I took report from Jake and his orientee on a patient in our Medical ICU that I'd had the day before. At that time, she was sick but stable, on 2 pressors and continuous dialysis but only on nasal cannula oxygen and able to communicate with me. Today, when Jake and his orientee cared for the patient, she'd gone sharply downhill, requiring intubation and significantly increased vasopressors. It was clear to the medical team that the patient was declining and Jake and his orientee took part in a goals of care discussion that broke the news to the family. They decided to progress to comfort care but were some hours away, so the patient was made a DNAR-B.
Thus far, Jake's actions were fairly typical for a MICU nurse. What really impressed me was what he did after this goals of care conversation. The patient's son is currently serving in the Navy, stationed in South Carolina. Jake took the initiative of calling the Red Cross to receive special dispensation for the patient's son to be released for an end of life visit. We do not know if he will be able to make it to UVA in time, but he should at least have the opportunity, thanks to Jake.
Jake also spoke extensively with the family and with the patient experience office to ensure fair and safe visitation for other family members while still adhering to our COVID-19 visitation guidelines. He found a recliner chair for one family member to stay at the patient's bedside and offered a list of nearby hotels for another to stay in the area. Currently, family members aren't allowed at the bedside unless the patient is officially a DNAR-C. Jake explained the situation to the patient experience office and worked to enable clear visitation parameters for all concerned. He went above and beyond for this patient and family in the midst of this pandemic, and I am proud to work with him.