AACN News—September 2000—Practice

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Vol. 17, No. 9, SEPTEMBER 2000

Circle of Excellence: 3M Health Care-AACN Excellence in Clinical Practice Award

Sponsored by 3M Health Care, the Excellence in Clinical Practice Award recognizes acute and critical care nurses who embody and exemplify the principles of acute and critical care nursing practice.

Recipients of this Circle of Excellence award received complimentary registration, airfare and hotel accommodations for AACN’s National Teaching Institute and Critical Care Exposition in May 2000 in Orlando, Fla.

Following are excerpts from exemplars submitted by recipients of the awards.

Judy N. Nichols, RN, CCRN
Columbia, S.C.
Palmetto Richland
Memorial Hospital

As critical care nurses, we have not only the power to make a difference in the lives of our patients, but also the passion to use this power to change outcomes. For critical care nurses who are committed to excellence, our promise is that we can and will make a difference, based on the needs of our patients in this ever-changing healthcare system.

Nursing, especially critical care nursing, is different from most professions, because it hinges upon life-altering events and the balance between life and death. Each day, I am required to give a part of myself to my patients and their families. I am a bridge between “high-tech” and “high-touch.”

In this case, Carolyn, a 52-year-old female, was admitted to our unit following a cardiac arrest in the emergency department. Although she was successfully resuscitated, she was engaged in a life-or-death, roller-coaster ride for six weeks. Her family placed their trust in me.

One of Carolyn’s greatest hurdles was severe depression and psychosis. Because her family members did not understand how the system worked, they trusted me to get the appropriate help for her. I could not let them down. I was the patient’s advocate.

After the appropriate referral and treatment, Carolyn was discharged to a rehabilitation facility. Unfortunately, she died three days after she returned home from the rehabilitation facility. Her family called to invite me to her funeral.

I feel richer because of just this one opportunity to make a difference in someone’s life. Think how many opportunities critical care nurses have to make this kind of impact. Each day renews the power, the passion and the promise I must uphold to fulfill my commitment to clinical excellence.

Mildred Swan, RN, CCRN
Raleigh, N.C.
Wake Medical Center
Teddy underwent coronary artery bypass grafts to three vessels. Because of oxygenation problems, he was not extubated until the early morning of the first postoperative day (POD). He was the perfect patient, who did everything asked of him. However, on the second POD, he required reintubation and was put back on the ventilator.

I was assigned to care for Teddy on the night of his third POD. Although his fraction of inspired oxygen (FIo2) was 75% and +12cm H2O positive end-expiratory pressure, his oxygenation was still marginal. Peak airway pressures were 65cm H2O. I have seen the benefits of rotational therapy for patients with oxygenation problems and thought it would be an excellent treatment for Teddy. Because I could not get a rotational bed at that late hour, we had to “make do” until morning.

I developed a schedule for turning Teddy every 20 minutes, realizing that when we started turning him, his Spo2 would drop. The “knee jerk” reaction is to turn the patient back to the position where the numbers were more favorable. My team and I decided that, if Teddy’s Spo2 dropped to less than 86%, we would reposition him after one minute and continue to turn him at the next scheduled interval.

By the fourth hour, we were able to start weaning the Fio2. His peak airway pressures started coming down and, by morning, his peak airway pressures were 48cm H2O and the Fio2 was down to 40%. Arterial blood gases were within acceptable range.

Impressed by Teddy’s progress, the pulmonologist ordered a rotational therapy bed for the patient. After four days of rotation therapy, Teddy was extubated on the sixth day. I believe that I played a significant role in Teddy’s recovery by providing “manual” rotational therapy and showing its benefits.

Carmelit Gefen, RN, CCRN
Milford, Conn.
St. Raphael Hospital
Tom Barron, a 49-year-old global idiopathic cardiomyopathy patient was awaiting a heart transplant when he was admitted to my care. Already in full-blown cardiogenic shock, he quickly progressed to renal failure that required continuous veno-venous hemofiltration (CVVH). An allergic reaction to heparin further complicated his course and caused considerable discomfort. Tom’s care was physically and emotionally draining. I had immediately bonded with Tom and his wife Nina, making it difficult to remain emotionally uninvolved.

Tom’s passion was his Harley Davidson. Nina, who rarely left his bedside, decorated the room with motorcycle posters. For her own well-being, it was essential to include her in Tom’s care plans.

A tragic blow came on the third day of Tom’s stay, when acute renal failure forced his removal from the transplant list. His optimistic attitude quickly deteriorated into depression, further complicating his care needs. Although devastated by the news, Nina was able, with my help, to walk the fine line between grieving and being “strong” for Tom.

I began to share my thoughts with Tom and Nina, opening the door to an honest and painful discussion of his prognosis and the possibility that he would not recover. Dialogue about an advance directive was initiated. To Nina’s great relief, Tom was able to participate in the decision-making process.

The CVVH was discontinued and the vaso pressor support was gradually removed. Tom slipped into a coma a few days later. Shortly after his 50th birthday and three months following admission to our unit, Nina made the difficult decision to withdraw all life support.

Although the outcome was not happy, I know I helped Nina to endure the most difficult experience of her life. I also hope that I helped Tom ride his last ride comfortably, fearlessly and pain free.

Kathy J. Dietz, RN, BSN, CCRN
Fort Collins, Colo.
Poudre Valley Hospital
The human spirit is an entity in which healthcare providers become the students and those they care for become the teachers. It is an entity in which sophisticated machinery, medical regimen and technology make vague impressions in the vastness of the spirit. Although most of our energy in healthcare is centered on the preservation of life, we must be aware and preserve the garden of the spirit, which has been carefully sowed and woven to create “life.”

At 76 years of age, Phillip epitomized the richness of the spirit, which was apparent even as the gravity of his health ensued and his physical condition deteriorated. He was a “wiry Irishman,” rich in charm and wit. He shared his life openly and provided many stories concerning the “things I learned.” His “bride” of 55 years enhanced his spirit and provided the seal to a relationship rich with honesty, clarity and depth.

As his health deteriorated and choices as to the plan of care waned, their strength was evident in the decisions and path they chose. The simplicity of their relationship was evident as they discussed their garden, which they tenderly worked every year together. Phillip provided the answers to her question of whom she should call for assistance and the amount of fertilizer and watering needed. Betty expressed how much she would miss sharing the tulips coming up, often “peeking out” after a late spring snow. Together they encircled the caregivers and helped us to grow by the richness and vastness of their relationship.

Phillip and Betty’s circle of life had grown in all those they had touched and taught that life’s most preserving factor was not the extension of one’s life, but the reality that the individual spirit provides a vehicle in which our own immortality grows.

Michele C. Balas, RN, MSN, CCRN, CRNP
Hatfield, Pa.
Hospital of the University of Pennsylvania
As I replay the memory of the day in my mind, the event seems almost surreal. Charles was admitted to our ICU following a motor vehicle crash. His injuries included a fractured femur, several rib fractures and pulmonary contusion. He developed acute respiratory distress syndrome, became floridly septic and went into multiple organ failure. Although these seemed to be almost insurmountable odds for a 70--year-old man, Charles survived.

Prior to the accident, Charles and his wife Maria were planning the wedding of their youngest daughter Kathy, a fellow nurse. Now, after being in our ICU for two months the “big day” had arrived. I realized that this was a wonderful chance to make a bad situation somewhat brighter. That day, Charles’ nursing assistant and I decorated his room and placed small party favors in strategic locations to distract from the technology.

Hair combed, glasses on and passe-mur valve in place, Charles was ready. Maria arrived first and looked absolutely spectacular. It was as though a weight had been lifted off her shoulders when she saw Charles and the decorated room. Charles could not take his eyes off her. When he said she was the “most beautiful woman in the world and that he loved her,” many of the nurses’ eyes filled with tears.

Next, the bridal party walked in, followed by Kathy. When she entered her father’s room, both began to cry and hugged each other. Charles kept saying, “You look so beautiful, so beautiful.” I can’t remember ever witnessing such a touching moment. The rest of us just stood by quietly in awe, watching the family celebrate not only the wedding, but also Charles’ recovery.

Award Exemplars Are Due Nov. 1, 2000

Exemplars for Circle of Excellence awards for 2001 are due Nov. 1, 2000. The annual awards program applauds exceptional practice on the part of critical care nurses in a number of arenas. For more information about the individual awards, call (800) 899-AACN (2226) or visit the AACN Web site at http://www.aacn.org.

Apply for an AACN Nursing Research Grant

Several grants to support research relevant to critical care nursing practice are available from AACN. The deadlines to submit proposals for some of these grants are approaching. Following is information about these grants:

AACN Data-Driven Clinical Practice Grant
This program provides six awards of up to $1,000 to stimulate the use of patient-focused data or previously generated research findings to develop, implement and evaluate changes in acute and critical care nursing practice.

Funds are available for new projects, projects in progress or projects required for an academic degree, as long as all other project criteria are met. Collaborative projects involving interdisciplinary teams, multiple nursing units, home health, subacute and transitional care, other institutions or community agencies are encouraged.
To qualify for an AACN Data-Driven Clinical Practice Grant, the principal investigator must be a regular or affiliate member of AACN and not currently conducting a study funded by an AACN research grant Applications must be received by Oct. 1, 2000.

AACN Clinical Practice Grant
This $6000 grant supports research that focuses on at least one of AACN’s clinical research priorities.

The principal investigator must be both an RN and a current member of AACN. Research
conducted in fulfillment of an academic degree is acceptable. Proposals must be received by Oct. 1, 2000.

AACN-Sigma Theta Tau Critical Care Grant

This $10,000 grant, which is cosponsored by AACN and Sigma Theta Tau International, funds research that is relevant to critical care nursing practice.
The principal investigator must be an RN. The proposed study may be used to meet requirements of an academic degree. Proposals must be received by Oct. 1, 2000.

To obtain application materials and instructions, call (800) 899-AACN (2226), or visit the “Research” section of the AACN Web site at http://www.aacn.org.

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