Julaine has been an RN for over 30 years, spending most of her career in the Henry Ford Health System. She has worn many different hats over the years, but her love has always remained bedside care. She is a nurse that is respected by her peer's for exceptional clinical expertise and her nurturing and compassionate care. She has in infectious sense of humor and can find ways to make the most difficult situations a learning experience.

A couple of months ago we had a patient admitted to our unit that was challenging to care for in many ways. He was a patient with ALS who used an Augmented/Alternative Communication device (AAC). For those who are not familiar with ALS it is a neurodegenerative disease that affects the brain and spinal cord, often leading to weakness of all muscles and loss of speech. ALS patients generally have fully intact cognitive function, but may lose control of all other muscles up to and including paralysis.

This was the first time many of the staff on our unit had experienced anyone using an AAC device, this patient had a device where he would use his eyes to look at letters and the device would then speak for him. This was very time consuming often taking 30- to 40 minutes for the patient to respond to a yes or no question. The patient would become very angry when staff would cut off his thoughts or look over his shoulder and "read his mind". He and his wife were very frustrated with the communication from the care team.

After being on our unit for a few days, Julaine took over his care. She was given report and told about his AAC. Initially Julaine did the same as others and would read over the patients shoulder, often finishing his thoughts for him. At one point the patient and the wife became very frustrated with Julaine and the way in which all the care team was communicating with them. At this point Julaine took a step back and listened, really listened to the family.

She said to me later that she realized at that point it was not about what we were communicating to the patient it was the lack of autonomy we were giving the patient. He was at a very critical point in his disease where there was progression and he and his wife were devastated. Julaine said even after 30 years of nursing this patient was able to remind her and teach her about compassion and most importantly about patience. She said she never really thought about it from the patient's perspective. To everyone else we were doing tasks but to him this was his loss of independence, his autonomy, his voice.

Julaine apologized to the patient and thanked him and his wife for teaching her such a valuable lesson. She was reminded how to be truly compassionate, how to be present. This experience helped her to execute the one patient at a time philosophy. Julaine then took it upon herself ensure clear communication to the team, providers, NAs, unit secretaries, etc. regarding the manner in which to correctly communicate with the patient. At discharge the patient and his wife were very satisfied with the care.