I worked with Maripaz for three consecutive nights. I helped quite often during this time to turn the patient. I saw how she related with “Ms. U” who never seemed satisfied with one way of moving her and repositioning her. She had a sacral ulcer, a wound vac on the right groin, and hip and shoulder problem. After finding the right position to make her comfortable for fifteen minutes, she would call to be turned again, thirty minutes after and this went on and on until she is able to sleep at night, 12:30 AM. This patient came to us from another critical care unit. The patient did not seem to appreciate the little but numerous things nurses and nurse aides did for her when she was under their care. However, Maripaz didn’t see this complex patient that way and actually persuaded nurses to view this patient differently; something that benefited the patient, the family, and the nurses.
Maripaz addressed the issue about the patient wanting to have the nurse at the room as frequently as possible. Maripaz discovered that she was frightened that no one would hear her if she needed help emergently. The patient’s daughter was usually present until 10:00 PM, but left then to be able to return the next day. The family expressed concern that their mom wouldn’t get help immediately for pain and for turning since she was unable to press the call light button. This went on for a week because her private room was three rooms away from the nursing station. Maripaz, on making her first night rounds, found a way to keep this patient unafraid and still be able to call for help whenever she wanted: she had the special blue call light connected to the room’s call light system. The patient wished to have the television kept on all night, but had been told that she could not have both the television and the special blue call light. Maripaz arranged for the patient to have both services, which met with many words of gratitude and a smile from the patient. The patient further reassured her family that she was much happier and more confident since Maripaz had made these changes on her behalf.
Every night, Maripaz spent initial 20 minutes of the shift with her discussing how her day went, how she wanted to be repositioned, if she wanted an oral swab, clean cloth over her forehead or if she needed the pain med, and what time she would expect her to be there again. Maripaz asked her nursing assistant to go to her every other hour and to ask the nurses for assistance if unable to meet this request. Maripaz is to be commended for the camaraderie and teamwork she elicited from the rest of the staff over the care of this one patient. Maripaz brought reading materials to assist with patient and family education. The wound vac was one of the points of care that she emphasized. She explained that the doctor ordered the high protein diet for her faster wound healing and provided copies of drug literature of meds their mom was newly prescribed with. This added attention to the family assisted them to feel more positively about further outcomes of their mom’s condition as well as realistic expectations on her medical condition.
Kind hearted Maripaz made arrangements for the patient to have the big VIP room when it became available. We all heard words of appreciation from the patient’s daughters who felt that their mom truly deserved the best after her month-long hospitalization. Every night after the patient’s transfer to the larger room, the daughters took turns watching their mom overnight, when she needed it the most... Maripaz used each night as an opportunity to teach the patient’s daughters how they could become more involved in their mother’s care... She presented to them ways they could support their mom not only emotionally but physically and psychologically as well. Every day the patient’s nutritional status improved so that she was graduated from enteric feedings to IV nutrition and then to a progressive diet. They stayed in the morning to assist their mom during breakfast; participate in the physician’s rounds and assist the medical team to establish goals of medical and nursing care.
Maripaz also assisted the patient with pain management that gradually progressed to longer intervals between doses of pain medication. She also appropriately offered anti-anxiety medication to reduce the patients stress and enable sleep. This nurse scheduled her time with the patient so she does did not have to call for medication, anticipating her need for repositioning and communicating the strategies that helped the patient get the right comfortable position. She also communicated honestly with the patient’s daughters about the day’s progress when they were not in attendance. She was able to help them understand their mom’s inconsistent behavior and work together with them to keep the patient comfortable at all times. In this way, she established a trusting relationship with the daughters that helped them feel confident in suggestions Maripaz made and explained.
Patient had improved a lot after two weeks and Maripaz followed up on the need to initiate physical therapy, occupational therapy and speech therapy. The patient’s dry, sore mouth was relieved with constant oral care that enabled the patient to express herself clearly, eat and develop an appetite. Maripaz went further to make sure that the patient was offered massage therapy twice a week.
The patient became conversant, appreciative and family knew what to do and how they should react whenever their mom randomly complained that she needed their attention and she wanted her personal needs addressed. Whenever a different nurse was assigned to their mom, the daughters mentioned the good things the Maripaz had done to improve their mom’s comfort.