DAISY Award—Kimberly Ann Daniel, M.S.N., R.N.

Kimberly Ann Daniel, M.S.N., R.N.
Tower 5 MICU

Kimberly Daniel, critical care nurse from Tower 5 Medical ICU, took care of a complex patient. This patient was well known to the nurses in the ICU from a previous admission to MICU service for respiratory failure. On this admission the patient suffered cardiac arrest and failed ventilator liberation.

This patient stayed stagnant for many days on the ventilator and sedated for comfort and ventilatory compliance. After nine days being on the ventilator the patient finally showed signs of progress and started interacting with the staff by writing notes. There were a lot of challenges in providing care to this patient because of mental slowness and the fragile pulmonary status that led to failed multiple ventilator liberation’s. The patient had not been up out of bed, nor had physical therapy because she was so weak from the prolonged bedrest and ventilator management. The only means of communication was for the patient to write notes.

One 12 hour shift, the patient tried to work with physical therapy (PT) but was too weak and declined standing up with PT. She was very awake and communicated through writing to Kimberly that she would like to see her 8-year-old pet, a bunny. The patient had not seen her bunny since admission to the ICU which is now 26 days to be exact. The patient had friends visit and also video chatted with her sister. She was able to see her pet bunny during the video chat. The longing to pet and hug the 8-year-old bunny named Stormy grew more intense especially now that she was more awake but still too weak to be liberated from the ventilator. She continued to write notes requesting to see, touch and feel her pet bunny. Only certified service pets are allowed in the ICU. This became the patient’s greatest desire but because policies and the patient’s very limited capacity and being on the ventilator, the patient’s wish never materialized.

Kimberly took a leap of faith. She coordinated a complicated plan to make the patient’s wish come to life. As the saying goes, if we cannot bring the pet to the patient, we will bring the patient to the pet. Kimberly collaborated with the medical team to allow the patient to be taken outside of the ICU while on the ventilator for the pet bunny to visit. She organized the plan with the respiratory therapist, the medical staff, nursing staff, lift team, and the patient’s sister to bring the bunny. The goal was to have the patient’s support pet visit the patient outside the facility. This took Kimberly a lot of planning to synchronize the mobility of the patient into a cardiac chair with the ventilator, the intravenous infusions, telemetry and other required equipment. Throughout the preparation and activity, Kimberly provided the patient instructions on what she could expect as well as the emotional and physical support to get the patient ready for transport.

The patient appeared scared but smiling at times elated about the plan and now very excited to take the trip outside the facility to pet, feel and hug the pet bunny. It took a good amount of time to transfer the patient. Kimberly and her team continued to push the cardiac chair and all their equipment to the paved lane across the hospital to the parking garage rotunda for the meeting place. The patient met her sister and Stormy at the spot. The patient’s sister took some photos. The patient enjoyed about 10 minutes of time being outside the facility and had to head back to the ICU. It took more time preparing and packing than the actual visit and experience with the pet bunny. This encounter with the bunny made the patient very happy after returning to the ICU. Granting the patient’s wish gave the patient the energy and determination to continue to feel stronger and better. The patient liberated from the ventilator and was extubated four days after her bunny visited. The patient continued to progress well, talking and gaining strength. The patient was downgraded and transferred to an acute care unit.

The event serves a story that inspires a lot of the nurses in the ICU. Kimberly cultivated a relationship with the patient by attuning and connecting with the patient in a meaningful way. A pet may not have the same meaning to everyone, but Kimberly kept an open mind and suspended her own assumptions that this is just a pet for the patient. Kimberly paid attention to the words that the patient could not say, but listened to the written words, I want to see Stormy. Kimberly held on to the thought of making the patient’s wish come true despite the complexities, time constraints, and the physical challenges of the plan. Kimberly is the magic fairy who granted the patient’s wish!