MRS. REYNOLDS NEEDS A NURSE

please adjust your sound to the level of this voice it will match the sound of the narrator in the film you're about to see [Music] I'm going to tell a story of an experience I had as a nursing supervisor one that taught all of us on this ward a great feel about what nursing is and what it can be it begins one sunny day at 7:00 a.m. time for Morning Report well good looking group you better get in the morning report I have to go to another ward it looks like it's gonna be some day the head nurse is a recognized authority on ward management in this 400 bed tax-supported General Hospital her relations with staff are excellent this ward has the lowest staff turnover in the hospital but doctors say she knows as much as anybody can about observing and assessing neurological symptoms she keeps the complicated equipment running like top she's the model head nurse graduated an accredited diploma School of Nursing she plays a key role in this story this is the night nurse couldn't write you all look nice and rested I've never had such a night every bed is full and you're short practical today let me tell you just a little bit about what happened last night and then I'll give the details about the cases first there was three admissions a head injury auto crash at 12:30 at 1:10 one of the characters from Skid Row found on the street convulsing he's him sleeping it off a stat admission at 2:30 girl she's 19 barbiturate overdose fight with her boyfriend well that's all 30 of them you know it really bugs me when I'm so busy I can't give these patients the care they really need I haven't even finished my charting yet well why don't you finish it up and go get some sleep don't worry we'll pick up the pieces it'll be better tonight it had been a hard night all right but nothing to the 8-month trial we were all about to enter this is going to be a very busy day Flo and Jerry remember we have six patients going down for X ray this morning Flo since mrs. Murphy isn't here I'll have to get help from the supervisor for you and Jerry remember the doctors are making rounds on your site at 10:00 please have you're sick of patients done first Bernie you'll have to help on both sides today I'm going down through the girl on the artificial kidney after seven years of supervisor here I'm just back with a new master's degree it's good to be in the woods again [Applause] pretty little thing isn't she you've had quite a night yeah I'm beat anyway how was your weekend sure I'm glad you're back know why it is but things even getting a mess around here when you're off we are quite short today we could use some how I've already been working on it they're mighty short-staffed all over the house hey when are we going to get some more loads pretty student nurses around headed liven things up a little is that all you can think of with all this going on oh it just so happens you're going to have some coming Monday and I want them treated gently after all they have other things to learn besides the doctor nurse relationship well that's a typical old major market I was wondering if you could discharge mr. piers we have no beds and if we would get a new admission I don't know what we do Brian ward clerk thank you a new admission is on the way up I better tell miss was Jenkins well that's all we need and here the story really begins Emma Reynolds partially paralyzed difficulty in breathing coming with her husband and what must be everything she owns onto a ward that already is straining at the scenes look at all that stuff I'll call a storm and get a bed but we're gonna have to put her in the hall I hope we can make her comfortable she's gonna have to get rid of some of that junk from such stuff this story is made it is too busy hours later send up that support slow dr. James wants to do a spinal tap on mr. Kelly he'll be here in 15 minutes would you please call dr. Matthews mrs. Wilson's blood pressure has dropped Jerry they're sending out the Foster frame for mr. Taylor very soon thanks for Maxine I've tried the big barn still to help them there just isn't in today how's that new patient making out she's had the whole staff jumping they're just about ready to crawl the wall I know it's not very pleasant to be out there in the hall and not have a room but we have a lot sicker patients and they're not complaining we'll try and move her into over the ward this afternoon I'll tell her mr. mrs. Reynolds I miss little the nursing supervisor am I'm real glad to know both of you I'm sure you're not too comfortable out here in the hall but we'll have you in one of the wards real soon Oh Lord she needs a private room she's been sick for nine months you make them find me a room John well we just don't have a private room available we'll look after her don't you worry where are you folks from we're from West River she was in the hospital a nurse can you rub my arm I thought at first it was a fluid the doctor did my neck - and that pillows bumpy then she couldn't move her arms your legs very good and they thought it was polio we had her home for four months we had a nurse that really knew how to take care of her we took her to a real rehabilitation center in Dawson River and the doctor said that she wasn't getting any better so that we'd have to have her hospitalized to find out what was wrong with it John take the covers off of my toes can't somebody get me a fresh drink of water I just like on somebody to pay a little attention I hope they can do something here mr. Reynolds we have the best specialists don't you worry I asked him for some reason to bring her some fresh water and they wouldn't do it there's this said to get everything John in the hospital mr. Reynolds we have no place for all these things in the room if they're my things I need them I'll bring you some fresh water and be right back you know to get a hotel room before just doc don't you worry they said everything's going to be all right mr. Reynolds the hospital's been trying to get you that say it's urgent hey forgot your personals she couldn't get her breath all of a sudden mr. Reynolds we had to give your wife a tracheotomy and opening into her windpipe there so she could breathe but she's doing very well why Gordon didn't yawn in a while I'll take care of him I'm senior all right it is two months later hi Bernie oh she won't be able to get here she's still with it mrs. Ralph and she hasn't had coffee for two days I don't understand how anyone can be getting so much better and act so much worse well how do you like the way she clicks her teeth at you I never said this before and I know she's a very sick woman but I don't like caring for make some difference what one does for it's never right well I tried for the last six weeks and I still can't like that woman after two months in the tank respirator mrs. Reynolds has now been introduced to the use of the shell respirator and the rocking bed her tracheotomy has plugged at intervals so she can speak but the degree of real communication between her and the staff is very slight she's a demanding patient and when they never seemed to satisfy when her tracheotomy is unplugged and she's unable to speak she has developed the annoying habit of summoning staff by clicking her teeth with them well I finally got time to take care of you let me fix your pillow you can hold it on key and throw them out the window [Music] what is it not mrs. Randall honey please give me the drink of water like it's so dry [Music] you're all is so good to me and those other nurses are so impossible I sometimes have to look after the other patients too you know I have to be suctioned through dairy no matter how hard we try we just can't please her she's a spoiled woman pampered by that old man and he's under feet all day always complaining and so is she my staff don't like to take care of her I have to rotate them with her now what do you know she want the shampoo before her husband comes what does she think this is a hotel there she goes with those teeth again yesterday we ignored her and find her cyanotic and almost unconscious if we suction her every time she wanted that's all we do but we're afraid to ignore her when we got in there yesterday she was blue it was almost as if she'd done it on purpose I wished we'd transfer her or get some more help here comes more trouble you take care of these complaints today she doesn't seem to be getting any better they don't take care of their now I keep telling him but they don't pay me no mind well there's no need to go in this room this patient in the first bed around the corner is mrs. Reynolds she's been here for months and got guillain-barre syndrome medically our most serious problem is the increasing paralysis of her extremities and her diaphragm and these have created some pretty tremendous nursing problems such as keeping her airway clear maintaining good skin care preventing contractures keeping her bowels and bladder functioning normally this taking a lot of work and the gals have done a fine job but she and her husband don't appreciate it at all they've been at the staff ever since they got here well let's see the next patient she complained about Marilyn again she talks about all of us I know you go do your other patients alcohol see what I can do very my year she said you left on a bedpan yesterday I forgot her oh we put it on that pimp six times and she still didn't put out mr. Reynolds don't you know she's on a thousand calorie diet if she ate that she'd have all the calories she can have for the rest of the day but she didn't get enough breakfast dude if he do too fast yesterday you brought her a hamburger and a milkshake you know she's on a diet and she has to lose weight so she can breathe better you also are well aware of the hospital rules that no patients are to be bought food or drink yesterday they wouldn't give me the bedpan I couldn't wait and wet the bed John I feel awful they just don't seem to make me here I like them but they don't like me it seemed to me like every second day I was called on the carpet over the Reynolds case things were getting worse month by month even though we were doing everything we knew how to do for her or so we honestly believed at the time well our dear mr. Reynolds says now not only got the medical director in the hospital administrator but he's even written the state legislature the director of nursing service knows perfectly well what you're going through but she can't give you any more help we'll have to do the best we can I've been in nursing ten years and I've never had a patient as bad as mrs. Reynolds well thank goodness we have that new student coming Monday and she's here to learn about complex patients and she has more time that should give you a breather why did I ever go into nursing why do we go into nursing what meanings does it hold for us at the beginning of this term you all summarized what nursing meant to you I wonder if you could tell me what nursing means to you now that your psychiatric experience is almost over well it seems that in psych we've learned more about people nursing the mentally ill isn't really so different from nursing people in a General Hospital they get depressed too and don't eat I think the way a patient acts will mean more to me now I got so busy that I don't think I ever really listened to what the patients were trying to say to me before sometimes the physical treatments you give a patient are most important for his recovery but at other times it's the way you make him feel that seems to help the most important thing to me is that I'm beginning to see myself as a person the way I affect the patient and other people as well like the staff of course it's not something that you pick up in just a minute but I really feel like I have a beginning and I think maybe because of it I'll be a better person and a better nurse I just know we'll be able to do a better job now a general hospital patient I'm really excited about going to mrs. Jenkins ward she's the best head nurse I've ever seen not one of us could foretell the events which were to happen now how this stronghold was to be breached by a mild-mannered student with their own convictions about the meanings of Nursing well I am Wilson Jones again how about you gonna have a bigger job today boy have you got a little on your hands but brenell-- good luck you'll need it hey there's a real cute resin who'll be glad ahoy you're handy get in trouble don't call us we'll call you well let's see what she can do with those psychiatric tender loving care principles well hello good morning mrs. Randall I'm Stephanie Andrew student nurse and I'm going to be taking care of you for a while Jerri I'm sure glad to have you dad Ivan comb my hair before habit gets here what you have oh here you know John this is my new nurse have you ever let that trade case I carried before Jared get me a drink of water perhaps she doesn't need our sympathy these next few weeks will tell hey how's it going after two weeks just fine I really like her and I can't figure out why the rest of you don't hey doctor I'd like to speak to you about my wife mr. Ellis what would you like to know they're very concerned about the attention she's giving me I just don't think that the staff pays enough attention to her I don't think she's too demanding or complaining I let mr. Reynolds feed her today and they both really liked it do you think it's wise on your part to make this kind of decision what if she would choke how would he handle it I know you're here to learn and I know you'd like to try different things but just because you have time remember that we don't please don't spoil her for us two months till I graduate and now I find that all this stuff about personalized nursing care for the individual patients is for the birds you give them their baths you do their treatments you change their bed that's what Nursing is and mrs. Reynolds she isn't a person she's just bed one room 14 in an order sheet and that poor old man who hasn't got anyone else in the world except his wife and who wants to help and who hasn't got anywhere else to go he's just a thing that gets in our way banish him get him out of our hair I will be a good girl and get a nice shiny degree I will be the doctors soft feminine and efficient handmaiden and perhaps in a couple years I'll be a wonderful head nurse like mrs. Jenkins admired and respected by all who doesn't care in the least that mrs. Reynolds is a poor frightened woman who's afraid she's going to die I ran into the problem quite by chance oh hi Stephanie how're things going well if you really want to know miss little if I don't talk to someone I'm going to blow my top well do you have a minute why don't you come into my office well what's the problem I get this mrs. Reynolds I think that I know how to take care of her and yet I'm really wondering if the staff here Dennis it seems to me Stephanie's it's the staff spend more time with her than any other patient on the ward I think they're doing a good job against big odds look at her skin it's perfect she doesn't have any contractors or foot drop and we haven't had any lung complications with her tracheotomy well I know but that's what you do for any patient and mrs. Reynolds isn't just any patient she's a person she's in them possible person to satisfy but no one tries to they avoid her all these requests for a drink of water and suction my tracheotomy and bring me the bedpan they're just ways of getting attention she's afraid I think she's afraid of dying and her husband he's afraid too he wants to spend every minute that he can with her she's everything he's got look I've had this in theory until it's running out of my ears you plan personalized patient care around the needs of the individual the physical needs the emotional needs the environmental needs the socio-economic level the rehabilitation needs they're not doing that here sure this is a great word for physical care and mrs. Jenkins it's just time well if I ever had a head injury this would be where I'd want to come but that's only half the problem in this mirror I see myself and I don't like what I see most of what she said is all too true I know all these things myself how could I have lost sight of them why doesn't anyone pay attention to me to me she's just been a difficult patient why couldn't I see her I've been concentrating on the same old things stopping the words Hospital policies routines doctors problems I've been blind to this patient's problems and to the real needs of the staff what am I going to do now some people you can talk to our psychiatric instructor is one of them I needed help and I went looking for it hi Betty well boy did you send me a prize package in that little student and have I ever got a problem can I sit on your couch and tell you about it sure sit down I realized the kind of leadership I had provided the staff we had missed the boat with this patient for four months one of the difficulties on a busy ward is that no one takes time to study a nursing problem systematically we're all too busy with tasks to stop and look at what's happening but we've got to stop and it should be worth the effort what we can learn from studying mrs. Reynolds care is bound to affect the nursing care of all other patients on the ward first I had to get the staff to see mrs. Reynolds as a human being expressing my feelings about her allowed them to get their own feelings out into the open where we could look at them together what else come on I feel the same way oh she's always calling us honey and Aryan boy that just cried well I don't mind that but she's always talking about us behind her back that adult she does she's important so does her husband he watches everything we do okay let's stop isn't it strange that not one of us has said a single good word about her okay what do we mean when we say it takes so much time before you even do anything she has 10,000 complaints I'll bet it takes an hour and a half to feed her what do you mean it takes an hour and a half to Peter do you time it what would happen if we kept track of everything we did for this patient for a few days that's a darn good idea let's write down everything we do for her including her requests and demands maybe then we'll get more help I wasn't worried that the staff felt that this was a chance to prove something to me I was sure the study would mean much more to all of us now you just take your time mrs. Ram let's do it hurry it off just take lots of time just rub my legs dearie why sure am yisrael than anything else you want just ask for it you just let us know when you want us to section you again mrs. Randall you must not be very busy today I guess never too busy to make you comfortable mrs. Reynolds now if you need anything else you'd be sure and let me know what are you writing on that piece of paper dearie why are people being so nice to me supervisor this 7 hours and 42 minutes a day of tender loving care let's do it that real pretty care which for 4 months had been anything but tender and loving for any of us but without really realizing it all the staff was beginning to be interested creatively for the first time in the care of this patient the prize package I guess this is make her stood up take notice she thought she had me right where she wanted me but her interest had been caught along with all the others figures in my life history you're real sweet at the next meeting I made sure that everyone had copies of all the data and we summarized it together and once we had the facts before they seemed to ask their own questions why does she have to ask for more coffee why don't we just order it why 19 requests for a drink the doctor has ordered that she get 2,000 cc's a day but look at your sheet when did she ask for all these dreams when she almost consistently asked when you come into the room well when you're leaving I kind of think maybe she wants to be sure you come to her and then she doesn't want you to leave maybe she's afraid to be alone she wants to be stuck till then does she needed this happen no we traumatize her trachea if we did it that often well what do all these requests mean stephanie says she thinks mrs. Reynolds is afraid of choking to death well what can we do about all this we can check your trach listen to her chest whenever we see her and tell her when it's clear maybe she wouldn't be so afraid if we told her when we were coming back alright let's try a few of these things before the next meeting we'll see if they really work they're gonna check your trach and listen to your chest to make sure you're breathing alright your trick is clear you seem to be breathing fine your chest sounds clear how about a drink of water I'll be back in 15 minutes now you try and get some read say this is reading working she hasn't been incontinent for three days you remember we thought it was her illness that made her wet the bed remember how worried she got about suctioning she doesn't ask for it half as much now how are you mrs. Reynolds oh I'm a lot better nurse but you know she says she'd be back in 15 minutes and I'm here hello 15 minutes sometimes things like 52 hours I'll be back in one minute see if you can time that when the head nurse began to take an interest in the plan I knew we had passed over a major hurdle and that things would now go well with this patient and with the staff caring for her now you'll see what they mean how does this sound to you we now began to develop a 24-hour plan of care and to involve mrs. Reynolds in it she made decisions about her diet we scheduled care around her favorite TV program then we involved him and if you get into any trouble just get one of us we'll be glad to help you thank you he was with her most of the day he would have to suction her when she went home and he wanted to help and so he entered the partnership that now involved all of us yeah good thought was better when you feed me Oh time to stop so me girl the Sun began to shine in this word and mrs. Reynolds improved markedly they began to look forward to her going home the staff now looked on them as friends and began to gain the satisfactions they had never before received from caring for this patient and at our meetings we discovered that staff time now spin and mrs. Reynolds care had dropped from 7 hours and 42 minutes a day to 1 hour and 50 minutes mine go as long as John can see me no plan is without its problems and reversals there came a time when mrs. Reynolds reverted completely to her old unhappy demanding and continent state no one could learn from her what had gone wrong we felt that in some way we couldn't understand we've failed her in the staff had to be helped to understand that there were reasons for mrs. Reynolds setback ok let's go back and see when or Cara started to change what happened well I don't know if this is important but you know mrs. Jones who was the roommate physician a long time when she was discharged and the day she left remember we put that poor old lady in mrs. Jones bed and she died and mrs. Reynolds coughed out her cheek tube and that new intern had trouble getting it back in I guess she was just afraid of dying again when we understood we could help her once again and once again all was well with the Reynolds how nice don't you like some of these clowns oh thank you mr. Reynolds they're beautiful Christmas number four [Applause] because of what we had learned about mrs. Reynolds care we began to deal more effectively with the nursing care of other patients on the wards - relp are you doing today mrs. Reynolds was certainly happier but the doctors were becoming very concerned over increased respiratory involvement and so the days passed it is eight months since the Reynolds came down the hall to our ward eight months that has taught us all a great deal that we will never forget about nursing life and what it means [Applause] [Applause] nice Renault [Music] [Music] [Music] thank you [Music] I wonder if it'll come there [Music] [Music]