James
Paugh
July 2015
James
Paugh
,
RN
Supplemental Staffing Team
Tampa General Hospital
Tampa
,
FL
United States
...James is a SST float RN who supplemented our staffing in the Adult ICU Stepdown on June 30th. He was assigned to a direct admit patient coming in for a PEG tube placement. The patient is a 61 y/o female with the unfortunate diagnosis of ALS. According to her husband and son, she has lost 9 pounds in the last 2 months and about 36 pounds since her diagnosis. The family had driven two hours to get here and she was prepared to have the procedure.
Upon arrival to the hospital, (actually, per the family, on the ride to the hospital) the patient started to write on her write board that she did not want to get the feeding tube. She was admitted to her room and immediately wrote "no feeding tube". The patient was nonverbal and used her writing board to communicate. Jim was kind and patient with her and did not pressure her. He called the physician who also spoke with her. She was still refusing. Jim again did not pressure her, just was her advocate. I, as a nurse manager, was made aware. I spoke with the patient and the family. She again wrote "no feeding tube". I asked her for her number one reason she did not want the procedure and she wrote "scared". I then proceeded to have a conversation with Jim her nurse.
Jim had listened, explained and comforted her with her decision making process since she was admitted. He decided to see if he could alleviate or minimize her fear by telling her that he had worked in the department previously. He explained that they were experts on this procedure. (of course she had been told that by me and the doctor, too). However, when she heard that Jim had worked there, her body language changed and her interest was peaked. Jim immediately asked her "If I come with you and stay with you through the procedure would you be willing to get the PEG tube?". She thought about it for a few minutes and agreed by writing "I would".
Arrangements were made by our charge RN to cover his other patients so he could accompany the patient and stay with her while they place the PEG tube. Jim was kind and compassionate, and more importantly an advocate for the patient. The husband had tears in his eyes as he thanked Jim and me. He was relieved because he was trying to so hard to provide her with the best nutrition and was not being successful and felt like he was letting her down. The patient successfully had the PEG tube placed with Jim by her side.
Upon arrival to the hospital, (actually, per the family, on the ride to the hospital) the patient started to write on her write board that she did not want to get the feeding tube. She was admitted to her room and immediately wrote "no feeding tube". The patient was nonverbal and used her writing board to communicate. Jim was kind and patient with her and did not pressure her. He called the physician who also spoke with her. She was still refusing. Jim again did not pressure her, just was her advocate. I, as a nurse manager, was made aware. I spoke with the patient and the family. She again wrote "no feeding tube". I asked her for her number one reason she did not want the procedure and she wrote "scared". I then proceeded to have a conversation with Jim her nurse.
Jim had listened, explained and comforted her with her decision making process since she was admitted. He decided to see if he could alleviate or minimize her fear by telling her that he had worked in the department previously. He explained that they were experts on this procedure. (of course she had been told that by me and the doctor, too). However, when she heard that Jim had worked there, her body language changed and her interest was peaked. Jim immediately asked her "If I come with you and stay with you through the procedure would you be willing to get the PEG tube?". She thought about it for a few minutes and agreed by writing "I would".
Arrangements were made by our charge RN to cover his other patients so he could accompany the patient and stay with her while they place the PEG tube. Jim was kind and compassionate, and more importantly an advocate for the patient. The husband had tears in his eyes as he thanked Jim and me. He was relieved because he was trying to so hard to provide her with the best nutrition and was not being successful and felt like he was letting her down. The patient successfully had the PEG tube placed with Jim by her side.