We get a lot of requests here in the administrative nursing supervisor's office. Tiffany received a call from a physician requesting assistance in trying to get a patient's parents here to OSUMC from China because their daughter had taken a grave turn. Tiffany had just started a 5-day work stretch. She went to the MICU to assess the patient's situation, collaborate with the physician and bedside nurse, meet the patient's significant other, and started blazing a trail to get the patient's parents here. Over the next days, she frequently went to check on the patient. She emailed and called numerous agencies - the US embassy and consulate in China to gain knowledge on visitation visas for an emergent health crisis. She looped the team in, and she kept the family updated about the steps necessary to obtain the visas needed. The patient continued to decline despite the team's best efforts. Tiffany continued her relentless efforts at trying to get this patient's parents here in time to say goodbye. The day came when they made the patient a DNRCCA. The family requested that when their daughter passed, she not be moved or touched for 24 hours per their cultural/spiritual beliefs. Tiffany communicated this request proactively and was trying to solve the issue before it became an issue. The patient died on the 5th day of Tiffany's work stretch. She attended a teams call with multiple directors, managers, and pleaded the patient's case, finally obtaining permission to leave the patient in her room for 24 hrs as requested per the family. She then took the death paperwork to MICU, went over it via Insight with her parents and boyfriend. Even if they weren't able to make it here, they were included and knew a team of people, led by Tiffany, cared for their daughter.
Tiffany went above and beyond for this patient and her family. She saw it through a full circle and was very inspiring.

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It was a Sunday afternoon when I received a notification from Tiffany Johnson, UH Administrative Nursing Supervisor, filled with urgency, compassion and commitment as she explained she was working to support an unexpected, terminally ill patient in the ICU suffering from a very rare, life-threatening condition in which the body’s immune system quickly attacks healthy blood cells. The patient was a PhD student, only in her 20’s and now intubated, requiring continuous dialysis, and on multiple life-dependent medications to sustain her life. Her prognosis was grim and suggested imminent death within the next few days of life.
After receiving a call from the physician team on a Sunday afternoon who had exhausted all resources, and without any success in finding the immediate support needed, Tiffany was quick to engage and take ownership of this challenging situation. She first responded to the unit and made an effort to sit down, listen, and fully support the patient’s boyfriend- a partner who was also from China and overwhelmed/unprepared to manage through this complication independently. The boyfriend shared that the patient’s family was unfortunately still overseas, but had been in touch with him from China and was hoping he could help arrange the patient’s affairs. Tiffany assured the patient’s boyfriend she would work through proper escalations to support him during this time and do whatever she could for him and the patient’s family. Tiffany then provided her contact information for additional support and reassured the boyfriend to reach out if he had any questions in the meantime.

Following this discussion, Tiffany truly expanded her reach and exemplified her leadership capability and commitment to those we serve by bringing together both internal and external teams-of-teams to expedite this case for additional resources. Tiffany contacted the U.S. Embassy, the Chinese Embassy in Beijing, and the Chinese Embassy in New York to determine and move forward with the next steps of escalation. She then worked with the patient’s boyfriend and family overseas to obtain the appropriate documentation, crafted a personalized letter of support, and submitted an expedited VISA application so the family could travel home to see their terminally ill daughter. From there, Tiffany engaged our Care Management, Patient Experience, and Destination Medicine departments for engagement, awareness, and support in the process. While these actions and follow-up would typically be managed through other supporting departments, Tiffany took it upon herself to share necessary information with stakeholders involved and requested her support in additional steps for follow-through on all communications over the next few days to come, despite not being scheduled to work.

Unfortunately, the erratic, terminal illness overtook the patient in the next few days to come; however, Tiffany’s support for the family and the patient’s boyfriend did not stop there. It was shared with Tiffany that, due to her religious background, the body of the deceased was requested to be untouched for 24 hours post-death. This request was met with uneasiness and challenged, as this religious request had many implications to consider and was not one that was historically considered. Tiffany was persistent in her approach and passionate about meeting the needs of the family, considering the situation. She went above and beyond to confirm, validate, and appropriately challenge policies and existing procedures to do what was best for the patient. She coordinated with our county’s Coroner’s office, reviewed current internal and external policy/procedures, and held discussions with stakeholders in our Morgue, Pathology, Epidemiology, Decedent Affairs, and Legal teams.

She then coordinated a multidisciplinary call to further engage our nursing teams and leaders across disciplines to discuss the patient's religious needs after death. Through this call, Tiffany shared the extensive background of this case and advocated for the need to honor the patient's/family's wishes to ensure the deceased body remained untouched for 24 hours. Despite previous practice and hesitation in thought, Tiffany’s message was felt with passion, commitment and remained patient-centric; ultimately leading to the decision to overcome historical habits and uphold the patient and family’s request. While the clinical outcome for this patient was undesirable, Tiffany’s actions exude inspiration, support, and commitment towards doing the right thing and going above and beyond for the patients we serve, even in the final hours of life. Tiffany, thank you for your engagement, advocacy, ownership in this challenging situation and persevering to ensure the final wishes of this patient and family were met.