Kierra Dye
November 2021
Kierra
Dye
,
RN
8th Floor Neuro Trauma
The Ohio State University Wexner Medical Center, Brain and Spine Hospital
Columbus
,
OH
United States
Kierra's observations motivated her to ensure the patient received the type of care needed for meaningful improvement while he was awaiting discharge.
Kierra Dye, staff nurse on 8 Brain and Spine cared for a patient who was transferred to her unit. The patient presented to the ED after a traumatic fall on concrete stairs while at work resulting in a significant head injury. The patient was in SICU for a month before he was stable enough to be transferred. When he arrived on the unit he was still in need of a significant amount of care: he had a trach requiring Bi-PaP at night and inline suctioning due to copious secretions, PEG tube, rectal tube for uncontrolled diarrhea, complex wound care, C collar for his unstable C6 fracture, a helmet to protect his skull bone flap when transferring or out of bed, cooling blanket with rectal temp probe for persistent fevers and a Heparin drip due to bilateral DVTs. After arriving on the unit, the patient developed a retroperitoneal bleed requiring blood transfusions, and an IVC filter was placed to prevent his DVTs from developing into pulmonary emboli since it was no longer safe to continue anticoagulation. He also had a biliary drain placed until he was able to have a cholecystectomy.
I share all this background because, despite the fact that the patient was no longer in ICU, he was by no means out of the woods and was presenting with minimal neurological functioning. The patient slowly began to make progress with his recovery. Initially, he did not track movement and was neglectful of his right side. He started to progress to crossing the midline of his visual field and his motor functioning was improving, his C collar was removed. Kierra noticed the patient’s subtle and slow change in his neurological functioning. She saw that his cognitive ability and gross and fine motor skills needed to complete complex tasks had returned. To further complicate the situation the patient could not be released from the hospital because his next of kin, his son was ambivalent about his responsibility and did not want to pursue guardianship of his father. This left the patient in limbo, he had no one to make decisions about his discharge plan.
Kierra recognized that the patient’s recovery was being hampered by the fact that he could not be transferred to a rehabilitation facility where he would receive a plan of care that included physical, occupational and speech therapy. She knew from prior experience that there would be a delay in discharging the patient since the patient needed a guardian. Kierra approached her manager to brainstorm about what could be done to provide rehabilitation on the floor. An Agiliti Stretchchair was ordered so the patient could get out of bed. She found that the patient was more alert in the chair but also more likely to investigate his medical devices instead of participating in her “makeshift therapies”. This motivated her to aggressively pursue the removal of as many unnecessary medical devices as possible through advocacy to his care team. She even took the patient herself to x-ray and CT in order to get him cleared to have his C-collar removed.
Kierra was armed with the knowledge from caring for other neuro patients that periods when stimulation was provided or deprived helped with neurorehabilitation. She put him near the window, played music, and moved him out into the hallway to watch the movement of staff. She also put him in front of a mirror so he could see himself and his own movements. She went to PT, OT, and Speech therapy for advice and interventions to try with the patient. Kierra talked to him whenever she cared for him, so he knew what was going on as well as to motivate him. She incorporated ways to engage the patient and make it fun for him. She had him use a squishy ball for gross motor function and silly string for fine motor skills. She used swabs dipped in Coke to improve swallowing. Whenever he reached a new milestone Kierra had him show her peers his newest accomplishment.
By the time this patient was discharged he was able to give high-fives, fist bumps, lift his left leg on command, provide his own nasal spray, brush his teeth, wash his face, lift his gown for his Lovenox injection, hand his PICC or PEG line to the nurse for medication and assist with turning by protecting his non-functional arm. The situation was certainly bleak when the patient arrived on Kierra’s unit. All patients receive exceptional care from the nursing staff on this unit. What is unique about this situation is an experienced, observant nurse noticed small changes in a patient that could have been easily missed. Her observations motivated her to ensure the patient received the type of care needed for meaningful improvement while he was awaiting discharge. She recognized he needed rehabilitation. It was not readily available. This did not deter her, she set out to develop a whole program for the patient resulting in a significant improvement from when he first presented with minimal neurological functioning. She not only implemented the plan herself but also cultivated buy-in from her peers in part by showcasing the patient’s undeniable progress.
Kierra made a choice to intervene in this patient’s life. She paid attention not just to the science of nursing but the art as well in caring for the whole person. She showed how thinking outside of the box and perseverance make a big difference. Working on the plan she developed helped the patient unlock his potential and regain function. This is priceless.
I share all this background because, despite the fact that the patient was no longer in ICU, he was by no means out of the woods and was presenting with minimal neurological functioning. The patient slowly began to make progress with his recovery. Initially, he did not track movement and was neglectful of his right side. He started to progress to crossing the midline of his visual field and his motor functioning was improving, his C collar was removed. Kierra noticed the patient’s subtle and slow change in his neurological functioning. She saw that his cognitive ability and gross and fine motor skills needed to complete complex tasks had returned. To further complicate the situation the patient could not be released from the hospital because his next of kin, his son was ambivalent about his responsibility and did not want to pursue guardianship of his father. This left the patient in limbo, he had no one to make decisions about his discharge plan.
Kierra recognized that the patient’s recovery was being hampered by the fact that he could not be transferred to a rehabilitation facility where he would receive a plan of care that included physical, occupational and speech therapy. She knew from prior experience that there would be a delay in discharging the patient since the patient needed a guardian. Kierra approached her manager to brainstorm about what could be done to provide rehabilitation on the floor. An Agiliti Stretchchair was ordered so the patient could get out of bed. She found that the patient was more alert in the chair but also more likely to investigate his medical devices instead of participating in her “makeshift therapies”. This motivated her to aggressively pursue the removal of as many unnecessary medical devices as possible through advocacy to his care team. She even took the patient herself to x-ray and CT in order to get him cleared to have his C-collar removed.
Kierra was armed with the knowledge from caring for other neuro patients that periods when stimulation was provided or deprived helped with neurorehabilitation. She put him near the window, played music, and moved him out into the hallway to watch the movement of staff. She also put him in front of a mirror so he could see himself and his own movements. She went to PT, OT, and Speech therapy for advice and interventions to try with the patient. Kierra talked to him whenever she cared for him, so he knew what was going on as well as to motivate him. She incorporated ways to engage the patient and make it fun for him. She had him use a squishy ball for gross motor function and silly string for fine motor skills. She used swabs dipped in Coke to improve swallowing. Whenever he reached a new milestone Kierra had him show her peers his newest accomplishment.
By the time this patient was discharged he was able to give high-fives, fist bumps, lift his left leg on command, provide his own nasal spray, brush his teeth, wash his face, lift his gown for his Lovenox injection, hand his PICC or PEG line to the nurse for medication and assist with turning by protecting his non-functional arm. The situation was certainly bleak when the patient arrived on Kierra’s unit. All patients receive exceptional care from the nursing staff on this unit. What is unique about this situation is an experienced, observant nurse noticed small changes in a patient that could have been easily missed. Her observations motivated her to ensure the patient received the type of care needed for meaningful improvement while he was awaiting discharge. She recognized he needed rehabilitation. It was not readily available. This did not deter her, she set out to develop a whole program for the patient resulting in a significant improvement from when he first presented with minimal neurological functioning. She not only implemented the plan herself but also cultivated buy-in from her peers in part by showcasing the patient’s undeniable progress.
Kierra made a choice to intervene in this patient’s life. She paid attention not just to the science of nursing but the art as well in caring for the whole person. She showed how thinking outside of the box and perseverance make a big difference. Working on the plan she developed helped the patient unlock his potential and regain function. This is priceless.