Between what? Well in this case between apathy and cruelty.
I had a rough day at work yesterday, being on the neurology unit is always challenging. Many of the patients have had some type of brain injury, either from head trauma, stroke, years of alcohol and drug abuse, dementia, any number of causes. As a result of this, their behavior is affected, and as a nurse, it's part of my job in caring for these patients to take that into account, and still treat them with dignity and compassion.
One of the patients I had this weekend was a 30 year old man. He was profoundly mentally retarded, severely autistic and partially blind. Mentally his age was about 2, and he had a sitter in the room with him for his safety. The sitter he had until 3 pm was very good with him, but the patient doesn't respond well to men, and around 1 pm, when his sitter was giving him his bedvbath, the patient became aggressive. I went in to help him, and he got hold of my arms, dug his nails in and drew blood.
Not the first time this has happened to me, so after we got him washed up, I scrubbed off my arms, put on some antibiotic ointment and band aids, and continued on with my day.
But the patient continued to be aggressive towards the sitter, and finally we had no choice but to restrain him.
Now, there are VERY specific rules regarding the use of restraints in the hospital. You have to use the lowest level of restraint, restraints have to be released every 2 hours, other interventions have to be tried first, the restraints have to be tied with a slip knot so they can be released with one hand, ect, ect. All of these rules were followed to the letter while the daytime sitter was there.
Then at 3, a new sitter came on. Again, a male, a CNA I've worked with before. He's a decent CNA if he knows the nurse is on top of him, but he'll slack off at the first opportunity, and I know this about him. So I gave him report on the patient, he went in to sit, and I started passing my meds.
After about an hour, I heard yelling coming from the patients room, and I went in to see what was going on.
The patient was laying in the bed, half of his vest restraint was up around his neck, and he had 2 restraints on each wrist, both of which were so tight that his hands were mottled and cold. He was twisting and yelling, and the CNA was sitting in the chair with the TV turned up full blast and ignoring him.
I asked WHY he had 2 restraints on each wrist, and the aide said he was getting free of the first ones, so he put a second set on. I asked if he had noticed that the vest was around the patients neck, and he said "I'm not getting close enough for him to hit me, he can stay like he is"
So, while this asshole stood there and watched me, I started re-adjusting the restraints. Every one of them had been double knotted, again, a HUGE no no. The CNA again said something about not wanting the patient to hit him when I asked why he was tied like that. I got everything squared away, made sure the patient was OK, stood there stroking his cheek and singing to him to calm him down, and then went and called the supervisor and told her what had happened and requested a female sitter for the patient.
A female sitter came up, and she was wonderful with him. She was kind, gentle, and compassionate. At one point we were both in the room and she and I got him singing "You Are My Sunshine". He was calm for the rest of the day, and we were able to leave him in just the vest and take the restraints off his hands.
I know this is a long intro into what I wanted to say. The thing is, when I looked at this patient, even though he's 30, I saw him as a child, because mentally, that's what he is. I also saw, that at a lower level of functioning, and without the early intervention, that could easily have been my son in that bed, so that's how I treated him. The sitter that came in at 3 saw something completely different. All he saw was someone who could potentially hurt him, not a sick, confused, disoriented human being. He classified him as a potential threat, and so any potential compassion he might have had went right out the window. He was there for a paycheck, he didn't give a crap about the patient, and so he was willing to jeopardize the safety of someone who was completely helpless to protect himself.
The thing is, when dealing with patients who are confused, for WHATEVER reason, it's our responsibility as caregivers to maintain their safety. And the key to this is all in how you approach them. With this patient, speaking in a soft gentle voice, using a calm tone, treating him in a way that was appropriate to his MENTAL age, was all it really took to calm him down.
Regardless of how confused or how developmentally disabled someone might be, they can still sense when someone genuinely cares, and when they don't. And no matter how diminished their capacity might be, they will respond accordingly. I'm not saying that they'll turn into sweet little kittens, I've had more than my share of bruises from confused patient to ever say that! But, what I AM saying is that ALL behavior is communication in some form, and when a confused or developmentally disabled patient acts out, it's because they're trying to communicate something. Pain, hunger, fear, having to use the toilet, being too cold or too hot, even just wanting some attention. They're trying to tell us something, and it's our responsibility to find out what that something is, rather than just deciding they're crazy, or a threat to our safety.
I hate like hell that this poor patient had to spend an hour with someone who clearly couldn't have cared less about him. I know the patient won't remember , but I will.
Showing posts with label nursing. Show all posts
Showing posts with label nursing. Show all posts
Friday, September 11, 2009
Another Monday, post work note
I got canceled yet again on Sat morning. At 4:30am. And that was it, I was up for the day. The upside to it was that Wyatt and I got to go to Beckys birthday party, which was lovely. As soon as we got there, Wyatt spotted a cicada, and promptly FREAKED OUT.
Not that I blame him. After having done the 87 Renn Faire, which coincided with the 7 year cicada swarm, I HATE those little fuckers. I have very unpleasant memories of the sound they make when you step on them in leather sandals, it's not pretty. And of how it feels to go sliding across a stage after stepping on one in leather sandals. And the utter freakout of having one fly down the front of a 10lb velvet dress you're wearing in 95 degree heat. Yeah, me and cicadas, not a good combination.
But Wy calmed down, we had a really nice time, headed back to my folks house, and then I went home and tried to get some sleep.
I say tried, because apparently it's a bad idea for me to drink Pepsi after 6pm. I was up until 1am.
But the dreaded 5am phone call never came, I got dressed and went in to work. I was assigned to 7 General, the neurological unit I worked on last weekend, and had one of the same patients I had last week. he in his 50's and has syphilis that's gone to his brain.
That's right kids, to the brain. The same shit that killed Henry VIII.
Of course, nobody would ever confuse this dude with a King of England. This guy was nasty, funky, with cornrows that grew out into mats a good 3 months ago. He'd had a bath the night before, but that funk was just so ground in, his whole room smelled like a hamster cage.
Luckily it was a mellow day, so one of my CNA's and I were able to give Mr Funky ANOTHER bath, we got some vasoline and greased up his hair enough to work out the mats and old cornrows, and them we each took half his head and re-did the rows.
Yes, I know how to cornrow. (Erica's so proud of me right now, because if Tim and I had kids, I wouldn't have been one of those white mothers of a mixed child who had no clue what to do with her daughters hair, so she wouldn't have had to laugh at me behind my back)
By 2pm, I was so wiped out, I ran to the Starbucks on the first floor, and got a White Mocha with double espresso, which perked me right up.
Which of course meant that I had nothing to do for the rest of the day.
I was chasing down every other nurse and CNA on the floor asking if they needed help, and nobody did. I was SO bored I ended up finishing the book I'd started reading the day before.
My shift ended, this time WITHOUT one of my patients coding, and I picked Wy up and headed home. As I was getting him tucked in, I had my hair down, and he started running his fingers through it. I asked if he liked playing with my hair, and he said "I love it. it looks just like the brushers in the Laser Wash 4000 car wash on University Parkway!"
Since car washes, and Goth Belly dancers are the new loves of his life, I took it as a compliment.
I feel asleep almost before my head hit the pillow, and woke up at 2am to Wyatt trying to pry my eyelids open, because he'd woken up, come into my room, put on Bee Movie, crawled into bed with me, and wanted me to watch it with him. Finally got him back to sleep by bribing him with a car wash promise for today (which I kept, because you can go through the car wash in your pajamas)
Not that I blame him. After having done the 87 Renn Faire, which coincided with the 7 year cicada swarm, I HATE those little fuckers. I have very unpleasant memories of the sound they make when you step on them in leather sandals, it's not pretty. And of how it feels to go sliding across a stage after stepping on one in leather sandals. And the utter freakout of having one fly down the front of a 10lb velvet dress you're wearing in 95 degree heat. Yeah, me and cicadas, not a good combination.
But Wy calmed down, we had a really nice time, headed back to my folks house, and then I went home and tried to get some sleep.
I say tried, because apparently it's a bad idea for me to drink Pepsi after 6pm. I was up until 1am.
But the dreaded 5am phone call never came, I got dressed and went in to work. I was assigned to 7 General, the neurological unit I worked on last weekend, and had one of the same patients I had last week. he in his 50's and has syphilis that's gone to his brain.
That's right kids, to the brain. The same shit that killed Henry VIII.
Of course, nobody would ever confuse this dude with a King of England. This guy was nasty, funky, with cornrows that grew out into mats a good 3 months ago. He'd had a bath the night before, but that funk was just so ground in, his whole room smelled like a hamster cage.
Luckily it was a mellow day, so one of my CNA's and I were able to give Mr Funky ANOTHER bath, we got some vasoline and greased up his hair enough to work out the mats and old cornrows, and them we each took half his head and re-did the rows.
Yes, I know how to cornrow. (Erica's so proud of me right now, because if Tim and I had kids, I wouldn't have been one of those white mothers of a mixed child who had no clue what to do with her daughters hair, so she wouldn't have had to laugh at me behind my back)
By 2pm, I was so wiped out, I ran to the Starbucks on the first floor, and got a White Mocha with double espresso, which perked me right up.
Which of course meant that I had nothing to do for the rest of the day.
I was chasing down every other nurse and CNA on the floor asking if they needed help, and nobody did. I was SO bored I ended up finishing the book I'd started reading the day before.
My shift ended, this time WITHOUT one of my patients coding, and I picked Wy up and headed home. As I was getting him tucked in, I had my hair down, and he started running his fingers through it. I asked if he liked playing with my hair, and he said "I love it. it looks just like the brushers in the Laser Wash 4000 car wash on University Parkway!"
Since car washes, and Goth Belly dancers are the new loves of his life, I took it as a compliment.
I feel asleep almost before my head hit the pillow, and woke up at 2am to Wyatt trying to pry my eyelids open, because he'd woken up, come into my room, put on Bee Movie, crawled into bed with me, and wanted me to watch it with him. Finally got him back to sleep by bribing him with a car wash promise for today (which I kept, because you can go through the car wash in your pajamas)
It's never boring in my neck of the woods!
I got canceled from work this weekend, so no funny hospital stories, but you know, when God closes a door...
One of my classmates, Theresa is staying with me during the week, which is really great. She's a really good friend, great company, and it's so nice to have another adult in the house. There's only so much carwash and elevator talk a Mom can take...
So, Wy got home from school, we got his homework done, and T and I were sitting on the back porch chatting, when we heard brakes squeal, plastic crunching, general - oh shit that sounded like an accident- noises.
T and I both being nurses (She's an ER nurse), couldn't help ourselves, we HAD to go look. There was a car stopped in the middle of the street, and an overturned scooter, with a guy in roughly his late 20's lying in the road.
Well, that was it, the adrenalin kicked in, and we both took off at a dead run to check the guy. He had some road rash on his arm, his head was fine, despite the fact that he wasn't wearing a helmet, but his ankle was a little floppy and he was having trouble moving it. By the time T and I got to him, he already had his cell phone out, calling his mother to come pick him up. He was adamant that he didn't need any help until Theresa started moving his ankle.
Now in this situation, I know who the expert is here, and it's T. She's a very experienced trauma nurse, so I ran back over to the house to grab gloves, a stethoscope, B/P cuff and HAND SANITIZER. (that's how you tell the experiences nurses from the nubies - we're not touching ANYONE without gloves and sanitizer!) Got back over, told my neighbor to call 911 on the way back, and as T was assessing his ankle, I checked his B/P and pulse.
He had called his mother 2 more times since I had gone. T and I both told him he needed to go to the hospital, his ankle was probably broken, but he kept saying - Nah, I can't do that right now, I'll have to do it later. Theresa and I both noticed his pupils were a little too dilated, and he didn't seem to be in quite as much pain as you'd expect, which explained why he didn't want to go to the hospital or have an ambulance called. Scooterboy looked like he was high as a kite, and the way he kept checking his pocket made both of us think he was probably holding.
But, they were already on their way, along with Fire and Rescue, and 3 Winston Salem Cops. Which meant that it's showtime in the neighborhood!
That's right, pretty much everyone on the block was out on their porch, or wandering up to see what happened, including Wy, who was standing in the driveway, VERY excited by the fire truck and ambulance. The EMT's got out of the firetruck, checked the guy out, ALSO told him he needed to go to the hospital, Theresa and I gave them his vitals and told them about the ankle pain. Then we headed back to the house for a smoke, a beer, some dinner and some more studying. The rest of the fools on my block stood around staring, joking, and generally making a social event out of what could have ended with this idiots brains all over the street. I've seen this guy come flying through the neighborhood, on dirtbikes and scooters, usually at about 60 mph ( the speed limit here is 35) and never with a helmet on.
So anyway, the block party ended with Scooterboys Mom coming and picking him up to take him to the ER, and one of his buddies (who he'd also called on his cell as he was laying in the street bleeding) picked up the scooter. The woman who was driving the car gave her info to the police, the rest of the crowd trickled away, and not Theresa, Wyatt and i all have an interesting story to tell when people ask how our evening was.
Never a dull moment here!
One of my classmates, Theresa is staying with me during the week, which is really great. She's a really good friend, great company, and it's so nice to have another adult in the house. There's only so much carwash and elevator talk a Mom can take...
So, Wy got home from school, we got his homework done, and T and I were sitting on the back porch chatting, when we heard brakes squeal, plastic crunching, general - oh shit that sounded like an accident- noises.
T and I both being nurses (She's an ER nurse), couldn't help ourselves, we HAD to go look. There was a car stopped in the middle of the street, and an overturned scooter, with a guy in roughly his late 20's lying in the road.
Well, that was it, the adrenalin kicked in, and we both took off at a dead run to check the guy. He had some road rash on his arm, his head was fine, despite the fact that he wasn't wearing a helmet, but his ankle was a little floppy and he was having trouble moving it. By the time T and I got to him, he already had his cell phone out, calling his mother to come pick him up. He was adamant that he didn't need any help until Theresa started moving his ankle.
Now in this situation, I know who the expert is here, and it's T. She's a very experienced trauma nurse, so I ran back over to the house to grab gloves, a stethoscope, B/P cuff and HAND SANITIZER. (that's how you tell the experiences nurses from the nubies - we're not touching ANYONE without gloves and sanitizer!) Got back over, told my neighbor to call 911 on the way back, and as T was assessing his ankle, I checked his B/P and pulse.
He had called his mother 2 more times since I had gone. T and I both told him he needed to go to the hospital, his ankle was probably broken, but he kept saying - Nah, I can't do that right now, I'll have to do it later. Theresa and I both noticed his pupils were a little too dilated, and he didn't seem to be in quite as much pain as you'd expect, which explained why he didn't want to go to the hospital or have an ambulance called. Scooterboy looked like he was high as a kite, and the way he kept checking his pocket made both of us think he was probably holding.
But, they were already on their way, along with Fire and Rescue, and 3 Winston Salem Cops. Which meant that it's showtime in the neighborhood!
That's right, pretty much everyone on the block was out on their porch, or wandering up to see what happened, including Wy, who was standing in the driveway, VERY excited by the fire truck and ambulance. The EMT's got out of the firetruck, checked the guy out, ALSO told him he needed to go to the hospital, Theresa and I gave them his vitals and told them about the ankle pain. Then we headed back to the house for a smoke, a beer, some dinner and some more studying. The rest of the fools on my block stood around staring, joking, and generally making a social event out of what could have ended with this idiots brains all over the street. I've seen this guy come flying through the neighborhood, on dirtbikes and scooters, usually at about 60 mph ( the speed limit here is 35) and never with a helmet on.
So anyway, the block party ended with Scooterboys Mom coming and picking him up to take him to the ER, and one of his buddies (who he'd also called on his cell as he was laying in the street bleeding) picked up the scooter. The woman who was driving the car gave her info to the police, the rest of the crowd trickled away, and not Theresa, Wyatt and i all have an interesting story to tell when people ask how our evening was.
Never a dull moment here!
More Fun From Workland
I had a really good day at work yesterday. We, with the exception of the nurse that relieved me and his poor orientee, but I'll get to that later.
I was in IMU - which is an ICU stepdown unit. The patients aren't well enough for a general medical floor, but they're not critical. It's one of my favorite units to work on, because I never have more than 3 patients, which means I actually get to spend some time with them, instead of running up and down the hall slingshotting pills into people. I get the chance to take a closer look at their history, do some teaching with them and their families, and really be hands on in terms of the level of care I give, which for me is very satisfying.
I had one patient who just tickled me to no end. He was in his early 50's, paraplegic and mildly retarded. By now most of you know that I love working with the MR/DD population (Mentally retarded, developmentally disabled), I really enjoy caring for them, and they seem to respond well to me. This guy was so funny, he kept kissing my hand and blowing kisses at me, and asking if I had a boyfriend. I told him I did (I don't but that's what I tell all my patients, keeps the men from crossing the line. Sometimes), but that he could be my friend.
He had a MASSIVE sacral (butt for all you non medical folk) wound that needed a huge, involved dressing, so about an hour before I was going to change it, I gave him 2 Vicodin, and after they'd kicked in, I went in to do the dressing change. Because of where the wound was, I had to lay him almost on his belly, which meant that I had to empty his colostomy bag. So I did, and as soon as I opened it he said "Girl that STANKS, did you fart?" and started laughing.
I lost it, and started laughing too.
I got him turned over, and started dressing the wound, and he started talking about how much he loves music. I asked him what he liked to listen to, and he said he loved 70's R&B,. He said Barry White, a 40oz and a good woman was all he needed to "get my squeeze on". After I stopped laughing, i asked if his pain medication was keeping him comfortable, and he said it was. Then he started singing I Can See Clearly Now, so I started singing along.
It was such a weird, cool, absurd moment, the 2 of us singing...it's gonna be a bright, bright sunshiny day... as I'm up to my wrist in his wound, stuffing gauze around his tailbone. But then, that's what a lot of nursing is, these moments of absurdity, intimacy, pathos and humor all rolled into one. I live for those moments, it's why I've stayed in hospital nursing for as long as I have. You don't get those moments from behind a managers desk.
Between him, and my other patient, ( an 85 year old who looked like he was in his mid 60's, and was completely alert) I got to spend the day with two sweet men who both were appreciative of everything I did for them. It made up for getting canceled Sat morning, switched to night shift, getting to work at 7pm on Sat and being told they didn't need me and then trying to fall asleep after the 3 cups of coffee I'd had so I could stay awake for the night shift I didn't end up working!
It even made up for the night shift nurse who decided to show off for the new graduate nurse he was orienting by nit picking everything I did over the course of my shift. He questioned every telephone order I wrote, every progress note, even tried to nit pick my interpretation of the telemetry strips on my patients.
He questioned why I held a dose of Vancomycin, when the order clearly said to hold if the Pt's trough level was >20. The patients level was 22.1, and he wanted to know if I'd called the MD. Well no, I hadn't, I had called the Pharmacy MD, because that's who wrote the Vanc order, and that's who I was supposed to call. So while I stood there, he called the MD about it, the MD asked him was the Pharm MD called, he said yes, and the MD said "Then why are you calling me?" and hung up on him.
Then he asked about the output from the patients colostomy. Usually colostomy output is liquid or semi liquid, so you chart it in cc's. This patients output wasn't liquid, it was solid. I'd charted that he had 2 formed stools, and he asked "Did you measure them?" I said "Yes. There were two."
He got pissed off and walked away, and his orientee started laughing as soon as he was out of earshot.
With all the nitpicking this asshole did, I ended up not clocking out until 7:50pm, so at least I got an extra hours worth of pay out of the aggravation!
I was in IMU - which is an ICU stepdown unit. The patients aren't well enough for a general medical floor, but they're not critical. It's one of my favorite units to work on, because I never have more than 3 patients, which means I actually get to spend some time with them, instead of running up and down the hall slingshotting pills into people. I get the chance to take a closer look at their history, do some teaching with them and their families, and really be hands on in terms of the level of care I give, which for me is very satisfying.
I had one patient who just tickled me to no end. He was in his early 50's, paraplegic and mildly retarded. By now most of you know that I love working with the MR/DD population (Mentally retarded, developmentally disabled), I really enjoy caring for them, and they seem to respond well to me. This guy was so funny, he kept kissing my hand and blowing kisses at me, and asking if I had a boyfriend. I told him I did (I don't but that's what I tell all my patients, keeps the men from crossing the line. Sometimes), but that he could be my friend.
He had a MASSIVE sacral (butt for all you non medical folk) wound that needed a huge, involved dressing, so about an hour before I was going to change it, I gave him 2 Vicodin, and after they'd kicked in, I went in to do the dressing change. Because of where the wound was, I had to lay him almost on his belly, which meant that I had to empty his colostomy bag. So I did, and as soon as I opened it he said "Girl that STANKS, did you fart?" and started laughing.
I lost it, and started laughing too.
I got him turned over, and started dressing the wound, and he started talking about how much he loves music. I asked him what he liked to listen to, and he said he loved 70's R&B,. He said Barry White, a 40oz and a good woman was all he needed to "get my squeeze on". After I stopped laughing, i asked if his pain medication was keeping him comfortable, and he said it was. Then he started singing I Can See Clearly Now, so I started singing along.
It was such a weird, cool, absurd moment, the 2 of us singing...it's gonna be a bright, bright sunshiny day... as I'm up to my wrist in his wound, stuffing gauze around his tailbone. But then, that's what a lot of nursing is, these moments of absurdity, intimacy, pathos and humor all rolled into one. I live for those moments, it's why I've stayed in hospital nursing for as long as I have. You don't get those moments from behind a managers desk.
Between him, and my other patient, ( an 85 year old who looked like he was in his mid 60's, and was completely alert) I got to spend the day with two sweet men who both were appreciative of everything I did for them. It made up for getting canceled Sat morning, switched to night shift, getting to work at 7pm on Sat and being told they didn't need me and then trying to fall asleep after the 3 cups of coffee I'd had so I could stay awake for the night shift I didn't end up working!
It even made up for the night shift nurse who decided to show off for the new graduate nurse he was orienting by nit picking everything I did over the course of my shift. He questioned every telephone order I wrote, every progress note, even tried to nit pick my interpretation of the telemetry strips on my patients.
He questioned why I held a dose of Vancomycin, when the order clearly said to hold if the Pt's trough level was >20. The patients level was 22.1, and he wanted to know if I'd called the MD. Well no, I hadn't, I had called the Pharmacy MD, because that's who wrote the Vanc order, and that's who I was supposed to call. So while I stood there, he called the MD about it, the MD asked him was the Pharm MD called, he said yes, and the MD said "Then why are you calling me?" and hung up on him.
Then he asked about the output from the patients colostomy. Usually colostomy output is liquid or semi liquid, so you chart it in cc's. This patients output wasn't liquid, it was solid. I'd charted that he had 2 formed stools, and he asked "Did you measure them?" I said "Yes. There were two."
He got pissed off and walked away, and his orientee started laughing as soon as he was out of earshot.
With all the nitpicking this asshole did, I ended up not clocking out until 7:50pm, so at least I got an extra hours worth of pay out of the aggravation!
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