Clinical Narrative

Caitlin Kowalski RN, BSN

Starting as a new graduate nurse on the
Acute Care of the Elderly unit I remember
feeling overwhelmed with the tasks that are
required by nursing. I started my day by
getting to the unit early to look up my
patients for the shift. On my report sheet I would write down tasks that needed to be
completed with boxes next to each one to make sure they were done by the end of the
shift. I would rush in and out of patients rooms completing the different tasks. I felt
uncertain because I thought I would be prepared coming out of school but it was like I
was starting all over again learning new things every day. I have been a nurse for almost
four years, but looking back I can see the extreme growth in my practice and the
interpersonal skills that I have gained while taking care of geriatric patients.
I continue to start each day by arriving early to look up my patients and writing
down tasks for the day, but Ive been able to transition into a nurse that sees my patients
overall story and adapt my day to meet their needs. I have learned that the geriatric
population is unique and requires specific skill sets. My interest in the geriatric
population matured as I was a nurse on the Acute Care of the Elderly Unit. To expand
my knowledge I got involved with Nurses Improving Care for the Healthsystem Elders
(NICHE), became a Geriatric Resource Nurse through NICHE, attended a NICHE
conference, joined the National Gerontological Nursing Association and currently
participate in the NICHE and Geriatric Leadership committees at University of Colorado
Hospital.
I understand not only the physical needs to provide quality geriatric sensitive care
to our patients, but also the emotional needs. Joyce Travelbees nursing theory focuses
on genuine human-to-human relationship between a patient and the nurse. This
relationship is built through five stages until the patient and the nurse attain a rapport.
Joyce Travelbees theory has influence my nursing practice by achieving sincere
relationships with my patients. I have been able to carry this theory with me as my
practice grew into a Level III nurse. I would like to share a specific instance where I was
able to build on this theory, develop a special relationship with my patient and how my
practice has grown to that of a Level III nurse.
It was in the afternoon and I was assigned a patient who was coming from Denver
International Airport (D.I.A.) for altered mental status. I figured it would be the typical
admission from D.I.A. were the patient would stay for a couple days and would be off on
the next plane back to their home. It wasnt the case for this woman. I got the room
ready for the new patient to arrive, grabbing supplies and writing my name on the
whiteboard. I didnt receive report on the patient as she was a direct admit and was
brought in by ambulance. The patient arrived enraged and ranting in Korean. Quickly, I
grabbed the interpreter phone and went to the room to start my first task, the admission
assessment. It did not go over as smoothly as I thought it would. The patient would not
use the interpreter phone but was continuously talking to me in Korean, which I could
not understand. Nothing was getting done and I was unable to communicate with her. I
went to my resources to help with the situation. First, I ensured the new patient was safe
by delegating to the nursing assistant to stay with her when I checked in with my other
three patients. I called my charge nurse to update her on the situation and ordered a live
interpreter to help me communicate with the patient effectively. As a Level II nurse this
situation would have been too overwhelming for me to do anything or I would to have
had to hand off my other patients.
When the interpreter arrived the patient was still infuriated and was repeating
the same thing over and over again, not making any sense and would not listen to what
we were saying. I spent over an hour in the room with the patient and interpreter trying
to help her understand where she was and calm her down but not much was
accomplished. Before the interpreter left I asked if he could write out the translation of
some phrases in Korean (you are in the hospital in Colorado, do you have to go to the
bathroom, are you in pain, etc.) so we could use them as cue cards to communicate
with the patient throughout the shift since the patient refused to use the interpreter
phone. This was not the typical admission I expected and the patient didnt stay for days
but for many months. In this time I built a relationship and rapport with her.
As she stayed on our unit I began to learn her routines. She was fit for her age and
sometimes could not stand staying in her room. Often she would become frustrated and
aggravated when contained to her room. During her long stay in the hospital her sleep-
wake cycle often became disrupted and she would sleep throughout the day and be
awake during the night. When I had her as my patient and even when she wasnt my
patient I would take her for walks in the garden in front of the hospital or do exercises in
the hallway. This kept her stimulated during the day so she could sleep at night to help
prevent delirium and agitation. When I would take her to the gardens outside she would
point to flowers and say something in Korean. I would reply in English talking about the
flowers or plants she was pointing to. We built a relationship even though most of the
time we werent communicating in each others language but through body language. I
remember the first time she wanted to hold my hand as we walked, which showed me I
had gained her trust and established a rapport. Looking back to our initial interaction I
had grown to know this patient as a person and felt empathy. From this relationship
built I felt like I was fulfilling part of Joyce Travelbees theory.
I exhibited growth as a nurse through this experience by being creative and using
different methods to decrease agitation, maintain a healthy sleep routine, and improve
communication with the patient. I helped keep her sleep-wake cycle regular to prevent
delirium and keep her health restored without turning to medication. I improved our
communication by making cue cards which allowed myself and other staff to address
needs quickly when the patient refused the interpreter phone. The cue cards stayed in
her room throughout her 5 month stay as a resource. Four years ago as a new nurse, I
may have went straight to Haldol to calm this patient, viewed ambulating this patient as
a task, or would be become overwhelmed. When caring for her it became my routine and
goal to take her outside as I know the importance behind it for her physical health but
also patient satisfaction. I took the extra time to care and be kind to her not because I
had to but because it was important to me as a nurse. From my first encounter with the
patient I felt frustration but through her stay we communicated in different ways and
spent time together in which we built a relationship.
We experience many complicated patients who stay on our unit for a long time,
but we are often motivated to provide unique care to fit the needs of the patient. I
integrate Travelbees theory of nursing in caring for all of my patients and building an
authentic relationship. During work there will always be tasks to be completed. Through
my experience as a nurse I have learned to be flexible and recognize the needs of the
patient to provide geriatric sensitive patient-centered care. I have also become a
resource and leader for other nurses and many come to me when they have questions
about providing geriatric-sensitive care.