Role Model Compassionate Care;
Jen Gargiulo is one of the most compassionate nurses you will ever find. She is kind and empathetic and will go out of her way to help those less fortunate and who are suffering. She demonstrates compassion in so many ways. If she is working and hears a confused patient yelling out, she will not hesitate to enter the room and find out what is causing their distress. She is also a team player and role model on the unit. She is a strong preceptor for the night shift, and she demonstrates patience and understanding with staff as well. When she has had stable patients and has seen me running around with a decompensating patient, she always lends me a helping hand.
Special Connection with patient or family member:
There was one patient Jen took care of on our stepdown unit who had been diagnosed with a deadly brain cancer. The location of the tumor was disrupting her memory and affecting her behavior which is probably why she was yelling out a lot on the unit. This distressed a lot of nurses on the floor, because no one wants to hear a patient yelling out, and with her poor memory she was labeled as a difficult patient. Jen got a report that the patient had been refusing oral medications for two days. It made her wonder why, but after a chart review, I don't think she had found the answer. Her experience showed because she didn't run in with her evening medications. She took the time to develop trust with her patient. She patiently conversed with the patient and offered to give her a bath to help her relax. She put on some soft music on the care channel and asked her how she was doing emotionally. During that conversation, she found out that the patient was scared of dying, and upset her hair was falling out. She also learned that her throat was sore, and it was painful to eat and take her medications. She also learned that the patient liked chocolate pudding. After she finished her bath she decided to try and crush up her medications and put it in some chocolate pudding. However, our unit had no chocolate pudding. Jen knew it was important for her patient’s comfort to get her oral medications. She went from floor to floor to find that pudding. She had to go all the way across the campus to CEL 2, but she found the pudding. AND her patient took her medications. For a while, the patient would still intermittently cry out, and Jen would go in, but before the end of the night, we finally noticed the patient stopped crying, and was finally getting some sleep.
Made a Significant Difference:
There are two examples that come to mind when I think about how she has made a significant difference in the life of the patient and the family.
First, there was a patient who was extremely sick and being specialed in the MICU (meaning a 1 nurse to 1 patient ratio), who had cardiac arrested at home during a bad storm. The power went out, and the patient was sleeping on their home bipap machine. The family was upset thinking that was the cause of the arrest, but whether it was, or if she had a thrombus, I'm not sure. I think staff just remember how distracting and distraught the family members were on the unit. If I recall, the daughter was distraught in the waiting room and collapsed triggering a code blue, and the patient's son and husband were in the room wailing and yelling.
The nursing care alone for the patient was extremely intense. Jen had to set up CRRT which is 24-hour dialysis and was on the arctic sun for therapeutic target temperature management post-cardiac arrest, which is a very complex protocol, with additionally hourly assessments. On top of that, she had to manage her family members in crisis.
She spoke in her usual calm manner and educated the family on the plan of care. She did not give them unrealistic expectations but reminded them that the next few days were crucial and allowed them to still hold onto some hope. I think she was also able to empathize with the patient's son. Jen lost her own dad and has gone through the loss of a parent. She was able to draw from her own experience to help provide that comfort. Although Jen provided a lot of care for her patient that night, I believe she made a big difference in her patient’s family.
The second example I can remember is when Jen had a patient who was having an identified cause of excruciating pain. I don't remember all the patient's history, I just remember thinking, "I'm sooo glad that's not my patient tonight".
The patient was initially on the SDU and had decompensated from a respiratory perspective and was brought to the MICU for intubation. The patient was screaming and writhing around in the bed, making it difficult to even get accurate O2 sat monitoring. Her dad was an anesthesiologist and was at the bedside in emotional agony, watching his daughter in pain, and not being able to get rid of it.
I remember one of the MICU residents asking me to call anesthesia for intubation. Jen was at the bedside with the patient, so I called anesthesia, called RT, and grabbed the intubation kit to bring into her. Jen stopped me at the door, thanked me and asked that I wait and leave the kit outside. I asked her if I could help, but got interrupted when her patient started screaming again. She said she was okay and would call if she needed help. So I left the room and kept my eye out to see if she needed help. It turned out that the patient had been intubated before, and was screaming that she didn't want the tube in and would rather die. The patient was alert and oriented. Her dad and the doctors were still concerned because, despite multiple consults, they did not know why she was having the pain and were concerned about her airway. Jen suggested that her dad speak with our CRNA due to some concerns with some of the analgesia/sedatives. While the doctors were talking, Jen remained with her patient and was rubbing her back, offering cool compresses, and doing deep breathing exercises with her patient, to help de-escalate the situation, and calm her. I just remember Jen being in that room almost all night. It was such a difficult case, I remember our APSM was present checking in with Jen. Jen was able to help her patient get through her crisis and avoid intubation for her patient.