April 2015
RNs and more
Medical ICU
Los Angeles
United States




My name is Kathleen Dean RN. I am night lead charge nurse in the MICU of Ronald Reagan Medical Center. We are a 24 bed unit divided into 2 teams. Our patient population consists of those who have multisystem diseases which require our staff to plan and care for a wide variety of biopsychosocial needs of individuals. My nominees are a team of west side nurses that developed and provided extraordinary care for a 27 yr. old. Cystic Fibrosis patient from her admission in March 2014 to her death in January 2015.This very special group of nurses came to my attention on night in March 2014. I was making my patient care rounds. What I saw was a nurse in the room plaiting the patient's hair; such a simple action but so meaningful to the patient but most importantly the nurse at the bedside was not her assigned nurse. Over the next months, I was privileged to witness the specific planning and delivering of specialized actions by these nominees who I call "Team Kalynn." This team of nurses was supported by Mark Flitcraft the MICU unit director. Mark supported staffing rations which promoted this very unique staff-patient relationship.
Patients are frequently dehumanized within an ICU environment. Preferred routines, habits and customs become secondary to the demands of critical care. Where did my daughter, sister, or friend go? "Team Kalynn" provided a nurturing environment which incorporated the strict standards for remaining on the lung transplant list. Erikson's theory of Intimacy vs Isolation was used in the planning of care for this twenty something patient. Her need to form relationships with other people was identified. Plans were developed and shared in an exquisite communication style with all staff members. Not every shift was able to be staffed to the core "Team Kalynn" nurses, however she received continuity of care by each assigned nurse.
A morning routine of personal care followed by a prescribed lung transplant conditioning regime was planned and executed. An appropriate rest period followed by lunch. Afternoon excursions to the outdoors required 4 oxygen tanks and multiple modalities which often had to be adjusted for significant hypoxia and weakness. Dinner ordered from a community establishment encouraged the nutritional needs of pre transplantation. Bedtime grooming, favorite television shows shared, followed by ventilator management and uninterrupted sleep patterns. Just a few activities planned by Team Kalynn that promoted intimacy between patient and team.
"Team Kalynn" monitored the highs and lows of the patient's mood swings. Special outings were constructed. One specific outing was escorting the patient to a movie. One of her favorite book series had been made into a motion picture. The nursing team met with members of the ling transplant team and with monumental obstacles to overcome, managed to escort the patient to a nearby theater. Of course, members of "Team Kalynn" came in on their own time to assist with a smooth transition.
Twice a lung possibly for transplant arrived. Twice the organ was found to be inadequate. Severe disappointment was experienced by patient, family and staff. Hoe to pick up the pieces? "Team Kalynn" managed. Activities such mani-pedies, football parties and great encouragement to continue forward were provided. Finally, after 11 months of waiting the day of a compatible lung arrived. "Team Kalynn" members arrived with wishes of hope and love but instead meet with great sadness relayed to them mid surgery. The patient requiring 36 units of blood experienced an anoxic episode.
The successes of "Team Kalynn" following the 11 months of admission, lead to the development of caring teams. 4ICU now utilizes record documentation of a patient's date of admission, RN who led the team at the time of admission and the collection of nurses' names who provided care. This data is saved for those who are more likely to be readmitted. Continuity of care is provided by this available data base at time of re-admission.
Critical changes in patient's conditions are information that must be guarded for privacy. Staff that is not directly involved in patient care may not arbitrarily seek information. "Team Kalynn" along with the family found a resolution which is now suggested for use by other long-term or frequent readmission patients. "Care Pages" an on-line program for communication allows the families to document daily reflections of care. The family can share the password with whomever they choose. In this case, the patient's parents shared their heartbreak with MICU staff following the ordeal in the post-transplant experience.
The grief that was experienced by the entire MICU team was deep. Physicians, nurses, ancillary personnel and therapists were at a loss. The use of Hospital Chaplain lead sessions included choices of prayer, meditation, and comfort. The importance of resolution in times of grief was acknowledged by our Unit Director who assisted with staffing allowing "Team Kalynn" to attend the memorial. Team Kalynn members continue to maintain outside relationships with the family.
Many of "Team Kalynn" nurses are volunteers in the medical missions. They travel abroad with learned tools of caring and competency. A few plan to return to school so as to provide advanced practice care. This team reflects brilliance in the future of nursing.
A number of "Team Kalynn" nurses attended a seminar "The Voice of Pain." The team was acknowledged for their actions which led to diminish patient pain responses. As a pulmonary patient, minimal sedation was required. These nurses utilized so many tools that assisted pain response and control. All of these methods were shared with other care providers. There are many nurses that participated in the care of this most amazing patient.