Rebecca McGonagill
September 2019
Rebecca
Mcgonagill
,
RN
Banner Staffing Services
Banner Desert Medical Center
Mesa
,
AZ
United States
Rebecca McGonagill was charged with care for a patient who previously sustained head trauma (resulting in a possible TBI) due to a suspected assault. The patient was on a regimen of prescribed/ordered medication but elected to cease taking her medication earlier in the day for personal reasons. Throughout the day, RN McGonagill reported seeing the patient's behaviors escalate and intensify, including verbal aggression with staff, oppositional behavior, and apparent loss of short-term memory regarding previous care.
RN McGonagill received an order for an emergency dose of stabilizing medication for the patient and requested security personnel respond to assist with a possible involuntary administration of the medication (as the patient had been refusing medications throughout the day). Upon the arrival of security staff, RN McGonagill worked with security to identify whether it would be an option for the patient to discharge AMA if she elected to do so (preserving her right to refuse care), and possible outcomes and strategies for administration of the ordered medication. Although this planning and research process was time-consuming, RN McGonagill demonstrated high professionalism and patience in exploring all possible avenues before contacting the patient to explain potential options and outcomes.
After security personnel engaged with the patient (who continued to refuse voluntary administration of the medication via injection), RN McGonagill joined the discussion. Although in possession of an order to administer the medication against the patient's will and restrain the patient if necessary, RN McGonagill demonstrated extraordinary compassion and empathy throughout the next approximately 45 minutes while staff discussed the patient's concerns and options. RN McGonagill had an honest and heartfelt discussion with the patient, talking about the obstacles they had already previously overcome together and the trust they'd already established when the patient made requests for accommodations in her care. Through this discussion, the staff learned that one of the reasons the patient was upset was because she was in the hospital on her birthday and her family was not available to visit her.
While negotiating with the patient for voluntary administration of the medication, RN McGonagill arranged for a phone call with the patient's sister, who had been a frequent visitor (but was unavailable to visit on that day). This call helped greatly in adding a voice to the chorus of people appealing for the patient to voluntarily accept her prescribed medication, rather than having it involuntarily administered.
At one point, the patient agreed to have the injection administered. However, just prior to the actual delivery, the patient demonstrated extreme anxiety and verbalized changing her mind. Rather than pressing on with the injection, RN McGonagill withdrew to find another solution.
As the staff continued to talk with the patient, RN McGonagill worked to identify an alternate route by which the patient could receive her medication. She ultimately determined than an effective combination of medications could be delivered orally, and when this option was presented to the patient, she agreed to voluntarily accept care. The patient's anxiety lessened dramatically when this solution was offered, and she ultimately thanked the staff for finding a way for her to continue her care without receiving an injection.
RN McGonagill was well within her professional rights and obligations to administer the ordered medication much earlier in this patient interaction, against her will if necessary. The patience, compassion, and willingness to explore alternative (but equally effective) solutions to deliver patient care embodied the Banner value of "Continuously Earning Trust," and demonstrated the extreme credit RN McGonagill brings to the nursing profession.
As a staff member present during this patient interaction, I am thankful for RN McGonagill's skill, perseverance, and patience, which ultimately allowed staff to avoid a negative and unpleasant outcome for a crime victim who was alone in the hospital on her birthday.
RN McGonagill received an order for an emergency dose of stabilizing medication for the patient and requested security personnel respond to assist with a possible involuntary administration of the medication (as the patient had been refusing medications throughout the day). Upon the arrival of security staff, RN McGonagill worked with security to identify whether it would be an option for the patient to discharge AMA if she elected to do so (preserving her right to refuse care), and possible outcomes and strategies for administration of the ordered medication. Although this planning and research process was time-consuming, RN McGonagill demonstrated high professionalism and patience in exploring all possible avenues before contacting the patient to explain potential options and outcomes.
After security personnel engaged with the patient (who continued to refuse voluntary administration of the medication via injection), RN McGonagill joined the discussion. Although in possession of an order to administer the medication against the patient's will and restrain the patient if necessary, RN McGonagill demonstrated extraordinary compassion and empathy throughout the next approximately 45 minutes while staff discussed the patient's concerns and options. RN McGonagill had an honest and heartfelt discussion with the patient, talking about the obstacles they had already previously overcome together and the trust they'd already established when the patient made requests for accommodations in her care. Through this discussion, the staff learned that one of the reasons the patient was upset was because she was in the hospital on her birthday and her family was not available to visit her.
While negotiating with the patient for voluntary administration of the medication, RN McGonagill arranged for a phone call with the patient's sister, who had been a frequent visitor (but was unavailable to visit on that day). This call helped greatly in adding a voice to the chorus of people appealing for the patient to voluntarily accept her prescribed medication, rather than having it involuntarily administered.
At one point, the patient agreed to have the injection administered. However, just prior to the actual delivery, the patient demonstrated extreme anxiety and verbalized changing her mind. Rather than pressing on with the injection, RN McGonagill withdrew to find another solution.
As the staff continued to talk with the patient, RN McGonagill worked to identify an alternate route by which the patient could receive her medication. She ultimately determined than an effective combination of medications could be delivered orally, and when this option was presented to the patient, she agreed to voluntarily accept care. The patient's anxiety lessened dramatically when this solution was offered, and she ultimately thanked the staff for finding a way for her to continue her care without receiving an injection.
RN McGonagill was well within her professional rights and obligations to administer the ordered medication much earlier in this patient interaction, against her will if necessary. The patience, compassion, and willingness to explore alternative (but equally effective) solutions to deliver patient care embodied the Banner value of "Continuously Earning Trust," and demonstrated the extreme credit RN McGonagill brings to the nursing profession.
As a staff member present during this patient interaction, I am thankful for RN McGonagill's skill, perseverance, and patience, which ultimately allowed staff to avoid a negative and unpleasant outcome for a crime victim who was alone in the hospital on her birthday.