Laura Ireland
July 2023
Laura
Ireland
,
BSN, RN
Cardiac Stepdown - 3C
Northwestern Medicine Central DuPage Hospital
Winfield
,
IL
United States
It is my belief that this patient would not have been ready for discharge by that date had it not been for the efforts of Laura to coordinate a multidisciplinary care plan and the above and beyond personal efforts she undertook to assist the patient in this process.
I am nominating my nurse manager, Laura Ireland, for the Nurse Leader DAISY Award for her efforts in assisting a patient to achieve optimal goals that enabled her to be discharged after a complicated and lengthy two-month stay in our 3C unit. Background information that may be helpful in understanding her efforts: the patient was a 63-year-old female with esophageal cancer who presented to CDH for a scheduled esophagectomy. Her hospital course was complicated by anastomotic leaks s/p esophageal stent and subsequent j-tube malfunction and revision, abdominal abscess, long course of antibiotics, severe psychological issues and hospital delirium requiring safety companion and video monitoring, and a multitude of tubes, drains, NG to suction, and multiple OR procedures to assist in the healing of the esophagus.
The patient was impulsive and, at times, aggressive and physically and verbally assaulted staff. The patient was transferred to 3C from ICU and remained there until she was finally able to be discharged. It is my belief that this patient would not have been ready for discharge by that date had it not been for the efforts of Laura to coordinate a multidisciplinary care plan and the above and beyond personal efforts she undertook to assist the patient in this process. Laura reached out to the multitude of physicians who were involved in the patient's care including two surgical teams, hospitalists, and psychiatrists as well as the family members, manager of the safety companions, PT/OT, case management, and 3C staff who were caring for the patient. She was instrumental in developing a plan of care to work on nonpharmaceutical interventions for delirium, improved communication amongst the caregiving team, increased PT/OT sessions, increased interactive involvement of the safety companions with encouragement to engage the patoent in playing cards, talking, etc, and ensured modified assignments for the nurses so that they would spend more time with the patient.
On top of all that, Laura herself committed to taking the patient outside in a wheelchair for a short period each day in which she was able to visit with her grandchildren whom she had not seen in a very long time. Laura used evidence-based practice to work to eliminate triggers for her aggression, increase social interaction with her family, and decrease the delirium she was experiencing. It is nothing short of a miracle for the response that this patient had to her interventions. Her delirium gradually improved over the next few weeks such that she became more conversant, relaxed, and able to sleep. Her family was so grateful. Her safety companion was discontinued and the video monitor. She was discharged for continued rehab.
It should also be noted that Laura is new to her manager role, having assumed this in March 2023. She has had a steep learning curve to negotiate while dealing with the overall hospital nursing staffing issues, high acuity, and overflow volumes of our unit. The nursing staff has been challenged to the point of exhaustion at times with all the precepting of new graduate nurses while trying to provide optimal patient care under trying circumstances. In all honesty, most of us felt helpless in the care of this patient and thought she would never be able to be discharged. Laura's efforts gave us hope. She took charge in a very difficult situation and we are beyond thrilled for this patient and her family. It is the type of care planning that every nurse works on during our academic programs but rarely has time or opportunity to implement in the hospital setting. Laura's actions not only helped the patient. She infused each nurse on 3C with a shot of hope and pride in our work.
***
We have a patient on 3C with a very complex medical condition that has been met with complications. This has greatly extended her care by several months. She has also been impulsive, pulled at her lines and tubes, and has been aggressive with staff members. It was also discovered that she has mental health issues that have been exacerbated by her length of stay.
I am nominating Laura for her collaborative approach to caring for this patient and for her support of her staff. Laura has arranged several meetings with this patient's entire care team, from the surgeons involved to behavioral health to her family to ensure there is a plan in place for this patient and one that is updated frequently. We also have an updated communication plan for nursing staff. Laura has taken this patient outside so she can enjoy time with her grandchildren and to enjoy the warm sunshine. She also brought in activities for the patient to enjoy in her room. Laura is an excellent example of providing excellent patient-focused care while also supporting her staff.
The patient was impulsive and, at times, aggressive and physically and verbally assaulted staff. The patient was transferred to 3C from ICU and remained there until she was finally able to be discharged. It is my belief that this patient would not have been ready for discharge by that date had it not been for the efforts of Laura to coordinate a multidisciplinary care plan and the above and beyond personal efforts she undertook to assist the patient in this process. Laura reached out to the multitude of physicians who were involved in the patient's care including two surgical teams, hospitalists, and psychiatrists as well as the family members, manager of the safety companions, PT/OT, case management, and 3C staff who were caring for the patient. She was instrumental in developing a plan of care to work on nonpharmaceutical interventions for delirium, improved communication amongst the caregiving team, increased PT/OT sessions, increased interactive involvement of the safety companions with encouragement to engage the patoent in playing cards, talking, etc, and ensured modified assignments for the nurses so that they would spend more time with the patient.
On top of all that, Laura herself committed to taking the patient outside in a wheelchair for a short period each day in which she was able to visit with her grandchildren whom she had not seen in a very long time. Laura used evidence-based practice to work to eliminate triggers for her aggression, increase social interaction with her family, and decrease the delirium she was experiencing. It is nothing short of a miracle for the response that this patient had to her interventions. Her delirium gradually improved over the next few weeks such that she became more conversant, relaxed, and able to sleep. Her family was so grateful. Her safety companion was discontinued and the video monitor. She was discharged for continued rehab.
It should also be noted that Laura is new to her manager role, having assumed this in March 2023. She has had a steep learning curve to negotiate while dealing with the overall hospital nursing staffing issues, high acuity, and overflow volumes of our unit. The nursing staff has been challenged to the point of exhaustion at times with all the precepting of new graduate nurses while trying to provide optimal patient care under trying circumstances. In all honesty, most of us felt helpless in the care of this patient and thought she would never be able to be discharged. Laura's efforts gave us hope. She took charge in a very difficult situation and we are beyond thrilled for this patient and her family. It is the type of care planning that every nurse works on during our academic programs but rarely has time or opportunity to implement in the hospital setting. Laura's actions not only helped the patient. She infused each nurse on 3C with a shot of hope and pride in our work.
***
We have a patient on 3C with a very complex medical condition that has been met with complications. This has greatly extended her care by several months. She has also been impulsive, pulled at her lines and tubes, and has been aggressive with staff members. It was also discovered that she has mental health issues that have been exacerbated by her length of stay.
I am nominating Laura for her collaborative approach to caring for this patient and for her support of her staff. Laura has arranged several meetings with this patient's entire care team, from the surgeons involved to behavioral health to her family to ensure there is a plan in place for this patient and one that is updated frequently. We also have an updated communication plan for nursing staff. Laura has taken this patient outside so she can enjoy time with her grandchildren and to enjoy the warm sunshine. She also brought in activities for the patient to enjoy in her room. Laura is an excellent example of providing excellent patient-focused care while also supporting her staff.