I arrived to work well rested and ready to start the day. I had just returned after a two week long vacation. Because of the time off, I arrived to 7 East to find that the assortment of patients was not familiar at all. As I began getting reports on my patients, one in particular I started to feel a little anxious and stressed. At first glance I could tell I would be busy for the next twelve hours. Lynda was a 45 year old woman that was admitted almost a week ago after having an emergent tracheostomy placed.
Lynda was newly diagnosed with laryngeal cancer with already having several other diagnoses including: seizure disorders, mild mental retardation, behavioral issues, and was legally blind. Lynda also lived in an apartment for assisted living, and her only support that was occasional present was her brother, Steven. That first day I have Lynda, she was started on a full liquid diet. It quickly became clear that she was aspirating food.
She was very angry with me after I took away her first real meal she was having in 5 days.
After the physicians came to see Lynda and she had a swallow evaluation preformed it was decided that the best option for Lynda would be to have a percutaneous endoscopic gastrostomy (PEG) tube placed, for feedings. Lynda was added to the schedule and had her PEG tube placed that day. She was not happy with me and blamed me. I explained to Lynda why she needed to have the PEG tube, she told me that she understood why, but just wanted to go home. I told her that we just had to look at this as another path she had to take in order to get home.
I told her that if she was able to care for her tracheostomy that a PEG tube would be nothing. It was at about this point I learned that even though, she had already been on our floor for almost a week with what would be a permanent tracheostomy no one had yet taught her to suction herself. As they were calling for her to go downstairs for the PEG tube placement, I assured Lynda that she was strong and that she would be able to do this. I told her that I would be there when she came back, and I would be there all week to teach her. With that Lynda felt confident and off she went.
As Lynda was having her PEG tube I was thinking about all the questions I had about Lynda. I started reading her history and physicals, and the clinic reports. The first clinic appointment she had was when she came in almost one week ago. At this visit she was told that she was not breathing adequately enough and it was because she had a large tumor that was starting to block off her airway. She was told that she need to have a tracheostomy and soon before it would close off her airway, and then she had two options radiation so see if it would shrink the tumor or surgery to remove the tumor.
She agreed to have the tracheostomy and planed to have surgery as it was explained to be her best option. It really didn’t say if Lynda understood the full extent of the surgery she would have, she just saw it as something she had to do and then she could go home. While waiting for Lynda to come back I met her friend Sister Mary. Sister Mary told me all about Lynda, about how she has known her since she was a teenager and all the hardships that Lynda has gone though.
Of the many things I learned about Lynda from Sister Mary was that Lynda was a trooper and she would be able to care for her tracheostomy and PEG tube. As my shift came to an end, and Lynda was still in recovery. I decided to write Lynda a note that state for her to get some rest because we had a busy day ahead of us tomorrow. Day two, my mission was to teach Lynda the basics of self suctioning. As I walked into her room this morning she was all smiles and told me she was ready to learn. We started with the basics showing and explaining her tracheostomy tube and the suction catheters to her.
I then gave her a dummy doll we teach patients how to suction on, and she was able to show all the correct steps that I have taught her on the dummy. At this point in the day after lots of practicing Lynda was able to remove the inner cannula tube of her tracheostomy and clean it. The look on Lynda’s face was that of incredible confidence, I was truly impressed with her. By the end of our second twelve hour shift, Lynda had learned how to suction herself. It was passed along in report to simply encourage her independence in suctioning herself.
Day three, my mission was to teach Lynda the proper care of her PEG tube, and to continue with the encouragement of her suctioning herself. After walking her though a bolus feeding in the morning, she agreed to do the next one. Lunch time came around and sure enough, she was able to complete the bolus feeding with minimum assistance. By the time came for the next feeding she was going to get the can of food to do it herself when I had walked in the room. She laughed and told me I was right that the PEG tube was a lot easier than suctioning.
At this point in Lynda’s stay I knew that she would be going home soon. Later that evening, while discussing Lynda’s progress over the last few days with the physicians I asked them what the plan was and instructed them that we needed to get nutrition, social work, and case management involved so that she could go home. The physicians stated that they would place the consults that I requested but as for discharge they were unsure about when this would happen because Lynda’s brother doesn’t think she can care for herself on her own.
I was shocked to hear this, the brother who I had not seen in the last three days, and from what I heard hadn’t even come to visit Lynda at all. I voiced my concerns with this to the physicians, and told them she has shown myself and other nurses her ability to care for herself, and maybe they should suggest that her brother come in and see her care for herself. I had their attention, and they called the brother to tell him all that she has done and suggested that he come in to see her new abilities because they would like to send her home.
Before I left that evening I told Lynda about what the physicians had said and about her brother’s fears. I told her that it was now her time to shine if she wanted to go home and that I believed in her. After being off for two days, I was so delighted to hear that Lynda was going to go home that day. Lynda requested to have me be her nurse that day, from what I gathered she had been asking where I was. Her discharge went off like a breeze, everything fell right into place. Lynda told me that she was going to miss me, and I told her she would see me soon enough. She was coming back for her surgery in two weeks.
When Lynda came back for her surgery, she had wrote me a letter, telling me that I was more that her nurse, I was her friend and that she was grateful I believed in her. Lynda had become a more difficult patient to have after her surgery, and she would need frequent encouragement to perform the tasks that we already knew she could do. It took Lynda a period of time to realize that all the nurse’s and not just I knew that she could do all these things. Once Lynda realized that it was her choice and responsibility, she started suctioning and feeding herself again.
Even to this day Lynda comes to visit me on the floor when she comes in for her clinic visits. I always get a big hug and smile from her. She reminds me that the things I do every day as a nurse make such a positive impact on my patients. This experience taught to trust my instincts and to believe in my patients. I am no longer afraid to speak up with it comes to advocating for my patients. My role as an advocate for Lynda helped her to obtain her main goal of going home. I was able to offer support, guidance, and knowledge to help ensure that she would be able to care for herself in a safe manner.