Download Clinical Narrative - Patient Care Services

Clinical Narrative
Susan Gage, MSN, RN
Ellison 16, General Medical
The Ellison 16 General Medical Unit serves a wide range of patients, often those with
complex medical, psycho-social and disposition issues that present unique challenges to
the multidisciplinary team. This is particularly true for the nursing staff who are at the
bedside. I am a seasoned nurse on the unit, and I also serve in the role as resource nurse
and is geriatric resource by my co-workers and unit leadership.
Ms. J. was came to the hospital following a stroke and had a long stay due to an
independent living situation that was no longer safe for her. Early in her course she was
quite confused and agitated, often refusing care or combative with staff attempting to
provide her care. I began to try to lead creative problem solving for this patient, by
drawing in resources (both geriatric and psychiatric clinical nurse specialists, chaplains,
PT/OT, pharmacist and social worker) to identify physiological problems that needed
intervention (such as urinary tract infection), to streamline medications (less is often
better), to determine ways to calm and reassure Ms J. (give her space, sing a hymn) and
to provide sensory stimulation, meaningful activity and social interaction.
Ms J’s delirium resolved, but she was quite demented at baseline. I learned more about
Ms J’s life, her strong work ethic, deep religious faith and incorporated this into her care.
Thanks to this patient-centered, geriatric-focused approach, Ms J was able to participate
in social interaction, and her agitation resolved. This paved the way for a trusting
relationship with staff. The staff was creative in fostering sensitive and individualized
care for this patient and her family. The patient’s room became her apartment, and she
would take her medications in ice cream or ensure pudding. She liked to make her own
bed, fold linen, sing hymns and look at Beacon Hill, and talk about her work and church.
An evidence-based, geriatric centered approach was instrumental in identifying possible
contributing factors for her agitation and confusion.