Compassionate care for people with complex diseases
May 6, 2011
Valerie Hauch
STAFF REPORTER
Nightingale Award Honourable Mention: Dan Parmigiano
Dan Parmigiano knows what it’s like to have a loved one live with a debilitating disease, trapped in the wasteland of the brain that is dementia.
His grandmother, who was taken care of by his mom and aunt at their home, had Parkinson’s, a disorder of the central nervous system. Later in life, she developed dementia.
While she was still alive and he was in nursing studies at the University of Toronto, the Richmond Hill native gained first-hand knowledge of what’s involved in caring for someone with advanced physical and mental infirmities.
“I believe it gave me strength in my profession ... it kind of instilled hope in me that perhaps I can continue to help and advocate for people in similar situations,” says Parmigiano, 36, a registered nurse who has worked for about 11 years in transitional care at Bridgepoint Health, a continuing care and rehabilitation centre at Broadview Ave. and Gerrard St.
A man who exudes warmth and smiles often, Parmigiano received an Honourable Mention in the Nightingale Award for outstanding nursing.
Bridgepoint’s complex continuing care unit, where Parmigiano works, has 34 beds that he says are “always full.”
It cares for many patients with conditions such as congestive heart failure or cancer, as well as those with behavioural issues that may be linked to dementia, Alzheimer’s, strokes or head injuries.
The goal is to stabilize medical conditions and behaviours. Many patients experience agitation, frustration and impulsivity. They may sometimes respond by yelling, swearing, refusing medications, throwing things and more.
Once, Parmigiano had to dodge a cup of hot coffee.
“You get to be quick — I moved out of the way,” he says, with a smile. When something like that happens, he knows the patient needs a breather.
“I might explain, ‘I’ll be back in a minute,’ and let them calm down. Or it may be a case of helping them calm down and a distraction can help, like turning on the TV or music. Or it could be something like just asking them how their family is, something that turns them away from themselves. You always try to offer choices.”
Parmigiano never forgets that it’s not the patient’s fault if they’ve lost control of their impulses because of a brain condition. What they need is patience and understanding, which he appears to have in abundance, and also a way to move forward, in whatever way possible.
For instance, if a patient won’t take medication, he might put it in their food. Once the medication has taken effect, the patient may be more responsive to reasoning and suggestions. The idea is to manage the disease and empower clients as much as possible.
Careful monitoring by the staff team can help them understand what triggers certain behaviours in a patient. By the time the patient is ready to move on, to a long-term-care centre, for example, Parmigiano and his colleagues will have developed a “detailed plan of care” so staff at the new facility will know what works.
“I take a genuine interest in the patient ... you have to listen to what they want to say,” Parmigiano says. “If you can make the patient feel the ball’s in their court ... you make them feel better about themselves.”
He feels a huge sense of accomplishment when he can ease or comfort patients and their families. That’s part of the Bridgepoint vision: making the lives of people with complex diseases better.
“The patient is no longer the sole client, especially in cases where the families are the substitute decision-makers,” says Parmigiano, referring to cases where dementia has robbed a patient of his reasoning.
Kathleen Valin is one family member who has become part of the care equation at Bridgepoint. Her 94-year-old mother, Margaret, has long been a patient in Parmigiano’s unit. Watching his dedicated care and interaction with her non-verbal mother, who has a neurological condition, moved Valin to nominate him for the Nightingale.
She was delighted to hear that Parmigiano, whom she describes as a “consummate professional,” was named one of three Honourable Mentions.
As a registered nurse herself, Valin knows good nursing and is heartened by Parmigiano’s enthusiasm for his profession. “He is constantly reading, updating with courses, and sharing information that may be of interest to me and helpful for my mother.”
Parmigiano combines “an inquiring, scientific mind with a compassionate, caring bedside manner,” she says.
She likes the fact he will frequently turn to her mom, “including her in the conversation, even though she is non-verbal and it is unclear as to how much she might understand.”
Valin notes that when Parmigiano is assigned to her mother’s care, he will bring her chair down by the nurses’ station, where he can continue to do other work but also observe her at the same time. “This is a comfort to me to know that she has company around her and that someone is interested enough in her well-being to do this.”
Every shift on the ward brings its own challenges, says Parmigiano, who admits the job can get very stressful.
If he finds he needs some calming himself, he has a routine. He’ll take five minutes in a staff room, where he can relax and listen to a CD with soothing sounds of waves. “I’ll meditate on that, and breathe with the waves going in and out. It helps ground me.”
What’s the toughest part of his work?
He thinks for a few seconds. “The hardest part of my job is prioritization of care needs. What needs to be done first?”
As for the most satisfying part of his job, there’s no hesitation, “When I can get a patient to smile ... that’s what’s most rewarding.”