When I think of compassionate care in nursing I think of Kathy Tonucci. She has the ability to transcend a patient's dire circumstance and perform interventions to alleviate their suffering or improve their quality of life. In my years working with her I have seen her be the conductor in patient's care - where we work we must wear many hats - care coordinator, social worker, and advocate. Time and time again she goes above and beyond. Whether it be paying for a taxi for a patient who did not have the funds (and was planning on walking home after an intensive all day treatment), or calling to check up to see if a new medication was helping a patient, or calling in VNS when appropriate to get the patient more support services. She is an excellent communicator, both in voice and listening. Her assessment skills are superb, she uses them to assist in making recommendations to providers or to the other members of the care team. She is firm at times with patients to help them see when they may need more help or not adherent to the plan of care. She is someone that I defer to time and time again with complicated patient issues or to ask what intervention might be most appropriate. Her distinct laugh lights people up and puts them at ease.
Kathy takes the time to make patients and their family feel comfortable to have an open and solid nurse/patient relationship. She takes extra time with them if there is something they feel is pressing, deferring her charting at times so she can hear a patient's story.
About a year ago, a patient came in emergently with stage IV breast cancer, her right arm was swollen 5 times its normal size. There was a fungating wound from the cancer on her right breast. The oncologist needed a lot of assistance, the patient was uninsured, she had noticed a breast change over 6 months before but had not gone anywhere for help. Her partner was finally able to convince her to go to a walk-in clinic. The patient had a very hard exterior, a blunt affect and was very disconnected from her predicament. Kathy booked her for a teaching appointment the following day. She spent over 2 hours with the patient and her partner explaining the diagnosis, treatment, etc. The patient continued to have a rough exterior and walked with her head down. Kathy though was able to draw her out over time. Kathy has the ability to make patients feel like they are the only patient in the infusion area (even if it is crowded and noisy). She focuses on that patient and their family and the outside world disappears and it is people having a conversation. The patient's tumor shrank remarkably after initial treatment. Kathy had also arranged lymphedema treatments nearby. The patient and her partner began to trust our clinic. Kathy continues to care for this patient, the patient has been switched twice now to different chemo agents due to progression, but she is experiencing a good quality of life and Kathy has worked hard to manage side effect from the chemo agents. The patient now walks in and greets everyone she meets. Kathy has the ability to reach inside patients' life and bring them out of their shells. She also helps to put things in perspective, she can find the silver lining for patient. She gives her patients "credit" warmly encouraging them when they make positive health changes or gently guiding them to help make better choices. She makes people feel comfortable all the while she is assessing how she can best intervene. In the case of this patient with breast cancer, it was to allow her feel more human and let her tell her story that led her to us. It is to facilitate open communication between us and the patient.
Recently Kathy took care of a young man with recurrent metastatic colon cancer, only 32 years old. Kathy had been one of his nurses when he was first diagnosed a few years before hand. He presented this time with headache; the cancer had come back and invaded his brain. The patient was high school educated. He worked under the table as a bartender and part time as a welder. His parents had moved to Florida. He lived with his girlfriend in a small house about an hour from the clinic. Kathy was his touchstone throughout treatment. His oncologist of several years had retired 6 months into his treatment and he began seeing one of the newer physicians in our clinic. Kathy acted as the bridge and sounding board for the patient to help coordinate his care. As the patient had an allergic reaction to one of the chemo agents he was switched to a new regimen. Kathy supported and educated him throughout regarding side effect management. The patient kept progressing despite changes to the chemo regimens. The patient's quality of life was becoming intolerable for him. After a hospitalization for new seizures the patient no longer wanted active treatment for his cancer. When he was transitioned to hospice Kathy was the one nurse he would call back and express his needs to. The patient lost his ability to see, spinal cord compression caused him to lose the ability to walk and urinate normally (Kathy was already anticipating his needs- ordering a wheel chair for home, a hospital bed, or a foley catheter) to allow him to have his wishes fulfilled to stay at home as long as possible. When the time came for the patient to be admitted to inpatient hospice because his girlfriend could not provide the 24 hour care he needed, Kathy had several phone discussions with him reasoning about his safety and quality of life. Kathy's non-judgmental attitude and ability to hear what the patient tells her allows her to advocate for the patient even in the most stressful of times. The patient died with dignity, she advocated on his behalf trying to find the middle road between safety/interventions and the patient's perception of quality of life for him. She individualized his plan of care to meet his needs best.
Kathy Tonucci is truly a role model for compassionate nursing care. She possesses an intuitive sense for the most appropriate approach to each patient which quickly establishes a trusting nurse-clinician relationship. Countless times the oncologists in our clinic will bring a newly diagnosed patient and their support system to Kathy for introductions and scheduling of the initial teaching visit/RN assessment. It is remarkable to witness this interaction because though faced with a life changing event, the majority of patients leave having shared a smile or even a laugh with Kathy. And yet, if they are in a place where they are unable to smile, Kathy has already astutely made this assessment and proceeds in a calm and quiet manner most conducive to their needs. If tears are shed, Kathy is quick to share a hug or guide the patient to a more private area to talk. She has the unique gift of balancing patient care with humor and the gravity of the situation.
Kathy honestly makes a significant difference in the life of every individual she encounters: patients, family and staff alike. She has the innate ability to make every single person feel special and the center of her attention. She always asks patients about their family members including beloved pets! She remembers and inquires about special life events like vacations, birthdays, graduations, and weddings which truly personalizes her delivery of compassionate nursing care.
Kathy made a huge impression with me as I witnessed her nursing care of a 53-year-old woman diagnosed with breast cancer. This patient had been diagnosed in 2011 and in 2014 experienced disease progression warranting a variety of different treatments. Kathy was a rock for this patient and expertly guided her through multiple new treatments and the roller coaster journey of short-lived responses. When all options had been exhausted, Kathy was there to ensure that the support services for the transition to hospice care were in place. Her compassionate nursing care was extended to this patient's elderly father who many times provided transportation to the office as well as the patient's young adult daughter. Kathy frequently receives thank you cards and visits from patients and family members expressing gratitude for her efforts and kindness. Kathy participates in the program services committee and provides invaluable input to advocate for our patients, helping to ensure that all their physical, emotional and spiritual needs are met within the community. Services are funded by the Center for Cancer Care Fund and include cancer support groups; reiki; hypnosis; massage therapy; nutrition; and education. This is just another example of her holistic nursing approach and dedication to patient care.