Isis Castillo
January 2018
Acute Rehab Unit
UC Irvine Medical Center
United States




Isis Castillo is a stellar example of a dedicated nurse and UCI employee. She has a special affinity for understanding and teaching patients about diabetes management. It is for this reason that she shines.
This vignette provides evidence of how Isis's delivery of care exemplifies her DAISY qualities. A patient, G, admitted to our hospital because her toe had a wound that would not heal. G blamed ill-fitting shoes and an admitted reluctance to address her own health concerns. The medical team quickly realized that her sore toe was actually gangrene and a ramification of her never-diagnosed nor treated diabetes. She underwent an amputation within 24 hours of arriving. The medical service, recognizing that she had no knowledge of her underlying medical condition, requested the diabetic educator meet with her and begin her training for the rest of her life.
She stayed in the acute setting for a few days, and then made the transition to Acute Rehab. We too, recognized her lack of knowledge and attention to her diabetes, and had our diabetic nurse educator meet with her. On both occasions, the educator reported that G downplayed the significance of her disease, declining to complete teach back or engage in educational efforts. She continued to maintain that the new amputation was all the fault of her shoes. This is the situation that Isis encountered on her first day caring for her.
Isis intuited that she was not ready to address her new body image change and therefore by extension, her diabetes. Sharing a cultural background and language, Isis determined that she first needed to connect with her a person, not a patient, and help G explore her feelings. Without that step, all the teaching in the world would have proven pointless, as G was simply unable to process. Isis worked most of the shift getting G to open up about the loss of limb, how it made her feel, and for the first time, her fears about how her life would be post discharge. G had to experience the emotional breakthrough and get past the barriers she erected for her to begin to understand the need to address her disease.
Because of the time, attention and caring demonstrated by Isis, the patient was able to process these feelings and was then open to starting the conversation about new medications, treatments, and lifestyle changes. While one shift is certainly not enough to overcome many years of dedicated inattention to her health, Isis was the only one to be able to make that connection and help G start the road to health stability.