Spontaneous Acts of Magnetism
Like many hospitals deserving of Magnet status, UC San Diego Medical Center exemplifies elements of the Magnet program in the daily activities, behaviors, attitudes, and professionalism of the nursing staff. During the writing process describing UC San Diego’s Magnet Journey, nurses were asked to supply “Magnet Moments.” This ensured the team of writers putting together the Magnet documents was aware of actions and ideas of UC San Diego nurses in all units and areas of the hospital. Over 300 stories were submitted from across the hospital system, creating a new enthusiasm toward the Magnet Journey, and truly demonstrating that UC San Diego Medical Center employees have the passion and drive evident in Magnet hospitals.
Reading through these stories, the reaction was one of the utmost pride, in the way nurses view their role as caregivers, in their accomplishments, and in their incessant acts of advocating for patients. The stories were categorized within the five Magnet components. Some of the most touching nursing stories of patient care at UC San Diego Medical Center could have fit under all components of the Magnet model. The outcomes of these stories are invaluable lessons, but they lack one key aspect of the Magnet definition of outcomes: they are not measurable. As a result, a new component was created to capture the art of nursing, which is called Spontaneous Acts of Magnetism (SAM).
This sixth component, SAM, combines the scientific, measurable nursing elements of knowledge and technical skill with the artistic, immeasurable elements of caring, humanity and compassion. Gramling (2004) researched the art of nursing from the patient perspective and found five themes present: perpetual presence, knowing the other, intimacy in agony, deep detail, and honoring the body. Her research study provided evidence to support that the quiet acts of humanity and exchanges between nurses and patients can be described as an ineffable, powerful holistic art. A student nurse, Kaitlyn Eydenberg, explored one of the research study interviews between Gramling and a patient, Frank (2008). She determined “nursing art is revealed through the simple, yet thoughtful actions that help a patient deal with his or her hardships during hospital care.” Furthermore, she concluded that the career of nursing requires technical skill, education, and a strong knowledge base; however, it is when the practitioner adopts the caring skills of compassion, empathy, responsiveness, and kindness, that nursing becomes an art.
Stories exemplifying the SAM characteristics are ones in which all Magnet components were necessary to arrive at the immeasurable outcome to display the art of nursing. For instance, an essence of Transformational Leadership may have been present to provide a supportive management style. Structural Empowerment may have existed in nurses’ commitment to professional development. Exemplary Professional Practice may have been evident in nurse autonomy. New Knowledge, Improvements & Innovation may have been the catalyst in sparking innovative thoughts and actions. Together, these resulted in the immeasurable outcomes of nursing being an art, revealing stories and examples of UC San Diego Medical Center’s Spontaneous Acts of Magnetism. As an addendum to this Magnet application, the following stories make up the sources of evidence for Spontaneous Acts of Magnetism (SAM):
A 32 year-old patient, well known to UC San Diego Medical Center as a patient in 2008, was re-admitted to the hospital in 2010. He has Spina Bifida and had been in and out of nursing homes; resulting in his 6-month stay at UC San Diego, as nursing homes refused to take him back. His behavior in these nursing homes illustrated his frustration with an inability to connect to anyone providing care. It was determined throughout his stay at UC San Diego Medical Center that it was necessary to find another plan for a living situation for this young man.
In addition to providing him with excellent clinical care, nurses partnered with social workers to heal the patient using a holistic approach – physically, emotionally, and spiritually. The team on 11 West went above and beyond for this patient. A clinical social worker found a brand new apartment building, which provided housing for low-income, single residents. She worked with the Center For-Disabled, visited the apartments, and ensured the rent was within the range for the patient. She assisted him in the process of applying for the apartment, completing necessary paperwork, and getting a social security card.
Through the process of taking these extra steps, which no other healthcare provider had done for this young man, the 11 West clinical team was able to assist him in creating a better overall quality of life. They opened doors which allowed him to become an autonomous, independent person. He in turn opened up to them about life issues and events, and would talk with nurses in the middle of the night shift, a dramatic change from his previous tendencies, characterized by staying in his room, voicing negative words and exhibiting negative behaviors. He was able to be open and honest, and he began articulating goals in his life. The nursing staff viewed him as courageous for all he had been through, and they became a true, supportive family for him; a crucial element he never had known before. Upon discharge, the patient was extremely excited about his new chapter in life. The nursing staff had provided him with “life skills,” such as budgeting, shopping, planning a meal, and other daily activities. The nurse manager, Elvie Sevilla, purchased basic supplies one would need for their first apartment. She provided him with sets of dishes, towels, etc. The social worker continues to call him and check in to be sure he is being successful, building trust with others, and learning essential life skills he needs now that he is on his own. The staff on 11 West was able to help this young patient move past dependency on the healthcare system. By giving him their attention and teaching him some basic skills, he no longer relies on nursing homes and hospitals. In addition, they gave him the ability to set goals. The interactions with the staff also gave him a sense of spirituality, something he never had known, and something that he now appreciates and has become a part of who he is. He now volunteers at a nearby church.
A mother-to-be was diagnosed with terminal cancer in her late 30’s. The story, told by the staff of 11 West, was one of a woman of true strength and courage. The social worker first met the patient on a Saturday. The social worker was called in because the patient had insurance problems. She had been diagnosed with terminal cancer in the 15th week of her pregnancy. At 27 weeks, she delivered a baby boy. UC San Diego Medical Center arranged for her to stay on the 11 West inpatient unit rather than going to hospice, so she was able to stay near her newborn baby.
In the short time between delivering the baby and her passing, nurses and social workers on 11West did everything in their power to provide the art of nursing in every interaction and every moment. In the span of a few weeks they threw the patient a birthday celebration, wedding, a baby shower, and a baptism. On days she was feeling well enough, they took her down to the NICU to see her baby boy. On the days she was not feeling up to it, the NICU staff brought the baby up to her room so she could see him.
Staff gave her the idea of keeping a journal of her thoughts, or of videotaping herself to give her son some “words of wisdom.” They loaned her a video camera. In every interaction, the patient showed her appreciation. Never a complaint, never a negative word. She thanked Elvie Sevilla, nurse manager, for the gifts and parties, and expressed her gratitude for being able to fulfill her goal of being a mom.
Debbie Ashton, BSN, RN, an Acute Dialysis nurse, told a “Magnet Moment” after a day of feeling as if she made a difference in the life of a patient and his family. She had just finished dialysis with the patient and took him off due to persistent arrhythmia, which he had had before. The patient felt fine, and vitals were stable. All of a sudden, he began complaining of pain and shortness of breath while on oxygen. Debbie quickly became aware the situation abruptly changed. The patient went into ventricular tachycardia and lost consciousness. His wife ran out of the room and help arrived immediately. The patient’s rhythm changed to a narrow complex bradycardia, pulseless, so Debbie started compressions. She was relieved by the patient’s primary nurse and went out of the room to find the wife sitting alone in the waiting area, obviously beside herself, unable to reach her kids on their cell phones. Debbie sat and talked with her, and prayed with her for the people working on her husband. A nurse appeared and said he was conscious and talking. Debbie defined this “Magnet Moment” as a peak moment in her career, knowing that she had made a difference in the life of her patient and his family.
A beautiful, bright young woman in her early 30s, who had been diagnosed with leukemia 2 ½ years prior, relapsed 18 months post-transplant, and was admitted to the Bone Marrow Transplant Unit at Thornton Hospital. The social worker asked the patient if there was anything she could do for her, knowing that her time here on earth was growing short. The patient expressed that she had wished she had married the man she has been with for the last 15 years, who was the father of her 3½ year old daughter. Staff enlisted assistance from the Medical Center Chaplain; Environmental Services; Deborah Wayne, RN, MSN, MBA, Director of Nursing at Thornton Hospital, and Ann Skinner, Patient Relations Representative. The Chaplain obtained the necessary paperwork from the County, and arranged for a notary, and the legal marriage took place that very day. The next day, the nursing staff on 3W transformed the hospital’s Triton Conference Room into a beautiful chapel and reception area, complete with flowers, decorations, cake, and refreshments.
The team even arranged for someone to videotape the joyous event. The room was soon filled with 40 of their friends, family and staff members who had lovingly cared for the patient over the years. As the wedding began, the patient was wheeled in on a geriatric chair so that she was able to sit up during the ceremony. Father Thomas, a member of the Chaplain service, led the vows, rings were exchanged, and when the wedding was complete Father Thomas baptized their daughter. The wedding was on a Friday and the patient died Monday morning. What a difference 24 hours can make in the lives of patients and in the memories of their loved ones.