5 West admitted an individual to our unit with a complex brain injury. Initially, this patient was combative with incomprehensible words, maintaining a fetal position. During this agitation phase, our goal was to prevent or minimize patient harm. Initially, restraints were utilized however, this was limiting his movement and activity progression. We implemented the enclosure bed to provide a safe environment. Throughout his course of care on 5 West, the patient's behavior ranged from a no eye contact, vegetative state, to throwing food at the nurse's station, crying inconsolably, and later having the capacity to have a rational conversation with his 5 West family.
Given his diagnosis, there was a poor prognosis for improvement. Ancillary support was minimized due to a lack of progression and inability to contact his limited support system. His only support system consisted of a Good Samaritan who had provided him a home and treated him like family, however, he was unable to visit during his entire hospitalization.
5 West staff members knew there was potential for improvement. Staff were adamant that his care consisted of an activity schedule, along with consistency in care. All members of the 5 West team were able to enhance his mobility by transferring to a chair, progressing from a few steps initially, to ambulating without assistance in his later weeks of care on our unit. Staff members found a chair that enhanced the patient's independence with mobilization around the unit. The patient's schedule consisted of being placed at the nurse's station for meals which included internet access to provide an opportunity for the patient to listen to his favorite music, movies, or fishing programs. Staff encouraged him without giving him an option, they were all on the same page. To ensure he was safe as he was a high fall risk, they would sit him in his favorite transport chair.
This truly was a team effort with involvement from every member of 5 West staff. No aspect of care was forgotten when it came to moving this patient forward. From calming music at the nurse's station, mobilization from numerous different team members throughout the day, to providing eyeglasses when the patient expressed difficulty with vision. Staff went as far as requesting an Ophthalmology consult from the primary team which ultimately led to surgical intervention optimizing the patient's vision and ability to perform ADLs on his own.
5 West demonstrated incredible teamwork, camaraderie while maintaining a primary focus on the end goal for this patient, who by the end of his hospital course became a member of the 5 West family. Throughout his hospital stay, staff members were faced with trying times both physically and emotionally but with persistence, perseverance, compassion, focus, and teamwork, staff transformed this patient from a vegetative state into an individual that could communicate and mobilize independently. The efforts taken by each staff member lead to a safe discharge after 94 days of hospitalization and most importantly a higher quality of life for this individual.
Two RNs were instrumental in the disposition plan of care for this patient. Given the complexity of this patient and the amount of time and energy required to move his care forward, Esther Samraj, RN 5 West, and Karan Gwynn, RN Case Manager were key in orchestrating a discharge plan. Initially, there were no options for discharge other than obtaining a legal guardian through the court systems, a lengthy and costly process. Their due diligence and vision led to a successful disposition to the patient's prior living arrangements. Esther was key in establishing a communication link with the Good Samaritan who had previously provided shelter for this patient. Her frequent communication provided a foundation and instilled confidence in this good Samaritan's willingness to allow the patient to return to his home after discharge. Esther remained focused on the patient, maintaining his abilities to remain as independent as possible. As the day of discharge approached, Karan ensured that all components were in place (transportation, home health visit, follow up appointment, medications, durable medical equipment). Karan continued follow-up after discharge to ensure a smooth transition post-discharge and that all necessary components were successfully implemented.