Jennifer Smith
January 2024
Jennifer
Smith
,
BSN, RN
5 Acute Care Surgical Specialties
Penn State Health- Milton S. Hershey Medical Center
Hershey
,
PA
United States
At some point, I shared with Jen that I had a feeling of "doom" and that I would not survive this surgery. After hearing this, Jen quickly took lead of the team and managed every point of my care over the next few hours. Jen never left my side. She held my hand and spoke to me in a calming tone.
Recently, I have been able to celebrate my one-year post-op anniversary for pancreaticoduodenectomy (Whipple) surgery. During this time, I was able to reflect on the care I had received while undergoing surgery and my subsequent hospitalization at the Penn State Milton S. Hershey Medical Center. It was the day after surgery, as I was downgraded from intermediate care to 5 Acute Care and given a room close to the nurse's station. Throughout the day, I had been kept very busy and occupied by many visitations from family and loved ones as physicians, students, nurses, and other healthcare providers continued my care, provided medications, information, education, and reassurance; however, later that night, when the activity had slowed, I started to feel the first effects of my intraoperative pain medications beginning to wear off. I had not yet requested pain medication, but at some point later in the evening, my tolerance level was beginning to wane and I pushed my call bell to inquire about something for my discomfort. I was given IV Tylenol which seemed to ease my pain for a short period of time; but within a few hours, my pain had returned and I again contacted the nurse to inquire about additional medications. At that time, I was told that I was on a "pathway" and that I could have Tramadol in addition to my IV Tylenol. Since I had started to tolerate clear liquids, it was agreed that I would take the tablet, which again brought only minor relief.
About 2 hours later, my pain returned with a vengeance, and I had to continually change positions in the bed. I was having difficulty taking deep breaths, and it felt like my chest and trunk were being compressed. I rang my call bell and Jennifer Smith, RN, CSL came into the room. She quickly assessed me and reassured me that she would not leave me alone. Her actions were deliberate in helping to ease my discomfort and addressing a situation that seemed rather alarming to me. She stated that because I had received intraoperative morphine, there was no order for additional pain medications due to the risk of respiratory compromise; however she did say that she would contact the physician on-call to see if a one-time dose could be administered. Jen never left the room (seeing how uncomfortable I was) and instead contacted the on-call team from my bedside. After some discussion, they decided to do some urgent tests since my heartrate was elevated and I was short of breath. Radiology appeared at the bedside with a portable x-ray machine and others piled into the room to attend to my acute symptoms. At some point, I shared with Jen that I had a feeling of "doom" and that I would not survive this surgery. After hearing this, Jen quickly took lead of the team and managed every point of my care over the next few hours. Jen never left my side. She held my hand and spoke to me in a calming tone. When the on-call team appeared in the room, Jen communicated my symptoms to the team in an assertive and educated manner and advocated for the care that I needed despite the team's continued response that I was "on a pathway" and that they could not veer from it without the approval of their attending. Jen immediately stated, "he needs pain medication - either you call your attending or I will." It was also during this time that Jen reminded the team that my surgery had taken over 12 hours and that the timeline they were following on the pathway did not appropriately account for those additional hours. After presenting this clinical picture to the team, an order for additional pain medication was entered and administered, and I soon had relief from many of the symptoms which had been left to spiral to extreme.
Upon reflection, I recognize how fortunate I was to have a nurse leader who is not only an expert in providing excellent clinical care and compassion to patients but is also proficient in her knowledge of pathophysiology, medication management, and interpersonal communications as my caregiver and advocate. Today, I work with Jen as a colleague and consistently see these qualities again and again in her professional practice.
About 2 hours later, my pain returned with a vengeance, and I had to continually change positions in the bed. I was having difficulty taking deep breaths, and it felt like my chest and trunk were being compressed. I rang my call bell and Jennifer Smith, RN, CSL came into the room. She quickly assessed me and reassured me that she would not leave me alone. Her actions were deliberate in helping to ease my discomfort and addressing a situation that seemed rather alarming to me. She stated that because I had received intraoperative morphine, there was no order for additional pain medications due to the risk of respiratory compromise; however she did say that she would contact the physician on-call to see if a one-time dose could be administered. Jen never left the room (seeing how uncomfortable I was) and instead contacted the on-call team from my bedside. After some discussion, they decided to do some urgent tests since my heartrate was elevated and I was short of breath. Radiology appeared at the bedside with a portable x-ray machine and others piled into the room to attend to my acute symptoms. At some point, I shared with Jen that I had a feeling of "doom" and that I would not survive this surgery. After hearing this, Jen quickly took lead of the team and managed every point of my care over the next few hours. Jen never left my side. She held my hand and spoke to me in a calming tone. When the on-call team appeared in the room, Jen communicated my symptoms to the team in an assertive and educated manner and advocated for the care that I needed despite the team's continued response that I was "on a pathway" and that they could not veer from it without the approval of their attending. Jen immediately stated, "he needs pain medication - either you call your attending or I will." It was also during this time that Jen reminded the team that my surgery had taken over 12 hours and that the timeline they were following on the pathway did not appropriately account for those additional hours. After presenting this clinical picture to the team, an order for additional pain medication was entered and administered, and I soon had relief from many of the symptoms which had been left to spiral to extreme.
Upon reflection, I recognize how fortunate I was to have a nurse leader who is not only an expert in providing excellent clinical care and compassion to patients but is also proficient in her knowledge of pathophysiology, medication management, and interpersonal communications as my caregiver and advocate. Today, I work with Jen as a colleague and consistently see these qualities again and again in her professional practice.