Janet Malachowski, RN, was called to the registration area near the Cedar City’s Emergency Department recently to speak with a distressed parent who declined to sign the consent for treatment for his 15-year-old daughter. The daughter had been bitten by a bat and came to the ED for help.
When Janet introduced herself as a nurse patient advocate and asked how she could help, the patients’ father said he didn’t like the wording on the consent form and was worried he was signing his rights away. He also said, “and by the way, I’m not putting a mask on either.”
Janet listened to the patient’s father closely. “I knew his daughter would need to begin the rabies series quickly and I surely didn’t want him to walk out the door and not seek treatment for his daughter due to a misunderstanding about the consent form,” she says. “I was also faced with some cultural barriers, his views about patient rights, and his beliefs about masking.”
Reflecting on the principles in our Compassionate Connections tools for caregivers, she listened to his main concerns, apologized for his experience, and let him know that she understood his feelings and wanted to meet his needs. She assured him that signing the consent would give them permission to treat his daughter, but he would still have control over all the care decisions.
House Supervisor Tom Giles joined Janet to discuss the process of getting the rabies vaccination series and the two worked together to address the family’s medical decision-making concerns and financial assistance needs. The father ultimately agreed to sign the consent and allow his daughter to receive the first of the series and immunoglobin. They then followed guidelines to isolate him and his daughter away from other patients and escorted them to a private room.
Patrick Thompson, PA-C, consulted with the Health Department to clarify the timing of the next three shots, then worked with the pharmacy to set up a plan that would allow the girl to come into the ED to receive treatment, but without being billed at the higher ED rate just to receive the injections. John Skougaard, RN, one of the ED charge nurses, was made aware of the special circumstances and ensured the treatment was administered according to the patient’s personalized plan — all while Janet and John followed the case to completion.
“We just recently followed up with the father and asked permission to share this story,” Janet says. “He thanked our team and asked me to share that the one thing that brought him the most comfort was our ability to connect and listen to him and assure him that he wouldn’t lose his rights as a result of signing our consent. He appreciated that we could sit and discuss his concerns ‘rationally’ and he expressed his appreciation for the empathy shown toward his situation.”
Janet adds, “Compassionate Connections definitely helped me understand that compassionate nursing care isn’t simply relieving a patient’s suffering.”
“Compassionate Connections is a great tool to help in difficult situations,” says Shelley Egley, system director for patient advocacy. “John, Tom, Patrick, and Janet all connected with this patient’s father, identified his needs, and worked together as a team to ultimately do what was best for his daughter and their family.”
For more information about Compassionate Connections, please review the website or take the computer-based training in MyLearning.