Nurses are compelling storytellers with compelling stories to tell. Nurses' most memorable stories include situations where they have made a difference, where breakdown has occurred or where there was important learning. Public storytelling among nurses helps make distinctions in clinical practice visible and creates opportunities for ongoing discussion and learning. Even the storyteller learns from telling the story.
BWH Nurse periodically features clinical nurse narratives for the purpose of stimulating discussion and advancing our learning as a professional community. This narrative is told by Michelle DelPrete, BSN, RN, nurse in-charge, Shapiro 6/7, and is followed by comments from Ellen Liston, MS, RN, program director, Nursing Practice Development, and advisor to the BWH Nursing Practice Committee. Please note that some details have been changed to protect patient privacy.
It was 6:45 a.m. on a Saturday when I walked onto Shapiro 6 East. As the night nurses hustled around trying to finish up their shift, I sat for a moment and mentally prepared for my first of three 12-hour shifts. I received handoff on my three patients, including Mr. B. The night nurse started report by describing Mr. B as "heavy." I immediately thought of what heavy meant to me, and I visualized a complex patient with multiple tubes, lines and drains. But as I listened, I learned "heavy" meant morbidly obese, weighing in at 384 pounds and measuring 6 feet tall.
Mr. B was a 40-year-old patient who underwent thoracic abdominal aneurysm resection just three days prior and spent multiple hours in the OR. He very quickly became de-conditioned and far from his baseline functional status. After hearing about Mr. B, I remained open-minded. I realized there was nothing I could do as his nurse to change his weight, but I knew I had the ability to develop a plan of care that would optimize his recovery.
As I entered his room, I saw Mr. B lying comfortably and watching the morning news. He introduced me to his wife, who was lying on the couch. We started to talk about who they were, where they lived and an upcoming family wedding. I asked Mr. B how he was feeling in his recovery. He told me he needed to get better soon to dance with his beautiful wife at the wedding. I sensed how much they both meant to each other. I was able to pick up on Mr. B's sense of humor. It set a casual mood in the room and allowed us to connect early on. I was concerned that what connected us was actually his coping mechanism in dealing with his obesity and his own self-deprecation.
It was time to get Mr. B out of bed. I spoke with the PCA about the plan. We entered the room optimistically. I asked Mr. B if he was ready to go, and he nodded his head. I could see he was apprehensive about taking his first steps since surgery. I sat next to him, looked him in the eyes and told him that the PCA and I were by his side to support him. He looked back at me, and I knew he trusted what I said. We all took a deep breath, counted to three and Mr. B stood safely and took three steps to the chair. I saw the look on his face and realized how much work it was for him to take those steps. I also noted the proud look on his face for what he had just accomplished. He advanced quicker than expected and progressed into the bathroom by the afternoon and even into the hallway by the evening.
I gave report at 7 p.m. to the night nurse. It was my goal to portray Mr. B as the person and patient, and to emphasize the progress we had made throughout the day. I wanted to avoid the labeling or stigmatizing of Mr. B. After report, we both went into the room. We discussed the day and spoke about the plan of care for the evening, and I told Mr. B, "I'll see you in the morning. You're in good hands overnight." I felt assured he would remain comfortable.
The next morning, Mr. B was making tremendous progress, but he still had a high oxygen requirement. He had received a portable chest X-ray, but it was not a good quality film. He was ordered for a PA/LAT that would need to be completed in the Radiology Department. I thought "How is this going to work?" I called the testing center to develop the safest plan. I was concerned that the Central Transport and Radiology staff may not know how to move the patient appropriately, and Mr. B may not advocate for himself while off the floor. I thought back to the day before and Mr. B's concern with standing, and I wanted to be able to support him.
Transport came to the floor and looked into his room. The transporter refused to bring him down, saying, "I'm not bringing him downstairs; he weighs too much, and I have lifting restrictions." I was thankful that Mr. B did not hear. I called the supervisor and told him of the situation. He said he would send a transporter who would be able to push the patient appropriately and safely. I thought now it is even more necessary to travel off the floor with him to make sure he remained safe. When the new transporter arrived, we moved Mr. B in the wheelchair and brought him down together. Once downstairs, I advocated for where he should stand and placed a chair close by in case he needed to sit. Mr. B tolerated the test without incident. Transport kindly stayed with us downstairs to bring us back up quickly and safely.
It was on the way back when Mr. B said something that impacted me. "Michelle, I want to thank you. Thank you for being with me down there and through all of this. I have never been at a place like this. A place where everyone takes such pride in what they do. I know you enjoy what you do, and you make a difference in patients' lives every day. Not many people can say that. And it's not just you; I have been treated with respect from the entire staff and not judged by my weight."
He spoke in detail about experiences he had in other institutions. He opened up about these experiences and how they made him feel. He said he felt judged about his size. He talked about the comments he had overheard at other places-people saying they shouldn't help him because it was "his own fault" he was so overweight. He talked about the fact he had lost 70 pounds recently and what that meant for him. I understood that traveling off the floor to X-ray meant so much more for Mr. B.
Pride is exactly what I felt after Mr. B's comment. I took care of Mr. B with an open mind and gave him the same compassionate care that I provide to all my patients. I never judged him on his weight, and he was able to sense that. Perhaps, I was in part able to change his hospital experience to a positive one unlike so many others before. It was his statement that made me feel so very honored and proud to be a nurse. I feel fortunate to have the ability to walk into a stranger's life, develop a relationship and make a positive change. It was also a moment of clarity that showed the power and importance of teamwork. It was not just me who impacted Mr. B, but the entire team on the floor treated him with the dignity and respect he deserved.