Jianna Donisvitch
September 2014
Jianna
Donisvitch
,
RN
R5-Medical/Surgical
Maine Medical Center
Portland
,
ME
United States
Everyday Jianna works, she is caring and compassionate, but one particular patient and 3 shifts stand out to me and screamed DAISY Award Nurse!
The patient had a 2 month, prolonged and complicated admission, in and out of intensive care at Maine Med and then discharged to rehab. After a couple days at rehab he was then readmitted to R5. At this point when Jianna was caring for him, he had been in the hospital for 2 weeks and not showing signs of discharging. Many nurses, CNAs, doctors and staff found the patient's personality and fluctuating behavior challenging to interact with. He was a difficult patient. The type of patient that on a busy day, nurses don't always have the extra time to show compassion to, but Jianna made time to show compassion to him and make a difference for him even if he didn't realize it.
I was in charge for 3 days in a row and Jianna was caring for this patient the same three days and I observed several smaller things that Jianna did that added up into one big thing; she truly made a difference for this patient, his family, and staff.
At times the patient would refuse care and refuse to take medications. The days Jianna was caring for him, he would refuse like he frequently does, but instead of saying "ok fine" and not give him his medications, which would be easy to do, she took the extra time and talked with him and got him to be agreeable. When I was talking to Jianna about this patient she said "it's just his personality, he's a nice guy, but everyone just sees him as difficult and hasn't learned how to work with him". She truly cared for this patient and wanted the best thing for him so she gave him extra time to connect with him.
The patient also had a tendency to be verbally aggressive to staff. One of those days Jianna was caring for him, he was aggressive towards the CNA caring for him. Jianna recognized this as not appropriate behavior and talked with the patient. She figured out exactly what his frustrations were and how we could work with him and prevent things from escalating with staff.
However, at one point doctors were trying to talk with the patient about his plan of care, but the patient quickly became frustrated, agitated and escalated. He was kicking people out of his room. His daughter left and stopped visiting him because of his actions. He was described as "belligerent". Jianna recognized this as an acute change and thought he may benefit from some medication to help calm him just enough to be able to interact with the doctors. When the patient reached this point, Jianna was the only one he would listen to or even allow to come into his room without becoming frustrated and upset. Medication was ordered and it worked wonderfully for the patient. He was calm and pleasant and able to be an active participant in his care. The doctors then came back to see the patient and was able to talk to him about his plan of care. I heard one doctor say "Jianna saved the day!"
Since the patient's first admission he had had an abdominal VAC dressing. This had been one of the few things that had been going well for him. During one of Jianna's shifts, the VAC started draining frank blood and clots. Jianna responded quickly and shut off the VAC and notified physicians. When they did not arrive to the unit quickly, she called again to reinforce how concerned she was with the patient's condition. Due to Jianna's clear communication and advocacy for the patient, the team came up quickly and then ended up needing to cauterize the bleed. Without her persistence in this situation, there could have been further complications for him.
Throughout the patient's stay, he was treated with continuous IV diltiazem approximately every other day. Due to the patient's soft blood pressures, he could not tolerate the drip for extended periods of time. A few days before he was discharged, his heart rate had crept back up into the 150s again. The doctor's first instinct was to again place him back on the drip. Because Jianna was intimately involved in this patient's care throughout his stay, she knew the bigger picture of his instability on the drip. She advocated to at least try a different oral medication to see if that was something that would work for the patient to decrease the yo-yo effect of being on and off an intravenous treatment. The physician's agreed that this was something that could work for this patient, however the patient did not agree. After Jianna spent much time in with him explaining the option and what it meant for the patient, he agreed to try the medication. Amazingly this medication worked perfectly for him and it was unnecessary to restart him on the diltiazem!
Jianna learned how to work with this difficult patient and bonded with him. I even heard him joking around and laughing with her several times. I believe with all the advocating Jianna did for this patient made a huge difference and made him able to discharge sooner rather than later. Jianna went the extra mile to show him that she cared and I believe that is why he was so agreeable to care when she was caring for him.
The patient had a 2 month, prolonged and complicated admission, in and out of intensive care at Maine Med and then discharged to rehab. After a couple days at rehab he was then readmitted to R5. At this point when Jianna was caring for him, he had been in the hospital for 2 weeks and not showing signs of discharging. Many nurses, CNAs, doctors and staff found the patient's personality and fluctuating behavior challenging to interact with. He was a difficult patient. The type of patient that on a busy day, nurses don't always have the extra time to show compassion to, but Jianna made time to show compassion to him and make a difference for him even if he didn't realize it.
I was in charge for 3 days in a row and Jianna was caring for this patient the same three days and I observed several smaller things that Jianna did that added up into one big thing; she truly made a difference for this patient, his family, and staff.
At times the patient would refuse care and refuse to take medications. The days Jianna was caring for him, he would refuse like he frequently does, but instead of saying "ok fine" and not give him his medications, which would be easy to do, she took the extra time and talked with him and got him to be agreeable. When I was talking to Jianna about this patient she said "it's just his personality, he's a nice guy, but everyone just sees him as difficult and hasn't learned how to work with him". She truly cared for this patient and wanted the best thing for him so she gave him extra time to connect with him.
The patient also had a tendency to be verbally aggressive to staff. One of those days Jianna was caring for him, he was aggressive towards the CNA caring for him. Jianna recognized this as not appropriate behavior and talked with the patient. She figured out exactly what his frustrations were and how we could work with him and prevent things from escalating with staff.
However, at one point doctors were trying to talk with the patient about his plan of care, but the patient quickly became frustrated, agitated and escalated. He was kicking people out of his room. His daughter left and stopped visiting him because of his actions. He was described as "belligerent". Jianna recognized this as an acute change and thought he may benefit from some medication to help calm him just enough to be able to interact with the doctors. When the patient reached this point, Jianna was the only one he would listen to or even allow to come into his room without becoming frustrated and upset. Medication was ordered and it worked wonderfully for the patient. He was calm and pleasant and able to be an active participant in his care. The doctors then came back to see the patient and was able to talk to him about his plan of care. I heard one doctor say "Jianna saved the day!"
Since the patient's first admission he had had an abdominal VAC dressing. This had been one of the few things that had been going well for him. During one of Jianna's shifts, the VAC started draining frank blood and clots. Jianna responded quickly and shut off the VAC and notified physicians. When they did not arrive to the unit quickly, she called again to reinforce how concerned she was with the patient's condition. Due to Jianna's clear communication and advocacy for the patient, the team came up quickly and then ended up needing to cauterize the bleed. Without her persistence in this situation, there could have been further complications for him.
Throughout the patient's stay, he was treated with continuous IV diltiazem approximately every other day. Due to the patient's soft blood pressures, he could not tolerate the drip for extended periods of time. A few days before he was discharged, his heart rate had crept back up into the 150s again. The doctor's first instinct was to again place him back on the drip. Because Jianna was intimately involved in this patient's care throughout his stay, she knew the bigger picture of his instability on the drip. She advocated to at least try a different oral medication to see if that was something that would work for the patient to decrease the yo-yo effect of being on and off an intravenous treatment. The physician's agreed that this was something that could work for this patient, however the patient did not agree. After Jianna spent much time in with him explaining the option and what it meant for the patient, he agreed to try the medication. Amazingly this medication worked perfectly for him and it was unnecessary to restart him on the diltiazem!
Jianna learned how to work with this difficult patient and bonded with him. I even heard him joking around and laughing with her several times. I believe with all the advocating Jianna did for this patient made a huge difference and made him able to discharge sooner rather than later. Jianna went the extra mile to show him that she cared and I believe that is why he was so agreeable to care when she was caring for him.