Holly was the Charge Nurse as well as care nurse for a patient admitted two days prior for acute and persistent nausea and vomiting. The patient reported a 20-pound weight gain in the past three months and was in so much pain, she refused to move, walk, help her caregivers get her out of bed, or do any physical activity. The patient was hostile with staff, providers, and family, refusing pain medication while threatening staff who tried to touch her or help her reposition. Her family felt helpless as the patient refused all care, including transfer to a skilled nursing facility where she could work to regain her strength. Her husband is also ill and cannot help care for her. She would not discuss a plan of care with the Case Manager, her family, or providers. She simply was shutting down.

During the bedside shift report, Holly reached out to touch the patient's abdomen and the patient wanted to “call the police” to report Holly for hurting her. Clearly, this patient and family needed some strong intervention and a solid plan of care. Holly and the Case Manager worked to contact the son and request a care planning meeting. While she waited for the family to arrive, she completed her physical assessment of this patient, working hard to reassure the patient she was there to help her and did not want to hurt her.

Holly prompted the patient on how to help move, again being met with hostility and what Holly quickly identified as severe pain and fear. Holly also focused on the patient's distended abdomen as she had during the bedside shift report. She asked the provider to come to the room so she could review her findings and assessments.

When calling the provider to the room, she was heard saying, “I think she needs to be tapped.” It was identified this patient would be a possible candidate for a paracentesis. Together with the provider, Holly helped organize the procedure, educate the patient and the family on what the procedure included, and together they obtained the patient’s consent. Even while preparing the patient for the procedure, the patient continued to verbalize her discontent with just about everything.

Holly maintained a calm and supportive tone and touch, reassuring the patient that this procedure could really help her feel better, reduce her pain and allow her to increase her mobility and regain her strength. Post-procedure, the patient was informed of the 11 liters / 25-pound weight loss removed from her abdomen. The patient felt so much better that she agreed to go to skilled nursing for intense physical therapy.

At the time of discharge, the patient asked Holly for a private moment. She thanked Holly for saving her life, apologized, and asked Holly if she could hug her, even with COVID all around. Holly hugged her. If not for Holly’s expert bedside clinical assessment skills, her calm response to hostility, recognizing it for the fear it was, and applying full human compassion for this person, the patient could have down spiraled past a point of intervention. Holly is an outstanding nurse who is known for seeing past a patient's “bad behavior” to identify the true source of pain. Her confident manner is reassuring to her patients and she quickly establishes a level of trust with them and their families.

This son and daughter-in-law were outwardly grateful for her assessment, clinical knowledge, and willingness to ask the provider for reassessment in the plan of care. Her ability to talk with and “get through” to their mother so that she may agree to get the care she needed allowed them to be a support person versus caregiver and gave them time to better prepare for her continued care needs.