoring our satisfaction scores through the implementation of programs to facilitate and enhance communication between our families and those of the health care team. Most recently she has developed a program to support families during the transition to palliative care.
Chrystal has also taken the lead in our efforts to address Post-ICU Syndrome by implementing the ICU diary; an initiative supported by the Society of Critical Care Medicine and John Hopkins that involves families in keeping a daily diary of events in the ICU. The diary helps patients in their recovery from critical illness by addressing their false memories of events in the ICU and replacing them with factual events. This approach has been successful in reducing Post-Traumatic Stress Disorder in survivors of critical illness. Additionally, Chrystal has become our unit’s champion to create a healing environment for patients and families; identifying the need for an environment that supports sleep in the critically ill. Chrystal’s compassion also extends to her co-workers, identifying a need for spiritual and emotional support for those nurses that have experienced a devastating patient loss. In order to support her peers emotionally and spiritually, she collaborated with our pastoral department to implement a “Code Lavender” box. Much like the Code Blue response hospital’s have for a cardiac arrest, Code Lavender can be called for a nurse that is experiencing emotional and spiritual distress. Once activated, a Chaplain from the Pastoral Care department will respond with a lavender box that contains aromatherapy, soothing teas, gift cards, a purple ribbon for the nurse to wear to let others know they are needing an “extra hug” today. If available one of our pet therapy teams will also respond to provide some extra love. The idea is to provide timely intervention and help to avoid compassion fatigue that can occur among health care workers. While there are many examples of how Chrystal embodies the characteristics of this award; I think this following patient interaction conveys her philosophy and approach to caring for our patients in her own words:
“As a critical care nurse, my initial plan for each patient usually includes return to homeostasis. This is reflected in Roy’s adaptation theory, the theory we use to guide our nursing practice at Morristown Medical Center. It’s just in our nature to want to find the problem, administer the therapy ordered and see them through their course toward recovery. Although sometimes that patient has a very different goal than the goal the nurses, doctors and even family members have set for them. This evidence-based clinical exemplar is such as an example. This April, I was given the pleasure of taking care of L while in MICU. L was suffering from terminal cancer and was sent to our emergency room in respiratory failure. The disease in her lung was so advanced that she already had a palliative drain in place to help remove fluid that continually accumulated in her lung to help her breath easier. She had been hospitalized several times at Overlook Hospital and was in a rehabilitation facility due to the cancer’s progression and her debilitating physical abilities. She had a breathing tube placed in the ER for respiratory support and arrived to our unit at the beginning of my shift. Upon arrival, I was introduced to many family members and they had many questions for me. I educated them on our unit based patient and family centered care model and the core concepts of treating families with dignity and respect, information sharing, participation, and collaboration. So based on these core principals, I began to listen to various family members’ concerns, questions, and requests providing them with the opportunity for information sharing and participation. After listening to them for a short time, I could tell immediately that the goals they had for L were different from the ones I had begun to set with her physicians, respiratory therapist, and residents prior to her arrival. L had been fighting cancer for some time and her support system was very strong. Her brothers were present and continually suggested ways we could improve her lung function while asking for consults from specialists. Her longtime partner was at her side through many difficult hospitalizations and was hopeful that this was just another “bump in the road to recovery”. Her daughter was concerned that we were causing her unnecessary pain and discomfort with the intubation and testing. She discussed her mother’s recent choice to make her health care proxy in case her health continued to decline, leaving her unable to make her own wishes known. L was seen by many different physicians and the healthcare team’s goal that day was to continue ventilator support, give medication to help remove fluid from her lungs, antibiotics, and support her with pain medication and a quick-acting sedative. Her lung compliance was not expected to improve due to her underlying lung cancer, so the likelihood of her being able to be liberated from the ventilator was minimal. Throughout the day my time was spent assisting her family with any questions they had regarding her care and educating them on the progression of her disease, declining lung compliance, surgeons evidence-based reasons for not operating, and information on the medications we were using to treat her disease and symptoms. They continued to be torn between aggressive life-sustaining treatments and end of life comfort-focused care. But L was very determined to tell me her wishes. I gave her writing utensils and she wrote, “Remove the tube”. I reviewed the plan of care, risks of removal and asked if she understood. She nodded yes and then wrote again, with her green nail polished fingers, “REMOVE THE TUBE”. We slowly weaned L off the ventilator, supporting her through each step to give her the optimal chance at a comfortable extubation. She was placed on oxygen after the tube was removed and slowly she began to talk with her family. Through the next hours, I was approached by many family members, all with different feelings and concerns regarding L’s wishes. I could see how torn they were with her decision and I supported them through their questioning while keeping L’s wishes as our goal. As the family was with her at the bedside, L asked “Can I touch the cold ground? I want to be one with the earth.” This was difficult for me at first due to safety concerns; however, I safely lifted L to a chair with her bare feet touching the floor and aligned the chair facing the sunlight coming through the window. I can remember her foot had a tattoo on it that read “One day I will fly away”; it was something everyone in the room read as we placed chairs around her for her family to sit and enjoy these moments with her. She immediately shared her feeling of happiness with her sensations and began to talk about her memories with her family. I could see the change in their faces and saw the acceptance of her wishes. Their focus turned toward comfort and bringing out their “true hippy L”. She later described her desire to taste nature and we gave her tastes of applesauce which satisfied her desire well. Her family began laughing with her and enjoying these moments. Later that night we moved L and her family to a private room on Franklin 4. This gave her a respite from the noise of the ICU and a large area to hold all her supporters. We continued our focus on comfort and family support through L’s journey. I remember the family thanking me and the staff, many with hugs. It is these encounters that stay with me and remind me of my initial drive in nursing, to provide humanistic evidence-based care."
Words could never express how incredibly thankful I am to have Chrystal as part of the ICU team, she is a true asset. The ICU team and our patients are so blessed to have her as part of our lives.