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During the December 2020 Nurses’ Luncheon and Lecture, McLean’s Professional Nursing Advancement Program honored eight recipients of its tiered professional nursing categories. Six recipients received Tier 1, and two recipients received Tier 3.
As part of the application process for Tier 1, the recipients provided a clinical exemplar essay to showcase their proficiency in assessing patient needs, planning, and implementing nursing interventions while utilizing therapeutic communications techniques. Tier 3 recipients’ exemplars depicted advanced practice and positive influence on patient outcomes.
It is clear from these exemplars that McLean’s nurses are establishing a therapeutic relationship with their patients. This ensures that in all situations, including crisis situations, the patients at McLean feel safe and secure and trust their care providers. Our nursing staff is listening to the whole patient, taking in all the patient’s symptoms in order to address both medical and psychological issues and to have a positive influence on patient outcomes.
Here are excerpts from the December honorees’ essays.
Sometime last year, we had a patient in her 50s who has a history of bipolar disorder and IBS.
She was having a hard time eating and needed to be fed. Feeding was also challenging because we needed to find the right food to avoid diarrhea. We made sure that she was hydrated, and we were also constantly applying lip balm on her lips to avoid dryness.
She started doing ECT, and she looked better and better after each treatment. She looked great when she left us. Her family was grateful for the care she received from us. She was supposed to go on vacation with her boyfriend in Italy. Her boyfriend told us that he was planning to propose. We found out months after she was discharged that they got engaged.
In my career, I have always operated under the belief that each ailment that a patient reports deserves attention. I do not believe that it is appropriate to ignore a patient’s symptoms simply because they have a history of reporting symptoms, sometimes many symptoms, that lead to no quantifiable diagnosis. It is important to believe our patients and always take their concerns seriously. And it’s also important to look at the entire picture and put together pieces of a puzzle because sometimes the completed puzzle can save a person’s life.
A patient on initial approach and assessment presented with a blunt/flat affect, guarded on approach, and difficult to engage. The patient did not want to be present on an inpatient psych unit and felt as though there was no reason for admission. It took some time to gain a rapport with him. After time and consistent presence, the patient became increasingly receptive to care. We discussed his interests, which fueled his motivation and curiosity in the future.
We gave him the opportunity to feel more comfortable/understood among his peers and create a community where he was no longer feeling hopeless/helpless to establish. This piece may seem simple, but approach to care is everything in nursing.
Recently, I had the opportunity to precept a nursing student. During her first week, she had a rather unpleasant encounter with a patient with borderline personality disorder (BPD). She later asked me about my experience in interacting with such patients, and to illustrate, I recounted an instance where I had a difficult time working with a former patient with a BPD diagnosis.
I was admittedly ashamed that this patient was able to elicit these negative reactions, which reflected the desperation and hopelessness I felt. I decided the best way for me to feel in control was to respond, not react, in an appropriate and professional manner. I went about doing so by creating a rough draft of a behavioral plan for this patient. It was at this time that I became aware of the fact that if I did not set my own boundaries, both in the work setting and in my personal life, others would set them for me.
One night shift, I was the charge nurse and working with two new staff, a float mental health specialist (MHS), and only one experienced MHS. The shift started, and the patient was awake but resting. I assessed her needs, first from her ulcerative colitis, which could lead to electrolyte imbalances. She was unsteady on her feet, which classified her as a fall risk. She was visibly anxious, but mute, so she couldn't verbalize her anxiety or pain. At about 0300, the patient had an unplanned, witnessed fall.
I used a non-verbal pain scale to determine she was having pain. I quickly got a set of vital signs, which indicated the patient was in pain. After the fall, I immediately paged the medical doctor on call. When he called, he felt like he did not need to assess the patient. I advocated for the patient and forcefully but professionally told him he needed to assess the patient. When he continued to decline, I notified the nursing supervisor and implemented my own q30min vitals and q15min neuro checks, which the patient allowed me to do.
As frightening as that night was for me, I realized how much I had learned. I was able to rise to the occasion when presented with this difficulty. This situation made me feel like a real nurse due to the critical thinking I needed to make decisions on the fly and thinking about the care of the whole patient, medical and psychological.