Applying Modeling and Role Modeling to Intermediate Progressive Care Unit Grand Rounds with Helen Erickson, PhD, RN
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| Lois Shillito and Kathy Cook with Helen Erickson |
Intermediate Progressive Care Unit (IPCU) hosted Dr. Helen Erickson in the first “Modeling and Role Modeling (MRM) Grand Rounds April 29. Application of our Professional Practice Model based on MRM theory to the diverse patient population in IPCU is challenging. PPM once understood by nurses is a guide to delivery of targeted care based on patient needs. These nursing interventions then lead to more satisfied patients with better outcomes. Katherine Cox, BSN, RN, Kathy Cook, BSN, RN, Esther Hazlewood, RN, Jenny Ramos, RN, and Lois Shillito BSN, RN, shared their personal experiences of the challenges and the benefits of integrating MRM in their nurse/client relationships.
Nurses face the challenge of adapting to ongoing changes and meeting the demands in healthcare added to the acuity of our patient population. Elements of care are being measured to provide better patient outcomes. Nursing can become so focused on achieving certain measurements that we can forget that we are working with an individual human being with basic human needs. We can only realize these needs when we are able to give ourselves a few moments to see our patients through their own eyes and see their disequilibrium between body, mind and spirit. We need to acknowledge that, in caring for our clients, we must address these three areas of the patient’s world to provide holistic care for better patient outcomes.
The following case is an example of how nurses were able to understand a unique individual patient and address this patients needs.
Beatrice (assumed name), accompanied by her father was brought from the Emergency Center to our unit during the night shift. While staff settled her into the new environment, her father approached me to share some of her history. She was 28 years old, but has the mind of a 12 year old. Born with hydrocephalus, she had several surgeries at another facility resulting in cardiac arrest, tracheostomy, and the inability to walk. She presented with fever, shortness of breath and diagnosis of pulmonary embolism.
The first night must have been frightening, as she was in an unfamiliar environment. While her father was welcome to stay he needed to attend to wheelchair-bound wife. She had also been a patient in our unit and they expressed confidence that Beatrice would be given the same level of care. This conversation opened a window of trust and facilitated an understanding of how to care for Beatrice that would be essential for getting her through procedures and daily care.
First challenge was a chest CT. I reassured her that I will be with her in CT which made her smile. Positioning her for the procedure was quite a challenge, because of limited ROM. With constant coaching and encouraging words regarding how much she is able to do, Beatrice successfully completed the CT. She had a big grin on her face, knowing that she did a great job during the procedure. We all praised her after the CT.
Daily visiting hours were always something Beatrice looked forward to. Her mom and dad came in the evening and staff allowed them to stay beyond the visiting hours, playing games or watching her favorite TV show together. I would hear laughter from the room and look to see her laughing with her parents. Occasionally, the father would perform trache suctioning. Beatrice would give thumbs up during these happy moments, perhaps reassuring me that she is happy and feeling fine. After mom and dad left, Beatrice experienced problems sleeping or would constantly be pressing her call light even after nurses had been in the room trying everything to make her comfortable. She would ask to be suctioned frequently just to get staff in her room.
Beatrice was in a room by herself. In reconsidering her emotional and mental equivalent to a 12 year old I asked if she would like to move to another room across from the nurses’ station. There she could see all the staff, and to this she smiled and nodded right away. So that morning, as soon as a room was available, she was moved to a room across from the nurses’ station, and from that point on she would hardly use her call light, as she began feeling that she was always with people. She still gave a thumbs up signal when I passed by, either a sign of reassurance for me or of appreciation for where was placed.
With all the collaboration of the different interdisciplinary team, Beatrice recovered and was discharged to a very supportive family. Emotions such as anxiety, fear, hopelessness, and powerlessness are not measurable, yet it takes very little effort to address these basic individual needs that are major factor to reach the goal of our patient’s holistic health. These basic needs should never be treated as a source of disruption, because all it takes is a moment or two of perception to understand the client’s world and to establish a trusting relationship, which is a basic essence of providing holistic care to achieve equilibrium of health for our clients.
