In September 2017 a local hero and firefighter began receiving care through Health First. He was admitted due to neck surgery for injuries suspected to be sustained in the line of duty. His exposure to second hand smoke over the last 20 years had left him with mouth and throat cancer. His course of care has included a temporary trach, which over our 7 months of treating him has become a permanent trach. Our nurses have been there to provide skilled nursing, as well as emotional support to this patient and family when he lost his vocal cords to cancer.
Nycol picked up his bare beginning in November 2017 when his first case manager left the field. Wanting to sharpen her trach skills, she began researching and reaching out to our educator for direction and to assist meeting the skilled needs. She embraced this with her normal enthusiasm and quickly became an expert on home trach care, suction, his specific mouth and throat cancer with attention to what this patient and his family may expect if his surgeon's conservative surgical approach was not successful and he ended up with a permanent trach.
This patient was complex and had bonded with his first nurse, Nycol had big shoes to fill. She had to engage this family quickly and earn their trust in this emotional and challenging situation. She was an excellent communicator and she immediately provided access and reassurance that she was going to wrap her arm around their case and be their greatest advocate and family champion. She creatively worked to help them adjust to a new "normal." This started with the personal delivery one night with a whiteboard and eraser when the patient identified that what "truly scared him," was his "inability to communicate." She developed an inclusive nursing care plan with an end goal in mind of discharging the patient to self-care with his family support. She identified teaching opportunities through a team approach with the patient and his wife. She addressed dietary intake with PEG tube feedings, effective hydration, weight loss, GI/constipation, effective coping with an alteration in communication and body image, safety in the home due to choking, use of home equipment like suction machines and wound vacs, wound infection and possible end of life issues. She coordinated every Orlando hospitalization discharge with DME equipment he had to have delivered at home before he could leave the Orlando hospital, many times making dozens of calls so equipment was in place by the time they arrived home exhausted from their experience.
There were several rehospitalizations as the conservative approach to removing the patient's cancer were unsuccessful and finally, her patient had to have a total laryngectomy surgery that left him without a voice. Nycol shared with me his last spoken words were "I love you," to his wife. This was an emotional time and Nycol was their constant rock. Nycol definitely was a dynamic collaborator and identified all her team players to assist this patient. She teamed up with another RN to cover her on days she was not working so this patient always had consistent care and a familiar face. At the top of her collaborative list was the surgical specialist in Orlando. They frequently texted back and forth on this patient and he answered whenever she called.
Finally, home after the last extensive reconstruction, this patient came home with a wound vac on his neck that required two nurses to change. Before the first dressing change, Nycol reviewed the operative and post-op hospital records and discovered post-reconstruction, every wound vac dressing change had been done while this patient was anesthetized. She immediately called the surgeon and planned a field trip for this first dressing change. Nycol and her team member drove with our educator to Orlando and performed the first wound vac dressing change with the MD in his office. He was so impressed by their technique that he called in his PAs and asked them to provide a "training in-service" and teach his PAs how to perform this wound vac change.
Another time he was advancing to oral fluids, and he was hospitalized for a bowel obstruction due to dehydration and she coordinated with our outpatient infusion facility so he could receive fluid infusions on an "as needed" basis if he was having difficulty tolerating enough fluids. She increased this family's independence and confidence by educating them on signs and symptoms of dehydration, prevention measures, and when to reach out for help.
He now takes the lead to get himself to the infusion center and just calls to tell her he's 'on the way' and does not need her skilled assessment to make the decision - Nursing goal met!
As her supervisor, Nycol met with me weekly so we could discuss the patient and her strategic creative ideas to help him and his wife become confident of their ability to manage his own care, troubleshoot issues independently and call for help appropriately. His outcomes have been excellent with no infections throughout this surgical journey and independent self-care evident.