In the photo Row 1 (l-r): Dr. Deborah LaFond, Monica Chen, Wendy Morales, Lenore Hall, Hajr Muhammad, Kathleen Messman, Dr. Deneen Heath, Dr. Niti Dham. In the photo Row 2 (l-r): Judy Ross, Laura Norris, Heather Langlois, Erika Apaza, Kathryn Conway, Kelly Forbes (HKU Manager), Lisa Williams (Heart Institute Inpatient Director), Kelly Venderwende, Lily Kawar, Kara Klem, Dr. Jessica Colyer, Emily Saracco, Nora Hammond, Jan Robison, Ryan Maddock.
As the Nurse Practitioner on the PANDA Palliative Care Team, I recently had the opportunity to partner with the nurses on the HKU in caring for a cardiology patient facing end of life. The HKU does a fabulous job of caring for patients with a variety of cardiac conditions with wonderful outcomes, however, they rarely have occasion to participate in End of Life (EOL) care.
Caring for a child at end of life is clinically, emotionally and morally challenging. In this particular case, this patient came from another institution for evaluation for heart transplant and was unfortunately found not to be a candidate. The family decided to remain at Children’s National for care, in large part due to the compassionate and skilled care of the HKU nursing staff. However, I believe what makes the HKU nurses deserving of the DAISY Award is the extraordinary EOL care these nurses provided for this patient and her family.
Nurses volunteered to be consistent and primary nurses for this patient. There were extraordinary family dynamics, and an adolescent patient who was frightened at facing the end of her life. Nurses quickly rallied to find activities that optimized her quality of life. They actively advocated for involvement of palliative care to promote comfort. Their quiet presence at the bedside provided comfort without needing to always be task oriented. They sat at the bedside, actively listening to the patient and her mother. Often no words were needed from the nurse, their presence was enough. They gave of their time to come in early to help their nursing colleagues in providing this emotionally taxing EOL care. These nurses prioritized the patient’s comfort and were strong advocates to optimize pain management. They did not take “we can’t do that” as an acceptable answer! They kept advocating until adequate comfort was obtained. This was particularly poignant in the actively dying phase of care, as the mother became conflicted about overly sedating the patient versus maximizing comfort.
These HKU nurses stood firm in educating the family about pain management at EOL and partnering with the palliative care team to develop an integrated plan of care. At the end of this child’s life, the HKU nurses united in providing support to one another and partnering in patient care. Rarely have I witnessed such a seamless and thorough hand off between nurses. Communication was exemplary and should be role modeled for all Children’s National nurses! Finally, it is the little things that make a huge difference for patients and families. The HKU nurses consistently provided those little things that made every day count and the best day it could possibly be for the patient and her mother.
The HKU Team deserves the DAISY Award because they embody what nursing is all about: compassion, care and competence! Well done! It should also be said that these HKU staff were part of an amazing interdisciplinary team caring for this patient and her family. This case truly exemplifies the collaboration of Nursing, Medicine, Pastoral Care, Palliative Care, Child Life and Social Work to provide the highest quality of care in the most difficult of circumstances. Collaboration, cooperation, and coordination helped this family have a better end of life experience. Thank you for your compassion and your expert care. We cannot do this alone.
The following team members were honored with this TEAM Award:
Erika Apaza, BSN, RN
Monica Chen, BSN, RN, CPN
Kathryn Conway, BSN, RN
Lauren Dorozynski, BSN, RN
Lenore Hall, BSN, RN
Sarah Hamilton, BSN, RN, CPN
Nora Hammond, BSN, RN
Lilly Kawar, BSN, RN
Kara Klem, BSN, RN
Deborah Lafond, DNP, PPCNP-BC, CPHON, CHPPN
Kathleen Messman, BSN, RN
Wendy Morales, BSN, RN
Hajr Muhammad, BSN, RN
Laura Norris, MS, PNP
Mark Pitcairn, BSN, RN, CPN
Jan Robison, RN, MSN, CCM
Emily Saracco, BSN, RN, CPN
Kelly Venderwende, BSN, RN
Bradley Clark, MD
Jessica Colyer, MD
Niti Dham, MD
Kathleen Ennis-Durstine, M. Div., BCC- Chaplain
Deneen Heath, MD
Heather Langlois, LICSW, C-SWHC, CCTSW- Social Work
Michael Lotke, MD
Ryan Maddock, LISCW
Rev. Eliezer Oliveeira, Ba.Th- Chaplain
Judy Ross, CCLS, CEIM - Child life
Janet Scheel, MD