Katie Hall, RN

The Emergency Department currently has a long-stay social hold patient who has been in the ED for 320 hours. This patient was brought to the ED by EMS after her family removed her from a living community. The patient arrived at the ED cussing out the team, headbutting the team, and quickly ended up in restraints.

For days, the patient kept up this behavior, refused all medications, frequently refused to eat, and refused to talk. The patient has significant delays and also has had no family visit her while in the hospital. She has been in the same room, with no windows and no entertainment for all of these days as well due to her violent outbursts. She has required a 1:1 sitter.

I know you probably are wondering about how this is a DAISY nomination, so here are the miracles that Katie and Andrian worked for this patient.

One particular day, over 250+ hours into the ED visit, Katie was the primary nurse for this patient. The morning started with Katie attempting to help the patient cover herself as she was exposing herself to everyone in the hallway. She was met in return with being cussed out and the patient throwing her blanket on the floor. Katie later took the patient's meal tray into her room and offered to take the patient on a walk around the department, to which she again was met with being cussed out.

Katie did not give up. In the last hour of her shift, when most RNs are trying to catch up on their orders and notes to set up the next shift, Katie offered the patient one more opportunity to get a change of scenery and walk around the department. The patient replied "Well I can't walk". Katie said, "That's no problem. Can I push you in a wheelchair instead?" The patient finally agreed.

Katie took this plan one step further and grabbed a shampoo cap and comb to take with her. The patient got in the wheelchair, and they wheeled around the ED and said hey to everyone, visited the doctors, and enjoyed the trip. Katie asked if she could take it even further and take the patient outside. The patient agreed.

While they were sitting in our ambulance bay, Katie got permission to use a shampoo cap to shampoo the patient's hair. She then stayed outside until she had combed all the patient's knots out of her hair. This is the first time that this patient agreed to anything more than a wipe down.

The patient opened up to Katie and voiced her frustrations. Katie explained the plan, how hard care coordination was working to find her a home, and that if she could help us by taking her medications and eating meals, it would probably speed things up. The patient then thanked Katie for taking her outside and asked if she could do that again another day because it really made everything a little bit better. Katie then took the patient back to her room, and the patient began eating her dinner tray.

The night following Katie's shift. The patient went back to refusing all medications, urinating on herself, and cussing out the team.

The following day, Andrian was her nurse. Andrian worked with the patient to get her bed cleaned up, and the patient dried off after urinating in the bed. The patient seemed uncomfortable with some of the care, so Andrian stopped and sat in the room for a long time with the patient to explain who she was, what she wanted to help with, promise the patient that she in no way wanted to hurt her, and then asked for permission to continue with the clean up. The patient agreed.

Andrian further worked with the patient to build a bond that led to another huge step forward in the patient's progress. She told the patient about the Pediatric ED having a shower and asked if the patient would like to have a real shower. The first one in over 300 hours. The patient agreed.

Andrian assembled a team, took the patient to the shower, and the patient had a full shower and room change. Andrian then used her own money to buy the patient a Chick-Fil-A meal. The patient ate her entire meal, took all of her medications, and thanked Andrian and the team for their help. The patient continued to progress during the day by taking multiple trips around the department, walking hand-in-hand with the team. Care like what Andrian and Katie provided is selfless, generous, heartfelt, and kind.

It is care that practices putting your ego to the side and putting someone else first every time. They transformed the most difficult patient in our department, who was verbally assaulting everyone, into a patient who willingly shared information, bathed, ate full meals, and complied during medication passes.

Giving care to people who do not want it and refuse it is one of the most difficult challenges in healthcare. Andrian and Katie met that challenge with grace, respect, patience, and a little creativity.

I am proud to work beside nurses who open up their hearts like this and hope they inspire others to do the same.

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This is Katie's 2nd DAISY Award!