Vicki was a true advocate for this patient who was having trouble speaking for themselves. Vicki was caring for a patient who had been admitted with a UTI. The patient has made it known to the family they are refusing care and interventions at this time including food/water. The decision between hospice and feeding tube placement was happening over the patient's objections, likely requiring restraints. The patient has a court-appointed guardian. The state appointment guardian wants NG placed even though the patient has adamantly refused.

Vicki enlisted the help of the Ethics team to aid in ensuring this patient’s voice was heard. Advocate Health’s Senior Clinical Ethicist responded with the following, “National ethical standards for guardians require that the guardian involve the patient/ward to the greatest extent possible in all decision making and that they select the option that places the least restrictions on the person's freedom and rights.” The primary physician was called and Vicki was able to participate in a call between the physician and the guardian. The physician strongly urged the guardian to consider comfort care and not starting feedings via feeding tube, to talk with hospice, he discussed code status again and he was very thorough. He also recommended that the guardian should come to the bedside tomorrow and meet with palliative again and have a hospice consultation.

He was very clear in the patient's refusal to take in food and liquids, refusal of care, and NG tube feedings. He was clear that he did not want to go against the patient's wishes. He recommended that the guardian also discuss this conversation with their siblings. The patient was discharged with hospice. Vicki not only advocated for the patient’s wishes she enlisted the right help, followed through, and participated in necessary conversations. Vicki is truly deserving of this award that recognizes nurses going above and beyond. She really saw through the eyes of the patient and acted on it.