Claudia McMahon
August 2019
Claudia
Mcmahon
,
BSN, RN
Cardiovascular Intermediate Care
Oregon Health & Science University
Portland
,
OR
United States

 

 

 

With telemetry short-staffed, Claudia was left to staff the front desk for most of the day on her own in addition to her normal charge nurse duties. I watched her put out fires all day with a smile, as she always does. What impressed me most, though, was her way of handling a situation involving a long-term patient whose family desperately wanted to take them home AMA. The patient was delirious, a fall risk, and not ready for discharge. Over the course of the day, the patient's family grew increasingly frustrated with the duration of the hospital stay and desperate to get their ailing father home, regardless of his condition. Nearing shift change, frustrations turned to anger, and the family began pressing staff for discharge orders. They were convinced the best option would be taking the patient home to reorient and came to the RN station to announce their departure AMA. At this point, Claudia asked the head of the household what his long-term plan was for his ailing father, and it became clear there was no plan other than leaving the hospital ASAP. This is when I have seen many RNs page providers to deescalate, but not Claudia. She saw the opportunity to make a connection with the patient's family by sharing a personal experience mirroring the current situation. This broke the ice and softened the tone, but Claudia went above and beyond in making sure the patient and receiving RN staff were well equipped should tensions rise again during the night (the patient had been sleeping all day). Claudia conducted a thorough interview with the family regarding redirection strategies that have been successful while at home. She asked about lifestyle, preferences, hobbies, politics, fears, and language, going as far as requesting the family write down their suggestions in Bengali to be sure the patient (English speaking, but delirious) would understand. After learning that the patient was an active part of weekly grocery trips, Claudia and the family then constructed a mock grocery list in Bengali and presented it to the receiving p.m. shift RN, should they exhaust more conventional redirection. Thank you, Claudia, for your compassion.