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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.