April 9, 2012

ST. LOUIS - The patient was like many others who came to Michele Gatzert’s ICU – elderly, heavily sedated and on a ventilator. He was seldom conscious and when he was, he couldn’t speak.

What set him apart? This particular patient led Gatzert to find a way for her staff to better connect with their patients and patient families. That and his superhero status.

Gatzert is the nurse manager of 8900 ICU, a 10-bed intensive care unit at Barnes-Jewish Hospital, the 1,200-bed adult teaching hospital for Washington University School of Medicine. Many of the patients in Gatzert’s unit come from adjoining oncology floors, serving the hospital’s Alvin J. Siteman Cancer Center. Others are recovering from surgery, trauma or serious infections.

Gatzert and her staff pride themselves on providing highly skilled, compassionate care to these critically ill patients. But when a patient is critically ill or unresponsive, it can be hard to engage with the patient and their family on an individual level. One patient and his son showed Gatzert and her team the value of forging that individualized bond.

The “superhero” was a 75-year-old patient from Joplin, MO, who had pulled several of his neighbors from their wrecked homes after the catastrophic May 11, 2011, tornado leveled part of the town. He subsequently developed a severe respiratory infection and pneumonia possibly caused by inhaling toxins during the rescue effort, and had been transferred across the state to Barnes-Jewish for specialized care.

The patient’s son, Ray Goodman, of Columbia, MO, wanted to encourage his dad’s recovery. So, Goodman, a talented amateur artist and comic book collector, began drawing scenes from his father’s life depicting him as a superhero, and hanging the pictures on the wall of his father’s ICU room.

Though the pictures illustrated seemingly ordinary scenes from the patient’s life – attending college, serving in the Navy, teaching his son to fish – in each drawing the patient was drawn in costume and with the massive musculature of a superhero.

“My dad was always a hero in my eyes,” says Goodman, “and after he got sick I decided to show him my feelings by drawing a series of scenes with dad in the role of a superhero.”

The drawings covered the walls over the course of a month and a half, and elicited comments from staff that entered the room, be it physicians, nurses, technicians, housekeepers, food and nutrition workers or unit secretaries.

Staff began looking for the next installment in the “graphic novel” of the patient’s life.

“We grew very close to him and his family,” Gatzert says. “Because of his son’s drawings, we felt we knew him.”

Goodman told Gatzert the drawings also helped him come to terms with his father’s illness, dealing with the emotions he felt during the long hours at his father’s bedside and in the ICU waiting room.

Sadly, the patient died after 50 days at Barnes-Jewish, becoming the 161st victim of the Joplin tornado.

But Gatzert realized how Goodwin’s pictures of his father – the story of his life – helped her staff bond with the patient. Being able to form a bond with a patient, especially one who is unconscious or unable to respond, can be difficult, especially in a busy ICU. Studies have shown nurses may become focused on tasks such as trying to start an IV, give meds or change a dressing, and less sensitive to a patient’s general state of well-being when the patient is unconscious.

“However, the more familiar a caregiver is with a patient and the patient’s history, the more likely they are to be able recognize subtle changes in the patient’s condition,” says Gatzert. In addition, having information about the patient’s background and likes and dislikes can help nurses get a feel for ways to make the patient more comfortable.

Gatzert researched nursing literature and the internet for tools her staff could use to learn more about their patients. She was surprised to find relatively little that applied.

She finally found “My Story,” a tool developed at and used by St. Jude Medical Center in Fullerton, CA. The tool was developed by California nurse Doreen Dann after her husband, Mike, was very critically injured in a car wreck in 2003. He was transported to a trauma center, where until Doreen arrived, Mike a “John Doe.” Doreen posted information and photos in her husband’s room to let his caregivers know “my Mike,” she says.

Though Mike died of his injuries, Doreen was inspired to create the “My Story” tool, a questionnaire given to patients or their families to fill out. The questionnaire asks about the patient’s the likes and dislikes, family members, pets and other things they’d like the staff to know about them. The questionnaire is then posted above the patient’s bed, so staff can learn about the patient.

St. Jude’s uses “My Story” throughout their hospital and offers it free to other healthcare institutions with the condition that they include the phrase “My Story is inspired by and dedicated to the memory of Michael G. Dann.”

Gatzert found that a handful of hospitals throughout the United States and Canada are now using My Story. She thought it would be ideal for use on 8900 ICU.

“My Story humanizes the patient for physicians and nurses,” Gatzert says in a presentation she created for patient care leadership at Barnes-Jewish. “It’s an opportunity for patients and families to speak.”

Gatzert, Justin Elliott, RN, and members of the floor’s practice committee worked to adapt “My Story” for use at Barnes-Jewish, including a cover page to explain the purpose of the tool:

At Barnes-Jewish Hospital here on 8900 ICU, excellence means more than just clinical expertise. It also means providing warm, personalized care. For that reason, we’d like to learn more about your personal story – or that of your loved one. Please take a few minutes to answer the questions and provide any other details you would want us to know on the reverse side of this page. Thank you for your help.

Staff on 8900 ICU began handing out My Story forms in December 2011. Response from staff, families and patients themselves was fast and overwhelmingly positivie.

“It's been a great success,” Gatzert says. “I'm really proud of the 8900 ICU nurses for moving forward with this project. We have been receiving great feedback from families.”

The response was so encouraging that after just a couple of months after introducing My Story, Gatzert presented her experience to the Barnes-Jewish critical care committee. The other managers and practitioners are looking to move forward and institute the tool in their units, Gatzert says.

In addition the Barnes-Jewish Magnet committee is currently looking at introducing My Story to the rest of the nursing units at Barnes-Jewish.

Barnes-Jewish Hospital is 1,288 bed teaching hospital affiliated with Washington University School of Medicine in St. Louis, MO. The hospital has a 1,763 member medical staff with many recognized as "Best Doctors in America." Barnes-Jewish is a member of BJC HealthCare, which provides a full range of health care services through its 13 hospitals and more than 100 health care sites in Missouri and Illinois. Barnes-Jewish Hospital is also consistently ranked as one of America’s “Best Hospitals” by U.S.News & World Report.

Contact:
Kathryn Holleman
314-286-0303
[email protected]