Mr. X was a direct admit in the afternoon. He had been seen at the cancer center for treatments recently. He received platelets and a blood transfusion earlier this week. He was having frequent nose bleeds and bruising. Plan of care was to administer one unit of platelets and send him home. He would have a follow-up at the cancer center Monday. Upon admission, LT Stratton got to know Mr. X and his wife. Due to being in a small community, one unit of irradiated platelets took three hours to arrive.

She checked in on them several times while we were waiting. LT Stratton then started the unit and introduced him to the oncoming nurse at shift change and went home. When she came back into work, he had been discharged that night.

A week afterward, LT Stratton came into report to hear of a one day admission, transferred from intensive care at an outside facility, of a very confused man with pneumonia. He could not maintain his oxygen saturation while on five liters of oxygen, but we could not use a simple mask since he was claustrophobic. The man was now a one to one nursing care for safety, and we had called in a night medic to assist. The man had attempted to crawl out of the bed and was very unstable. He had received platelets and packed red blood cells along with a few anti-anxiety medications that day.

Upon entering his room, I did not recognize the man although the name was familiar. I couldn't place who he was until I saw his wife. She was happy to see me and had a lot of questions about his plan of care. Due to his declining condition, my current plan was the same as the day shift nurse; maintain his oxygen saturation and advocate to the doctor to transfer him back to intensive care at another hospital.

Considering the wife's culture, LT Stratton explained how she could help during the shift. She wanted to be very hands-on and support her husband. LT Stratton knew that her husband was not in the state to make an informed decision or to receive information. She also explained to the medic the previous history of the patient and the previous state of the patient from prior admission. This helped the medic to see the situation and better help with incorporating the wife into the plan of care while maintaining patient safety.

Throughout the night the patient's oxygen requirements increased and his respiratory rate changed. We had already given him an anti-anxiety medication to calm him down which maintained his respiratory drive and allowed him to have a ten liter non-rebreather mask held to his face without using the elastic band. This calm state lasted less than two hours and still did not maintain his oxygen saturation above ninety-two percent. The only other medication ordered was morphine prn for agitation. LT Stratton felt that this was not the medication he needed in his compromised respiratory state. She informed the medic and wife that she would need to leave their side to discuss the next care option for Mr. X.

After paging and speaking with the physician, the patient's clinical picture had changed to warrant a transfer. LT Stratton began to discuss this plan with the wife while the physician and other nurses began transfer procedures. The wife could see her husband was declining. She mentioned several times she didn't know what to do. LT Stratton reassured her that she had been a great support for him by being at his side to calm him and help him feel more comfortable. As she was carrying their things out to the car, she sat down on the hallway floor and cried. LT Stratton went to her side, placed her hand on her shoulder, and just sat with her.

As she mentioned she didn't know what to do and asked for guidance, LT Stratton told her it is okay to be upset and strong at the same time. LT Stratton also informed her that both people in a marriage cannot be strong at the same time. One is always stronger to help the other. If both people are strong at the same time, they fight. LT Stratton told her that her husband had been strong for a long time and now he needed her to continue to be strong. This seemed to reassure her. She informed her she was strong and would fight for both of them while the doctors and nurses helped her husband get better. LT Stratton also spoke with Mrs. X, after we transferred her husband, as we were heading out to her car. She thanked her for the hug and the kind words and support for her and her husband.

Mrs. X came into the hospital within two weeks of her husband passing away. A belonging of his had been left on our unit. With some of the other staff members, LT Stratton made it a priority to help this lady find something of her late husband. LT Stratton went to several places in the hospital to look for this item, speaking with her about her gardening and travel plans for the summer. It seemed to comfort her just knowing that LT Stratton was helping her to find one more item that belonged to her husband, to comfort her.