“Debbie exhibits brilliant examples of dignity in the real world,” claims Labor and Delivery Manager Mary Wright about L&D Nurse Debra Bolton. “”She strives to make each interaction one which is filled with respect, hope and dignity. In a crazy world of labor and delivery, living this value on a daily basis is quite a feat, but Debbie has found a way to nurture and sustain it. I believe Debbie is an inspiration to all who are blessed to have an encounter with her and experience her expressions of dignity.”
Uses open, honest and respectful communication during all interactions
Throughout her 18 years as a Labor & Delivery nurse, Debbie has thrived on “making it a good and pleasant delivery” for each family. Her reputation as an L&D nurse who will honor the family’s birth wishes and make them feel comfortable is well known in the community. That fact has led many a new mom from her network of acquaintances and her church in Orange to select St. Joseph Hospital and specify Debbie as their L&D nurse of choice.
While enjoying what she calls “the heart-pumping excitement” of delivery babies and not minding the screams that often come from the laboring mother, her ability to bring dignity to the experience is not dependent upon a good outcome. Six years ago when a perinatal hospice began here, Debbie became the L&D representative. She has chosen to maintain that role, and has expanded it from serving as the inpatient liaison to being the outpatient liaison as well.
As a St. Joseph Health System Perinatal Comfort Care Program team member, Debbie has been a pioneer for one of the nation’s first perinatal hospice programs. She has shared the components of this dying-with-dignity program with nurses nationally through Magnet and Association of Women’s Health Obstetric and Neonatal Nurses (AWHONN) conferences.
Mary states, “Debbie has provided dignity to these families who will experience a neonatal loss. She attends the family conferences, which usually means coming in on her day off. She helps them plan the birth of their baby, who may only live for a few precious moments. Once the plan has been made by the family, Debbie attaches this plan to the patient’s prenatal instructions and makes sure appropriate hospital staff members are aware of their wishes. All this care is done to provide a perfect delivery and is evidence of the dignity Debbie strives to provide each family as they celebrate this special birth. Her interactions with this population are too numerous to count and the success of this program has been largely with Debbie’s input and devotion to make the life and ultimate death of a new birth filled with dignity and beautiful memories for that family.”
Debbie adds, “I have a heart for still birth parents and want to help them find ways to still celebrate that life during the pregnancy. We can’t change the outcome, but we can walk the path with them and hold their hand through it. We don’t force them into the program; we respect their wishes and look at how we can best help them. We follow their desires for photography, baptism and whether to involve siblings. A tour of the unit helps them decide if the mom wants to recover on the unit or would prefer to go to 2 South. When they come in, they’re prepared.”
Holly was one of the moms who leaned on Debbie and the Perinatal Comfort Care Program when her unborn daughter was diagnosed with a terminal illness. The bond of trust that developed prompted Holly to request Debbie’s help when she returned to the hospital to deliver a healthy baby boy. Giving her that baby, Debbie remembers her tears of joy as Holly whispered to her son, “I don’t have to tell you goodbye; I get to tell you hello and take you home.”
Perinatal Comfort Care Program Coordinator Suzanne Engelder, MSW, points out that Debbie is gifted in all the core values of the Sisters of St. Joseph of Orange, and relays how most of all she shines in displaying Dignity: “It was about 9:00 pm when I entered the Labor and Delivery Department. Debbie was coming out of a room where one of our Perinatal Comfort Care Families was being cared for. Earlier they had delivered a beautiful baby boy with Potter's Syndrome. Baby G had lived a few hours and had just taken his last breath while in the arms of his parents. Debbie was by their side, accompanying them on this journey. With love and tenderness in an atmosphere of dignity and respect Debbie helped this family welcome their precious baby and say "hello" and "good-bye" in a very short period of time. She was present for this family - allowing them to do what they needed to do to celebrate, bond and remember their baby. Later, together with the family she collected mementos that they could treasure for years to come. She gently clipped a small piece of hair, made handprints, gathered his clothes and blankets. Although Debbie's shift was over at 7 pm she had stayed to finish this sacred journey with the family. But there is more to this story. Out of respect to the nurse coming after her, Debbie brought her into the room and introduced her to the family. With a gentle hand on Baby G's head, a touch to mom's brow and a kiss on her cheek, Debbie lovingly placed her into the capable hands of her co-worker, knowing that this nurse would continue the perfect care that she had started. In that moment, Debbie demonstrated dignity for this family, their newborn baby and the nurses that she works with side by side every day."
Listens to, acknowledges and shows respect for all people with their differing viewpoints and ways of interpreting the world.
A Muslim family in the Perinatal Comfort Care Program experienced how Debbie respects the dignity of diverse families in all cultures and in all stages of their lives while providing personalized care. In the midst of their grief, they were impressed and thankful that their wishes were honored, from having dad whisper in the baby’s ear to needing to bury the baby within 24 hours of death.
Debbie elaborates, “I’ve learned that we’re all different, and it’s okay to have different thought processes. Each patient is special and a being of worth. I look at this as their time. I remove my own biases, even if it means they want to deliver with few interventions and in ways different from how I would choose to deliver.”
Another example of how Debbie developed dignified care concerned pictures taken of the fetal demise babies. Debbie felt the pictures the nurses took did not reflect the beauty of these babies. She contacted Now I lay Me Down to Sleep (NLMDS), a company with professional photographers who donate their time and talent to come in and take pictures of these infants. As a result, families can have lifelong memories that reflect the dignity and beauty of these precious moments with their newborn.
In some instances, mothers in labor who expected to deliver at home with a midwife experience complications and wind up at the hospital. “They’ll tell me they don’t want to be here and don’t want me to intrude. There are times I have to say, ‘I’m sorry, but I’m here to do what’s best for you and the baby.’ It’s important to gain their trust. They have to feel you really care about them, and then they become cooperative.”
An expectant mother of twins recently called the unit and spoke with Debbie. She said she’d heard in the community that we wouldn’t give formula, but she didn’t want to breastfeed. Debbie explained why breastfeeding is encouraged, and that we do provide formula and would honor her preferences. She affirmed that the mother was still a good and loving parent.
Mary recalls Debbie delivering dignity to the birth experience of a 12-year-old girl who had been abused by her father. “She gave the girl and her aunt a very thorough tour of the unit. She took extra time and explained in great detail such concepts as a Foley catheter, an IV and an epidural. Since this patient had only had one period prior to her pregnancy, Debbie explained the drainage she would experience, since that could have been extremely frightening. Debbie was so connected with this family by the end of the tour that the family requested that Debbie be assigned to her when she came for her cesarean section.”
Debbie added, “I promised to do her delivery. So many people had let her down and I couldn’t too. I held her hand, like a mother would. I went to see her post-delivery and encouraged her to stay in school.”
Creates and promotes positive working relationships that foster a healthy and effective work environment
Debbie has served on the committee that prepared St. Joseph Hospital for its exclusive Orange County designation as a Baby Friendly Hospital. At first, some staff members in Women’s Services were unsure about incorporating processes required for this designation. Debbie was excited about Baby Friendly and was among the staff members demonstrating that this initiative was research-based, and much more than a push for moms to breast feed. Debbie explains, “The whole skin-to-skin concept makes a big difference with bonding and for the baby’s health in terms of regulating the baby’s breathing and temperature. Instead of the traditional method of taking the baby from mom to warmer to bath (which causes the baby’s temperature to drop), the mom’s chest temperature rises when needed to warm the baby. The baby is less stressed and calmer. And parents like being the first ones to count all the fingers and toes. Once the nurses saw how babies were transitioning better, they became excited about it too.”
Mary comments, “Communication is a vital component in being a competent leader in the L&D world. Debbie has been complimented by many physicians for her leadership style, and her direct and timely communication as a (relief) charge nurse. She understands the unique role that this provides as being a peer and then leader. She gives respect for those she is supervising. She is straightforward with difficult conversations and looks for opportunities to improve the care given to our patients.”
Debbie claims communication is all in the delivery. She remarks, “Our unit you has very few problems; still, you have to continually watch that you don’t say negative things or talk behind someone’s back. If you have a disagreement, take it up with that person. Regarding their practice, ask why they’re doing it that way.”
Debbie has also involved in the multidisciplinary High Risk Perinatal Conferences since their inception. She interacts with various clinical specialists as well as those in social services, case management and spiritual care.
When it comes to parents delivering a dying baby, some of the nurses are understandably fearful of what to do and say. Debbie teaches a demise class. She provides a list of things to say. “I also tell them that sometimes,” Debbie says, “it’s better to say nothing and to just be present with them than to offer clichés.”
Recognizes and celebrates the unique contributions of all coworkers
Debbie and her L&D colleagues comprise a close-knit unit. She shares, “Our unit is a family. We have lots of parties to celebrate births, marriages and other special occasions. We share support when there are deaths and divorces. If someone is sick and off work for a couple of months I’ll call to see how they’re doing. We care about each other and we’re there for each other.”
In incredibly vulnerable times of need for families, dignity flows through the capable and loving hands of Debra Bolton, R.N.C. St. Joseph Hospital proudly shares her extraordinary example.