I'd like to take the opportunity to recognize Peggy for the outstanding teaching she did with one particular patient. This delightful patient was diagnosed with a mass that was pressing on her bladder, causing urine retention. Peggy was instructed to complete teaching on self-catheterization so she could be discharged home without a leg bag. In Observation, we rarely have to place Foley catheters, let alone do teaching with the patient to learn how to perform this procedure at home. Peggy knew coming in one day that the plan was to remove the patient's Foley catheter and start the teaching.
First thing in the morning, Peggy alerted the Charge Nurse and other staff of her goal and asked for any tips that we may have. I, the Charge Nurse, was able to print off step-by-step instructions from Clinical Keys to provide to Peggy and the patient. The night-shift nurse allowed the patient to watch a video regarding self-catheterization. Peggy presented the patient with the plan to remove the Foley after breakfast and to begin the teaching. The patient was very nervous yet very receptive. Peggy presented the patient with the printed instructions along with a Foley kit for her to read and put her hands on the items that were needed to perform the procedure. When Urology came Peggy asked for any words of wisdom or tips. They reiterated everything that we already had.
About 1130 the first self-cath was attempted. Peggy used technology to her advantage to assist the patient. Mirrors are hard to come by, so she suggested to the patient she use her personal phone camera to look at her anatomy with the Foley in place and then to assist with placing the catheter. This worked beautifully and the patient was appreciative that she was able to see what she was doing.
This attempt resulted in NO urine. The patient and Peggy were discouraged with the results. Peggy reassured the patient that she was in the right spot, that she did everything right, that she did excellent, and that the results were no fault of her own.
After talking with the patient, Peggy came out to brainstorm why there was no urine. After talking with the providers and nurses we concluded that we didn't wait long enough after the Foley was removed for enough urine to produce. Peggy explained her findings to the patient, told her not to get discouraged, and that they would be successful and continued to boost her confidence, as she could do this! Our plan was to wait at least four hours before the next attempt.
The patient was able to void during this time but did not completely empty her bladder. After about six hours with the patient voiding on her own, we decided that we needed to have urine in her bladder to attempt the self-catheterization again. Peggy talked with the patient and when she felt the urge to urinate they were planning to self-cath instead.
About 1800 the patient rang out. Peggy went in and performed the procedure with the patient. About 10 minutes later Peggy came out holding a beaker with about 400ml of urine and was stating, "She did it, she did it, she did awesome. Look at this!", with the biggest smile on her face. From there the patient was given supplies that she would need at home and lots of continued encouragement and support from Peggy. Peggy was her biggest cheerleader the entire day.
About 1840 Peggy came out into the nurse's station with tears coming down her face. I asked if she was ok and she stated, "She just asked me for a DAISY nomination form and I told her NO, that this was my job and I was just excited that she was able to perform the task so she could go home." Peggy was so proud of her patient and was elated to know that her teaching, encouragement, compassion, and support was noticed. She doesn't want this recognition, but I think that she is deserving, so I proudly nominate her. All of this was accomplished as she handled a full team of other patients.