In February, Heidi was assigned a very complicated patient with multiple medical and psychosocial issues. He also had a fairly new ileostomy that was challenging to pouch. Over the previous weekend, the patient's ostomy appliance had leaked multiple times and had to be changed.

On the morning of February 17, I changed the patient's appliance and all was well until I got a call from Heidi at about 1700 alerting me that the patient's appliance was once again leaking. I was about to go off service and so I asked Heidi if she was comfortable changing the appliance with the supplies I provided. Without hesitation, she said, "no problem." I told Heidi that the patient was actually capable at this point to change it himself.

When I returned the next morning, I asked Heidi how the appliance change went. Heidi reported to me that the patient became upset and was crying hysterically when she told him that she was going to watch him change it himself. She said "it was bad". I am sure it was having witnessed one of his tantrums before. Heidi said that she calmed him down and told him that they were going to do it together without rushing. She said that they got through it and that the patient actually demonstrated that he could indeed perform most of the change independently and that he was very particular.

I am so impressed with Heidi for several reasons:

- She readily took on the task of changing this challenging pt's appliance w/o complaint.

- She handled his emotional outburst with grace, calmed him down and guided him through the changing process.

- She took the time despite her heavy load to help this patient who had many needs and could be demanding.

- She is always pleasant to deal with and very professional in her manner.

- I feel that I can collaborate with her in dealing with the patient's skin, wound and ostomy issues and this always provides better outcomes for patients and staff.