A patient with dysphagia and a hiatal hernia requiring gastropexy surgery was found to have severe aspiration on all food consistencies postoperatively for a couple of weeks. This situation eventually resulted in the patient receiving a PEG tube to meet the patient’s nutritional needs. Once his tube feedings were established and tolerated and the patient was being prepared for discharge, the patient and his family were opposed to the patient coming home due to anxiety about assisting with the tube feedings, etc. The patient was competent yet seemed irritated with his care team regarding his discharge. Finally, his nurse took the time to inquire as to what was most concerning to the patient. The patient confided in his nurse and said he never really wanted the PEG tube and felt that if he could not taste and enjoy food again, that was a life he did not want to live.

The patient was not able to share this with his wife and wanted his care team to inform her of his wishes. The astute nurse shared her concerns that her patient’s values did not match those of the care team. Charity took the time necessary to learn what was most important to the patient, valuing his voice! She shared her concerns with the attending physician who consulted with the Palliative Medicine team. The PM doctor then had a meeting with the patient and his family where his wishes were explored. The wife was given permission to allow her spouse to choose to eat foods he enjoyed despite understanding the potential risks of aspiration, pneumonia, and death as it was his rightful decision. The couple ultimately opted for a discharge home with hospice care and suction equipment was ordered for home delivery.

The patient was relieved to have garnered the support of his wife and family in proceeding with his desired plan of care. The extra time expended by this nurse made all the difference in this situation. Wellstar’s values include honoring every voice…most especially, the voice of the patient. This nurse did exactly that and escalated her concerns that her patient’s plan of care did not match the values of the patient. This nurse was also instrumental in helping the family to appreciate and understand what the patient truly wanted. Serving as a patient and family advocate is a hallmark of a competent professional nurse! Kudos to Charity Hill for her compassionate care.

Note: This is Charity's 2nd DAISY Award!