Profiles In Practice: Skills, Compassion and Collaboration Really Deliver
When a pregnant patient with cardiomyopathy was admitted to BWH in June, nurses, physicians and staff from units throughout the hospital collaborated extensively to provide the best care possible, bringing Christine Clayton and her baby to a favorable outcome.
“It was Nursing at its best,” said Connors Center-5 Nurse Educator Susan Hayes. “We placed staff where they needed to be to give her the appropriate care.”
Dr. Alison Stuebe, who coordinated Clayton's care, found the nursing care exceptional. “I was incredibly impressed with how nurses stepped outside their traditional job descriptions to accommodate all of the patient's medical and social needs,” said Stuebe, a clinical fellow in Obstetrics and Gynecology.
Interdisciplinary Teamwork
Clayton came to BWH through Labor and Delivery and, due to her heart condition, was admitted to Tower 10 for the majority of more than a two-month stay. Nurses from each unit met often as teams on their units, with both Cardiology and Obstetrics units together and then as one multidisciplinary team.
Sylvia Francis, RN, Clayton's daytime nurse on 10A, was one of the caregivers responsible for ensuring that all clinicians involved were on the same page. She communicated with a multidisciplinary team of care providers from Cardiology and Obstetrics, and eventually Renal and Endocrine, because the patient was evaluated for diabetes insipidis.
Each week, doctors from the four divisions met to discuss the plan of care, which they shared with Francis and others.
“Every aspect of her care was closely monitored,” said Francis.
Being Prepared
To provide Tower 10 staff with a knowledge base, Dr. Lydia Lee of Obstetrics and Gynecology delivered a PowerPoint presentation on pregnancy, cardiomyopathy and resuscitation.
“We had to readapt our pace to provide consistency of care for a long-term patient,” said Tower 10 Nurse Educator Michelle Glowny, adding that Tower 10A usually treats patients able to be discharged within several days. “We assigned a group of nurses to know the plan of care and kept several others in the loop so they could help out if needed.”
Francis helped to communicate daily to Tower 10 nurses one critical piece of the plan of care-how to respond if Clayton went into cardiac arrest.
In this situation, Connors Center-5 physicians would need to deliver Clayton's baby within minutes if she didn't turn the corner. The Labor and Delivery team placed an emergency cart on the floor and informed Tower 10 nurses how to prepare for the delivery. At the start of every shift, Francis gathered a team of five nurses and assigned tasks to each in case Clayton went into cardiac arrest. Discussing the tasks and having a clear plan in place helped the nurses feel confident they could handle the emergency, which fortunately never happened.
Connors Center-8 Lends Expertise
Labor and Delivery also coordinated with the NICU and Tower 12, where Clayton was cared for post-partum, for the delivery. The staff of Connors Center-8 played a crucial role after the delivery in allowing her to keep her baby with her on Tower 12. “We readjusted our staff so we could provide 24/7 one-on-one nursing coverage for Clayton for six days,” said Connors Center-8 Nurse Manager Julianne Mazzawi, RN.
Prior to the delivery, antenatal nurses from Connors Center-8 made two to three visits to Tower 10 each day to monitor the fetal heart rate.
“Everybody wanted the best outcome for Christine,” said Francis. “Each piece of the plan of care depended on the next.”
Francis made certain that Clayton and her husband knew about every aspect of her condition and the necessary treatment. Another common thread throughout the hospital stay was a team of two social workers, Christine Dolan and Claire Welch, who were carefully attentive to support services during Clayton's extended hospital stay and following her discharge.
Clayton Remembers Nurses' Compassion
The careful communication and compassion exhibited by Francis and the many other members of the care team comforted Clayton. After several weeks on the floor, Francis surprised Clayton by bringing in pillows, blankets, a rug and other effects to give her room a homey feel. Staff also threw her a baby shower and a birthday party for her young son at the hospital, said Francis.
Clayton was touched by the warmth and kindness of her nurses. “I want to thank everyone who shared this special moment of my life, giving me the best care, the support I needed and the magic of love and understanding,” she said. “I will always remember those who helped me find strength through this experience.”