We had a patient today that threatened to leave AMA. She had already done so once last week and was readmitted for pain. The patient has a perforated bowel and an abdominal abscess with a drain in place. She also had IV fluids with a PCA. I witnessed Mary Nelson with this patient today. She was truly an advocate for this patient. The patient got in a fight with her boyfriend and wanted nothing but to leave the facility. She stated that she had enough and she just needed to get out of here. Mary very calmly explained to the patient the risks that she would be taking if she left and that she was very concerned for her safety and wellbeing. The patient wanted nothing to do with anything Mary had to say. She told Mary that she was going to leave and if she didn't take her IV out, she would do it herself. Mary took the IV out and while doing so asked the patient to describe in patient's own words what could happen to her if she would leave. Patient stated that her bowel could perforate and she could die, but she didn't care and just wanted to leave. Patient stated "don't worry about me, I am not worth it". Mary explained to patient that she is a human being and that we do care about her. Mary went on to say that if we didn't care we wouldn't be doing everything we could to get her to stay. Mary again told the patient that we were concerned about her safety and where was she going to go? Mary asked the patient if she had a ride, the patient told her no, but she has 2 perfectly good feet that can take her anywhere she needed to go.
The patient was still upset, took her clothes and said she was going to the bathroom to take out her drain herself and get dressed so she could get out of here. Mary again advised her to keep the drain in. While patient was in the bathroom, Mary asked the patient if she wanted her to remove the sutures so it would be easier for her to take out the drain. The patient was sitting on the toilet at the time so Mary gave her some space. Shortly after this the patient began to cry. Mary went in and asked if she could assist her. The patient had calmed down at this point. Mary asked if she wanted to help with her drain. The patient had told Mary that she decided she was going to stay. Mary got the patient settled back into her bed.
I truly believe that the patient stayed because of Mary's calming demeanor. Mary did not let the situation escalate out of control. It was also evident that Mary cared about this patient and her wellbeing.
Mary is our Resource Nurse and was not assigned to this patient. Mary took the initiative to take care of this situation herself - keeping the primary nurse informed along the way.