Laurie Varela shows us all what it means to be an amazing nurse. She leads by example and holds us all to the same standards she applies to her practice. She does so many wonderful things for our patients each shift she works, but this series of events really struck me as an example of her ability to be an advocate, be compassionate and be diligent to ensure quality nursing care is provided.
An example of Laurie's dynamism occurred this past fall. She was taking care of a patient who was at the end of life. This patient was diagnosed with metastatic abdominal cancer and the prognosis was grim. As the patient and the family were coming to grips with this sad news, many consulting services were employed to determine the next steps in treatment. As each member of the care team made their assessment it became clear that there were no treatment options and some difficult decisions would need to be made in the days ahead. A family meeting was organized with the medical team, nursing and case management to discuss the entire hospital course as well as the sad news of her poor prognosis. The meeting was extremely fruitful and everyone involved in this patient's care and her loved ones were in agreement that comfort care was the best option at that point. The location of her care was not yet determined, the family needed some more time to decide whether they had the resources to provide end of life care at home or if an inpatient hospice unit was the best choice. However, they did not have the luxury of time to decide as the patient was declining quickly.
Laurie was a great support for the family at that difficult time and she did all within her power to ensure all comfort measures were put into place. She diligently made certain that this patient was pain free and that the family was also accommodated so that she would always have a support person available. The semi-private room was blocked and the extra bed was removed to allow for more chairs. Laurie kept up frequent and inclusive communication with the family spokesperson to be sure that everyone was aware of all changes in the patient's status. Once all of these measures were in place, focus shifted into ensuring that everyone on staff was aware of these comfort care orders and that the patient and family's comfort and privacy were maintained continuously. This process usually does not occur on this unit, typically patients who have comfort care or hospice orders are transferred swiftly to that level of care at an outside facility or to their home. Laurie made it her goal to maintain the patient's dignity throughout this hospital stay. Passing along the comfort care measure during bedside shift report between the nurses and nursing assistants became a priority.
As things were drawing to a close, the medical team recognized the patient's increase in oral secretions and how this was also compromising her respiratory status. They added a medication which reduced these secretions and eased the patient's labor of breathing. Laurie was familiar with this medication from a previous job and worked persistently to ensure it was available for the patient and that other nursing staff were educated on its use to ensure this patient's comfort.
Laurie was also the nurse on duty when this patient did eventually expire. She ensured the family was notified and encouraged to come to the nursing unit to pay their respects. She was available to the family when they arrived and arranged for pastoral care to provide them with spiritual support. She left them with the patient and quietly closed the door to ensure privacy. The relationship she had built with this family was evident and they appreciated all she had done for their loved one. She knows what needs to be done and intuitively makes it happen without a second thought, she is a true DAISY Nurse.