Jessica was caring for a patient who had a diagnosis of Crohn's disease. On her initial rounds, Jessica took the time to explain this patient's plan of care including the need for a nasogastric tube, nothing by mouth, and a surgical consult. The patient initially was very agitated, anxious and demanded to be allowed to have ice chips, threatened to pull out her NG tube, and sign herself out against medical advice (AMA).

Jessica recognized that she needed to change the priorities of her nursing interventions. She negotiated with the patient to leave the NG tube in place and promised to contact the physician about the ice chips. Jessica then contacted the physician, gave the patient some ice chips, and allowed her to rest. Once the patient had slept for a little bit, Jessica sat down to speak with her. She re-addressed her concern about ice chips and desire to leave AMA earlier this morning. Jess attempted to further educate but the patient stared at the wall and was not responsive. Jess remained calm and acknowledged the patient's anxiety. After a while, the patient informed Jessica that she had minor bowel obstructions in the past that did not require surgery. Jessica took the time to further explain that while a surgical consult had been ordered, that did not mean the patient was definitely having surgery. She reviewed the physician's progress notes and let the patient know that in fact, the attending and the GI consult were both hopeful that surgery would not be necessary. Once this had been explained, the patient became calm, cooperative and open to further education.

While it may have been easier and less time consuming to bring paperwork and allow this patient to sign out AMA, Jess took the time to establish a therapeutic relationship with this patient that provided for a good patient outcome.