Katie's care for a medically, socially and psychologically complex patient helped create the calmest and safest environment in a potentially volatile situation; and potentiated a flawless discharge. Katie's sincerely compassionate care for this patient exceeded all expectations in not only his care during his hospital stay, but through his transition out of the hospital as well. Without Katie's presence during this discharge, the outcome most definitely would have been very different.
Imagine being eighteen, healthy, on your way to college. Suddenly you are sick, your mind and body no longer feel like your own. You are vulnerable, a victim of your mind, and you can no longer maintain your own safety. I sadly watched this scenario unfold on R5 last week, but from it I found the most genuinely compassionate nursing care.
Let's call the patient "Dave". Dave was the teenager I described above. Young, healthy, state champ wrestler, headed to Massachusetts Institute of Technology on a scholarship in the fall. When suddenly over the summer, his life came to a screeching halt after a Lyme disease diagnosis. Dave developed encephalitis from the Lyme, it altered his mind, his personality and overall his life. His mother became his guardian and had to make difficult and sometimes unpopular decisions about his treatment. At the hospital Dave was an easy going kid, he was friendly, staff enjoyed him. He was pleasant though refused all PO medications and basically all medical care. The time in which his care was most difficult was when we needed to provide medical care that he did not want. Unfortunately Dave could not make these decisions for himself.
Early in the week the psychiatry department in collaboration with the patient's parents decided to trial the patient on Ativan. He was showing signs of catatonia and an Ativan trial is the first line treatment. This meant starting an IV on Dave and giving him medications. Dave did not want an IV nor did he want medication, but luckily Dave had Katie as his nurse. Over that day and the course of the week Dave developed a trusting relationship with Katie. She was able to put an IV in Dave and administer Ativan without complication. At the time, this may have seemed like a small feat, but later in the week the patient had a much different outcome with a similar situation.
A few days later Dave needed a new IV and another dose of Ativan. This interaction did not go as smoothly. Unfortunately, due to Dave's anxiety around medication administration and IV insertion he tried to elope and became extremely combative. He was restrained by six security guards, while flailing his head hit the wall, he was given IM medication to help calm and sedate him, and he was placed in four point restraints. Dave was scared. He did not understand. He was fighting for his life, even though the staff was just trying to help. It was upsetting for not only the patient but also for staff, and called for preparation to prevent this from happening again.
As we arranged for Dave's discharge it became more and more clear that he would need to be admitted to Spring Harbor. We organized as a unit in collaboration with psychiatry and security to determine how we could make the transfer as smooth as possible for the patient, as well as the staff. I could not have predicted how it would go, but can say that had Katie not been there with the patient that evening the discharge would not have gone well. Katie had spent much time with Dave. She often covered the sitter's breaks and sat chatting with Dave while he ate his lunch. She joked with him, laughed with him, engaged him and brought him out his shell. It was obvious; he felt comfortable with her and trusted her.
An ambulance was scheduled for 6:15 pm to take Dave to Spring Harbor Hospital. Katie was the charge nurse that day. Because of her close and trusting relationship with Dave, and her successful interaction earlier in the week placing his IV and administering his Ativan, it was decided that she would sit with him and administer the Haldol for his transfer. Katie entered Dave's room around 5:30 pm in hopes to administer the Ativan and give him time to settle down prior to the ambulance arriving. Security arrived as a precaution to prevent what had happened earlier in the week. Katie shut the patient's door so that he would feel safe and would not see security. She explained that he needed to get some more medication and that he was going to go to another hospital. She worked tirelessly with the patient as his anxiety began to rise. She calmed him, they called his dad, and she spoke to his dad and waited behind the closed door as the patient talked to his dad for reassurance. Katie also spoke with Dave's father and helped him decide that he should come in to be with the patient. She communicated thoroughly but briefly with security as the situation progressed. Her commitment was ultimately to the patient. She stayed with Dave at all times, he was afraid; he didn't want her to leave. This helped maintain Dave's safety, kept him in his room, and maintained the safety of all others on the unit. The process was long, but quiet, collected and smooth.
When the patient's father arrived Katie explained the situation in great detail and together they worked to get him to take the medication. They explained to Dave that he could let Katie give him the medication quietly just the three of them, or that security would have to become involved. By 6:40 the medication had still yet to be given, but Katie continued to work tirelessly, talking and finally convincing the patient to take the medication. Katie's shift was supposed to end as 6:30, but she continued to stay.
She strongly advocated to keep security out of the situation as long as possible, but knew that they may be needed at some point. She did not want to breech the patient's trust after all this time. Katie stayed with the patient and his father even after the medication was administered. They now needed to convince the patient to get onto a stretcher and go to a place he did not want to go to. There was some concern that the patient would attempt to elope when he left the room. With the help of his father, Katie was able to assist the patient quietly to the ambulance stretcher. The patient was uneventfully belted onto the stretcher, and by order placed in restraints for his safety and the safety of the ambulance crew. Just before 8 pm, the patient waved to staff as he was rolled by the nurse's station. He seemed medicated, but content, safe and happy. I believe strongly that because of Katie's unrelenting commitment to his care, a positive discharge experience was the outcome. Even after the patient was gone Katie looked up Spring Harbor's address for Dave's father and spent a few more moments talking with him. He thanked her over and over for her care during this difficult situation. Katie definitely left a lasting impression on this family in a very trying time.
I am honored to nominate Katie for a DAISY Award after watching her so compassionately and caringly take care of this vulnerable patient and his family. Without her they truly would not have had the same experience at MMC. We are privileged to work with such a great nurse.