This was truly a multidisciplinary coordinated effort on Jes and Brittany. They showed excellence in nursing care. Our pt "Smiles" has a long psychiatric hx and an organic brain injury. Due to a stroke no motor function on her left side, ie: schizophrenia, drug abuse, mental and physical abuse, rape and murder all played a part in this pt's dynamics. Her mother died suddenly and there was no one to care for her. Patient. "Smiles" could not feed herself much less provide perform activities of daily living. Jes and Brittany had to help this patient grieve (to any one who walked in her isolation room she asked “Did you hear about my mama?” She’s dead. I want my mama. I miss my mama.”), control her anger (she had out bursts of cursing, yelling and hitting), be confidential from press, family, and visitors, and get to her mother’s funeral.

Jes spent the better part of an hour coordinating care from Medicine and Psych services incorporating IOP-level of care on a non psych unit, for example developing a plan regarding telephone use. Brittany consulted with the Psych Liaison RN.

The next step was educating all staff on the issues so that a cohesive plan of care was established. Jes met with the Case Manager and Social Worker with the directive to get the patient to the funeral because it is the right thing to do. Brittany had the MDs write the order so that legally the patient could leave the grounds yet have the order open ended enough for the timing to be adjusted as needed. With CM and Social Help, calls were made to DSS to look for transportation and a care giver. In the interim, discussion was held to address with Medicare. Due to press and volatile family members, Jes has to make the patient confidential for her protection so Brittany had to work with Security adjusting changing what is possible in confidential rules – making the patient confidential for reasons not addressed in policies. Jes and Brittany also moved the patient to another room to increase security.

Then family comes in from out of state and Jes and Brittany have to adjust the confidential issues based on the needs of the patient and do so without warning. Their decisions were based on what is right for “Smiles.” The next day Jes finds out that a wake for the patient’s mother is being held and arrangements start to get “Smiles” to this wake. Hair needs to be fixed, clothes to be brought in, anti-anxiety and anti-psychotics meds need to be timed appropriately, and transportation, custody issues, liability issues and the like are coordinated by Jes .

All the while Jes has 3 – 4 other acutely ill patients for which to care and Brittany, as the Charge Nurse, has 26 patients and 10 – 11 staff to oversee. These nurses perform all these tasks, coordination of care, and integration of the total needs of the patient and family and community with grace. Just what nurses do every day.