DAISY Award—Oanh K Nguyen, B.S.N., R.N., C.C.R.N.
Oanh K Nguyen, B.S.N., R.N., C.C.R.N.
Tower 7 MSICU Gold
This Daisy nomination is for Oanh K Nguyen CNII. Her dedication to her nursing practice in the ICU to alleviate suffering of dying patients through a 3 wishes pilot project on Tower 7 MSICU Gold is exemplary. Oanh used her creativity, dedication, and innovation to lead the 3 wishes project for the benefit of patients/families and care providers. She had a vision and led a dedicated team that personalized the dying process while maintaining fidelity to the original vision of 3 wishes by Dr. Cooke. While it cannot be stated enough that nursing care is a team effort, the actualization of the 3 wishes takes a nurse leader like Ms. Nguyen to lead the way, organize the resources, and completely commit to a process to make it happen. In the course of one year, 3 wishes have been granted to at least 8 patients, each patient and family with unique circumstances but each situation was done with equal dedicated compassion. I will share Tower 7 MSICU Gold’s 3 wishes to exemplify Oanh’s vision.
To give some context and history, 3 wishes was inspired by T7 MSICU Gold medical director Hugh Black MD. He learned about 3 wishes 7 years prior to approaching the nursing team but did not have a dedicated ICU to actualize this project. His primary drive was to collaborate to alleviate the suffering of the dying patients in the ICU. Particulary during Covid where we witnessed so many patients died without the love and physical comfort of their loved ones, he was determined to start 3 wishes. He envisioned 3 wishes as a multidisciplinary project involving multiple stakeholders so he met with Tower 7 MSICU Gold nursing leadership team. When this was presented to the staff, Oanh K Nguyen stepped up to champion this pilot. At the time, she had stated this would be good for the moral distress of frontline nurses when their patients are dying. This was a novel concept to me since most of the literature was focused on the patient/family experience. And so, because of Oanh’s vision - the journey began in the spring of 2022 for the unit.
The literature recognizes that the ICU can be a depersonalized environment for patients, families, and caregivers. Despite significant improvements in the delivery of palliative care, the ICU remains a setting where the dignity of patients is forgotten to the technological interventions that are necessary to sustain them, even at the end of life. In 2013, a critical care group at McMaster University led by Linda Cooke developed and published the 3 Wishes Project, where a dedicated team delivered 3 wishes to dying patients and their families in the ICU. Qualitative analysis of interviews with families and caregivers documented significant success in multiple areas including dignifying the patient, giving the family a sense of choice and control, and fostering caregiver compassion. Multiple studies have documented that implementation of the 3 wishes project helps allow the dying process in the intensive care unit to be individualized and personal. It places families at the center of activity and a shift in the goals of care, rather than the cessation of care itself. The 3 Wish Project is an example of organizational compassion since it supports the ICU care providers who collectively respond to suffering by engaging with acts of kindness. Since then, multiple centers including UCLA and Stanford University have adopted the program which has achieved worldwide attention.
Oanh spent months organizing her team. She led meetings with Dr. Black and multiple stakeholders such as palliative care committee, chaplains, hospice, child life, social workers, unit-based practice council and Tower 7 MSICU Gold leadership. She contacted Linda Cooke MD, the creator of 3 wishes as well as Thanh Neville MD who was leading 3 wishes at UCLA. She created brochures, badge budges, and created education for staff. She and her team created 3 wishes bereavement boxes with meaningful keepsakes. She created the palliative cart that signals for others the process in a room. And while, the process was ongoing, Oanh efforts were actualized for patient N and her family.
N was the first patient to be the recipient of the Three Wishes initiative on Tower 7 MSICU Gold. She was a 17yr-old with history of severe depression and multiple suicide attempts who suffered a cardiac arrest after self-inflected hanging. She was discovered by her father who got her down and started CPR before EMS was called. They arrived soon after and continued CPR. She was taken to a facility close by where she was intubated. She was transported to UC Davis Medical Center for additional evaluation and management. She had difficulty maintaining saturations on the ventilator during transport and was bagged through most of transport on 100% oxygen. Her family stated that the patient had been struggling with depression with several suicide attempts over the past couple of years.
When the patient arrived on Tower 7 MSICU Gold, the family was still hopeful that the patient’s status would improve, however, they knew the prognosis was bad. Sierra Donor Services was already involved but they gave the family space to process everything that was happening to their child. They were overwhelmed because there is no parent prepared to deal with such a heartbreaking scenario. Oanh and the team allowed the family time to process N’s situation and witnessed how N's condition changed. The nurses supported the family on next steps with the medical team to determine goals of care. Because Oanh advocated for ICU-IMPACT classes which teaches how to approach and have supportive conversations with the family in the face of unbearable pain; the nursing staff were empowered to initiate meaningful conversations that honored the dignity of N as a person while acknowledging the suffering of her parents, siblings and friends.
In this case, the family knew what their daughter wanted and it become their responsibility to fulfill the 3 wishes. One of the wishes was to have an ECG printout of N’s heartbeat for each sibling which they stated they would tattoo on their arms in memory of her. Fingerprint keychains were created, and they were given locks of their sisters hair as well. In addition, the family decorated her room with N’s favorite things like pictures, posters, and stuffed animals so everyone would remember N as a beautiful girl who loved the outdoors. The second wish was to have all of her friends create a play list of her favorite songs. This playlist was played during her honor guard.
The patient and her parents third and ultimate wish was to find a heart recipient. The parents knew that their daughter signed up to be an organ donor and N had expressed a sincere desire that if something happened to her, she wanted someone to receive her heart. This was truly a team effort by the PICU medical team, PICU cardiology team, Sierra Donor services and nursing. Oanh advocated for a procedure that needed to be done for donor readiness and she talked to a PICU cardiology fellow who came in on his day off to complete the procedure so the last and final wish could be honored.
When the heart recipient was identified, and all the clinical issues were addressed, the staff prepared N for the honor guard. The honor guard was beautiful. She was led by her parents, siblings and followed by all her loved ones. Even though it was at 2:00 am, many of Tower 7 MSICU Gold staff came in to honor her. Her family expressed so much gratitude for the care their daughter received and in particular, the 3 wishes. This family will never forget how Oanh and the other care providers kindness and compassion helped through their tragedy. 3 wishes allowed this family a moment of joy in their enormous pain and grief of losing a daughter. We were told by Sierra Donor Services that this young woman saved 4 lives with the gifts that she gave: the heart, liver, left kidney, and the right kidney was transplanted into a UC Davis patient on our hospital's wait list. They also let us know that they completed the paperwork to have a star named after her because they learned from us how much she loved the outdoors.
I am in awe of Oanh’s dedication to a vision, her support to her peers and impact to this family. The experience is something they will remember their entire lives. She had worked months to create a plan of action with all the important stakeholders including getting the blessing from the original creator, Dr Linda Cooke. She created the 3 wishes brochures and badge buddies, promoted and encouraged the staff to get educated and involved. She used her creativity to innovate keepsakes. She even connected with other organizations that had 3 wishes. I am most impressed with how she got the entire unit including all the HUSC’s to be involved and engaged.
What I learned in witnessing her journey is that she was accurate about the impact to nursing, that 3 wishes was as much for the nurses as it was for the patients/families. That the engagement of the entire staff in making sure this family had their 3 wishes shifted moral distress to moral courage to true empowerment. The process reminded us all of why we got into nursing and our purpose. Therefore, I have nominated Oanh for the Daisy award. Her dedication to alleviate suffering and mitigate moral distress was actualized in the most beautiful way. We are blessed and honored to work with such an extraordinary nurse. She is truly deserving of a DAISY Award.