Lita
Balbarin
September 2010
Lita
Balbarin
,
BSN, RN
Med-Surg
Advocate Illinois Masonic Medical Center
Chicago
,
IL
United States
Daisy Award Nomination.. Lita Balbarin RN 11-7 shift
A post –op patient was transferred to 9 stone from another unit towards the end of 3-11 shift. He was dissatisfied of his care, sarcastic, insulting and angry about his care thus far. The staff received constant insulting phrases. He kept on insisting that this "hospital has incompetent staff and you do not know what you are doing" Being ignored of his "excruciating" pains and delayed responses to his questions made him more irritated and annoyed. His responses were sarcastic & uncooperative. As he settled into his bed at the time Lita came in, the staff was all over trying to respond to his needs and constant demands of attention. He was calling every 15 minutes. It made the report time more chaotic as staff constantly making effort to respond to him. The PM charge Nurse ask for assistance from the Nursing Supervisor was notified who also supported the staffing ratio and gave the unit added 3rd NCT. As the in-coming charge Nurse Lita recognized that there was a need of tremendous coordination among her team. Lita identified that the Patient’s anger related to his dissatisfaction magnified his pain complaints. She recognized that his pain was not managed effectively before and during transfer and that this patient felt that his questions and concerns were not being heard. This also resulted in his being uncooperative; he did not allow nurses to assess him or touch him nor did he answer questions appropriately during transfer to 9 stone.
After receiving all this communication from the outgoing /Charge RN, Lita started a nursing plan of care. After her short introduction, during her interaction, using AIDET tools for communication, with-in a short time period, Lita observed and identified the following problem: “Patient is a post TURP with three way Foley draining fresh bright bloody urine but not draining very well, Bladder partly distended, patient screaming in pain and is partly relieved with pain medication.” Lita communicated that she will do the best she can and partner with his physician to resolve his pains. But will also need his cooperation to do so. She identified and initiated her plan of care:
1. Got the support from co-nurses to attend to some of her patients when caring for this patient as she will likely have to spend extra time with him. Her co-nurses answered Lita’s other patient calls and needs when she was with this patient.
2. Called the Resident for pain management and insisted they see the patient ASAP. The resident did.
3. Initially applied aggressive irrigation to the clotted Foley cath to achieved potency.
4. Planned and implemented irrigation frequency was every 5-15 mins until the Foley was clear of bloody urine. and the patient was relived from pain R/T to distention and clotted Foley cath. cleared with-in 30 min
5. Assessed bladder distention until subsided. & resolved.
With on one hour his pain was resolved bladder distension resolved His nurse still was attentive without any feeling of neglect or negativity towards him. She carried out all her promised action plans and kept on updating him with the status and plan of care. In the middle of the night He allowed Lita to get his head to toe assessment done. As the night progressed he became amicable and appreciative and towards the end of the shift he was apologetic for the behavior that he knew “was un-tolerable.”As stated “Lita was so patient with me” “she is diligent and resourceful” “very dedicated nurse, she follows through and was very detailed-oriented”.
As the Nurse Manager made rounds the next day I expected to hear lots of complaints.
However I was really surprised how he verbalized his overwhelming appreciation of 9 stone staff team doing their best to make him comfortable. I never heard the awful complaints that were shared with me by the staff. In fact he shared how impressed he was and gave positive praises of his care. The other issues seem to have been forgotten. A feeling of relief came over the staff for the opportunity to recover his impression of the institution. Leaving the room, I was rest assured that Lita and her team performed/ delivered Service Recovery at its best!
A post –op patient was transferred to 9 stone from another unit towards the end of 3-11 shift. He was dissatisfied of his care, sarcastic, insulting and angry about his care thus far. The staff received constant insulting phrases. He kept on insisting that this "hospital has incompetent staff and you do not know what you are doing" Being ignored of his "excruciating" pains and delayed responses to his questions made him more irritated and annoyed. His responses were sarcastic & uncooperative. As he settled into his bed at the time Lita came in, the staff was all over trying to respond to his needs and constant demands of attention. He was calling every 15 minutes. It made the report time more chaotic as staff constantly making effort to respond to him. The PM charge Nurse ask for assistance from the Nursing Supervisor was notified who also supported the staffing ratio and gave the unit added 3rd NCT. As the in-coming charge Nurse Lita recognized that there was a need of tremendous coordination among her team. Lita identified that the Patient’s anger related to his dissatisfaction magnified his pain complaints. She recognized that his pain was not managed effectively before and during transfer and that this patient felt that his questions and concerns were not being heard. This also resulted in his being uncooperative; he did not allow nurses to assess him or touch him nor did he answer questions appropriately during transfer to 9 stone.
After receiving all this communication from the outgoing /Charge RN, Lita started a nursing plan of care. After her short introduction, during her interaction, using AIDET tools for communication, with-in a short time period, Lita observed and identified the following problem: “Patient is a post TURP with three way Foley draining fresh bright bloody urine but not draining very well, Bladder partly distended, patient screaming in pain and is partly relieved with pain medication.” Lita communicated that she will do the best she can and partner with his physician to resolve his pains. But will also need his cooperation to do so. She identified and initiated her plan of care:
1. Got the support from co-nurses to attend to some of her patients when caring for this patient as she will likely have to spend extra time with him. Her co-nurses answered Lita’s other patient calls and needs when she was with this patient.
2. Called the Resident for pain management and insisted they see the patient ASAP. The resident did.
3. Initially applied aggressive irrigation to the clotted Foley cath to achieved potency.
4. Planned and implemented irrigation frequency was every 5-15 mins until the Foley was clear of bloody urine. and the patient was relived from pain R/T to distention and clotted Foley cath. cleared with-in 30 min
5. Assessed bladder distention until subsided. & resolved.
With on one hour his pain was resolved bladder distension resolved His nurse still was attentive without any feeling of neglect or negativity towards him. She carried out all her promised action plans and kept on updating him with the status and plan of care. In the middle of the night He allowed Lita to get his head to toe assessment done. As the night progressed he became amicable and appreciative and towards the end of the shift he was apologetic for the behavior that he knew “was un-tolerable.”As stated “Lita was so patient with me” “she is diligent and resourceful” “very dedicated nurse, she follows through and was very detailed-oriented”.
As the Nurse Manager made rounds the next day I expected to hear lots of complaints.
However I was really surprised how he verbalized his overwhelming appreciation of 9 stone staff team doing their best to make him comfortable. I never heard the awful complaints that were shared with me by the staff. In fact he shared how impressed he was and gave positive praises of his care. The other issues seem to have been forgotten. A feeling of relief came over the staff for the opportunity to recover his impression of the institution. Leaving the room, I was rest assured that Lita and her team performed/ delivered Service Recovery at its best!