Great moments in nursing

Today was a great day.  I didn’t think it would be great, but sometimes it’s nice to be surprised.

I admitted a very sick 1 day old infant yesterday afternoon.  He had a bulging fontanelle, lethargy, poor tone, and very frequent episodes of apnea (not breathing) & bradycardia (low heart rate) – signs of a very serious infection, likely meningitis.  After another nurse initially said we didn’t have an IV small enough for the baby, L, one of our nurses, stepped up to the task and not only started an IV with the less-than-ideal IVs that we had, she also gave the baby everything I’d ordered to be given right away.
Then the nurses asked me what they should do that night when the baby’s heart stopped.  I said that if they corrected his apnea – pauses in breathing – his heart wouldn’t stop.  They repeated the question, reminding me that they have a lot of other patients to see; they were worried they wouldn’t notice if the baby stopped breathing.  I told them that if the baby’s heart stopped they could use the ambu-bag (used to breathe for the baby) and do chest compressions like M and N, our visiting neonatal nurses, had taught them.
I noticed that the baby was still bleeding from where I’d pricked his heel (to check his blood sugar) for quite some time after I’d stuck him.  Even applying pressure for 10 minutes wasn’t stopping it.  I asked for vitamin K to help stop the bleeding, but was told we didn’t have any.  Not good.
So I left the baby in a warmer with a monitor attached to check his heart rate.  The monitor was of dubious value since the baby’s grandmother (the one watching the baby) could not count.  She also had failed to recognize that the baby had stopped breathing several times while we interacted, even when I pointed out to her that the child’s chest wasn’t moving.  She was the only family member available, so I taught her how to stimulate the baby when he stopped breathing and told her to call for help if that wasn’t working.
I let the nurses know I left an ambu-bag at the bedside, but left feeling very doubtful about this baby’s chance of surviving the night.  So imagine my surprise when I arrived this morning to find the baby breathing consistently, with a neat bandage on his heel and another on his thigh – where he’d been given an injection of vitamin K!  I asked the parents in the room what had happened.  They told me how the baby was alive because of the great nursing care he had received.  Apparently during the night he had begun to bleed from his mouth.  Our nurse L came in, suctioned the baby’s mouth, used the ambu-bag, gave chest compressions, and successfully resuscitated him!  Everyone in the room was very impressed – none more so than me!  (She is also the one who gave and documented the dose of vitamin K she administered.  Not sure where it came from, but I’m thankful she gave it!)
I saw L this afternoon and congratulated her on saving the baby’s life.  She was beaming.  She told me how our visitors M and  N had told her that they recognized she had a lot of strength that she could use to help give good neonatal care – the very diplomatic end to a conversation with her about not yelling at parents, as I recall.   I told her what a great job she had done, and let her know I’d already sent M and N an email to share the good news.  It was fantastic.
The baby is still really sick, but he got the best chance at surviving this by getting such outstanding nursing care last night.  I’ve talked about nursing training as an effective intervention here before, but it is just so heartening to see how M and N’s training has had a direct and meaningful impact on patient care here.  I am extremely thankful for our visiting nurse educators and feel very lucky to have such great allies in my quest to improve care here.
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9 Comments

  1. The DAd

     /  April 2, 2012

    wow finally something to cheer about. Take the wins when ever and whereever you find them. It would be nice to improve your batting average, “BUT THIS AINT’T BASEBALL”
    this is the real world, the reality sometimes is disappointing. So i hope tomorrow morning you will have the celebratory breakfast “spaghetti and hot dogs”

    Good news is always welcome, perhaps things will get better with time, but keep one foot firmly on terra firma.

    Love ya

    the DAd

    Reply
    • Thanks Dad! I know it’s not a big change, but it is encouraging to see that things can improve, even a little. I jumped the gun with the celebration – we had spaghetti breakfast this morning! I guess I just didn’t realize what I was celebrating yet.

      Reply
  2. What a wonderful report Sara. It is so exciting to read how happy and rewarded you we’re about your most recent experience. I’m so proud that your my neice Sara, you are truly a very special person.

    Love,
    Uncle Dick

    Reply
  3. Karen Stockmal

     /  April 3, 2012

    Sara,

    It is really great to hear from you. We look forward to your posts and are glad you are seeing progress. We love you!

    (Oh, and Elise’s report was a huge hit – her teacher emailed me and said the girls in her class were fascinated to learn about the differences and similarities between here and Haiti.)

    Stay strong!
    Love,
    Karen

    Reply
  4. Mom

     /  April 4, 2012

    It sounds as if you really are helping to improve the overall care of your little patients there, Sara, one by one. Especially the nursing care, which as you have described, covers more hours of the day than the doctors’ care there. Little steps turn into big ones and the fact that the Blan has perhaps modified and improved the care of the nurses is HUGE. We continue to be so proud of you ……Love, Mom

    Reply
    • Thanks Mom. It’s not so much me making the changes, it’s the nurses. I am really proud of the work they are doing. I’m just providing the support; this is all them.

      Reply
  5. Anna Montana

     /  April 8, 2012

    So I have no idea how you could implement something like this at your hospital in Haiti, but at our hospital in Montana (sometimes not that far off from Haiti–or so it feels like it) we have a “Caught you at your best” system. If one employee (doesn’t matter who–doc, nurse, cafeteria worker, person who cleans the floor) sees another employee (again doesn’t matter who) doing something really great, they can fill out a “Caught you at your best” paper and somehow that person gets recognized. I think it goes to their manager or goes in their file or something. Some of them get published in the weekly hospital newsletter. We also have a separate system for family memebers and patients to fill out about staff members. If we get one of those, we get a pin and for each 5 subsequent ones we get a charm for the pin or something like that. I’ve only had one from a family member. (I like to think its because no one can spell my name.)

    So whether its on an entire hospital level or a smaller level, maybe you could devise a simple way to recognize employees who do things like this nurse did. Our system doesn’t involve monitary rewards and I don’t think yours would have to either. Just recognition of a good job. Even something simple like a star on their name badge (do they wear name badges?)

    Just my two cents from Montana!

    Reply

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