CIWA woes - page 4

by Indy 12,846 Views | 52 Comments

I don't really have any complaint with the CIWA protocols, I am grateful they exist and enable me to sorta get a handle on the ETOH'ers when they decide it's time for withdrawal. It's a lovely thing. What I really dislike are... Read More


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    Quote from Indy
    Yeah, okay, wow what a hornet's nest. I'm glad someone (forgot which poster, didn't hit reply) is better than me. It's two days since I left that shift, make that three, and my butt still has a bruise on it from where the dude tried to pull my cheek right off. Ever been in a bear trap? I haven't, this made me think of that. It was a rant, it was labeled as a rant, it was done on monday. It's thursday. Take the self righteousness and stuff it back into whatever hole it fell out of, I'm not buying it.

    There is not now, and has never been, any sort of demand on nursing or on me personally to like my patients. There are things about most of them I do like. The alcoholics in violent DT's just aren't people I get all warm and fuzzy for. They aren't in the unit every day, and I don't need a break from ICU just because they exist. What I needed was a heating pad, a day or two of rest, (got that) and it helped to rant a bit. Thanks for being so understanding.
    we all have those days...((HUGS))
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    Quote from subee
    But what does C I W A actually stand for?
    Clinical Institute Withdrawal Assessment
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    Anoetos "I can say with absolute certainty that I will never do this."[QUOTE]
    (in reference to passing judgement )[/COLOR]


    ]Anoetos,
    I can admire your heart in the desire to seek to be non judgmental . However, As soon as something is simply not possible,you have opened a gate for it to not only become possible,but highly probable.

    When we become aware of our frailties and capacity to judge only then are we in a position to do something about it. In the fixed mind their is no possibility of change.

    It is humorous to me that we all can point the finger at another in judgement that the "other "person should be non judgmental! (Sort of like ,"you shouldn't judge but I am allowed to judge you ")

    Hmm.sometimes we teach best what we most need to learn. (yep, myself included)
    canoehead, not.done.yet, Anoetos, and 1 other like this.
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    As many of you know I'm an old bat, having graduated from college in 19mumblemumble. I have seen just about all of it and done most of it, including plenty of alcoholics in every stage, from the stupid-ass teenager on his first ill-advised beer binge to the terminal yellow woman bleeding out of everything like she had Ebola.

    But I never, never came close to appreciating the experience of living with an alcoholic until this past year, when a friend's adult son came to school in our area and stayed at our house on weekends to get out of the dorm. We knew ahead of time that he had had "a problem" and had been in rehab, had once been given the choice of rehab or jail, had lost his licenses, and had stolen from his family to drink. HIs mother divorced his father for alcoholism; there were others in that family. All behind him, they all said, he's decided to turn his life around. We welcomed him with open arms and eyes, knowing part of our "job" was to support his sobriety; he was happy to be with us, helped us with some big projects that were more than we could do ourselves, we treated him as one of our own kids, which is to say, pretty well, and life was good.

    Until it wasn't.

    Skipping all the gory details, we gave him the ultimatum of "one more time and you're gone, you go to AA q week or you're gone, you're here every night or you're gone," and he sat in my kitchen and wept and apologized and begged for forgiveness over and over, and did the AA twice a week down the street from our house. Until he didn't.

    The worst thing about it was after we threw him out (still stinking drunk at 1pm after the night before, when I found him at nearly midnight with stuff afire on the stove and broken crockery on the floor) -- the incredibly vile emails and texts and phone calls, the vicious lies he told to everyone about us to our friends and family...and to his family, whose friendship we had treasured. We had many sleepless nights; it would start over again when we discovered yet another something missing that we knew he had taken, or bottles in the deep grass behind the garden. He flunked out of school and stole and crashed a vehicle belonging to another friend. I knew about this stuff happening intellectually for years and years, but the experience in my own house, the breach of trust, was truly shattering.

    So do I have sympathy, do I know it's a disease, do I know his brain was irrevocably altered and he couldn't really help it? Yep. Do I care? Nope.
    Sadala, jmll1765, not.done.yet, and 1 other like this.
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    I care.

    I care because once upon a time, I was that guy.

    I can certainly understand needing to protect yourself and your family from such people. I can even understand being completely worn out by caring for someone like this.

    What I can't understand is a nurse who gets on a message board to expose themselves as frustrated and essentially uncaring. I also cannot understand people who are, generally, well compensated for and used to dealing with all manner of disease sequelae lining up to agree with them.
    Last edit by Anoetos on Nov 15, '12
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    Echo, I get what you're saying. I was thinking about it as I wrote what I wrote.

    I am not without character flaws. God knows I have many.

    But I am also of an age where I don't have a lot of illusions about who I am and what I am and how I will respond to things. I've had a broad and rich life experience up to this point, full of choices both bad and good. It is permissible for someone who is seasoned to say things about themselves which from the mouths of those in their twenties would sound ridiculous and full of hubris.

    I do regret the comment that this makes me better.
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    Anyway, to get back to the topic, and I apologize for derailing it, people addicted to drugs and ETOH are difficult to deal with. I work in progressive care, we get advanced CIWA cases very often, according to policy, we can administer more Ativan than other floors in the hospital where I work.

    So, we get he "frequent flyers" and those whose behavior leads personnel in the EC to conclude that they need something more than 2 mg at a time.

    It's funny, I was talking with a nurse today who will soon be moving to the PICU. We were discussing several differences about what he will be dealing with and what we deal with on MPCU. His patients will not be in the hospital due to choices they have made, they will be motivated to improve, they will be young and resilient. Our patients are not usually these things.

    CIWA cases are just advanced examples of this made worse by the fact that they are sometimes combative and just out of control.

    I just find myself wondering if we can't change the mix here. These people need to go somewhere where they can get help, not judgment.

    We all make choices that we regret and become caught up in the results in ways that we cannot control. Caring for victims of their own foolishness is hard, but it's what we're called to. It's what we do. I just don't think we have the luxury of passing judgment on people who, but for a very few differences (usually accidents of birth and family) are no different than we are.
    Last edit by Anoetos on Nov 15, '12
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    Quote from Anoetos

    What I can't understand is a nurse who gets on a message board to expose themselves as frustrated and essentially uncaring. I also cannot understand people who are, generally, well compensated for and used to dealing with all manner of disease sequelae lining up to agree with them.
    Why? Why can't a nurse be a human being and be frustrated with a patient? Are we supposed to hold in that frustration and never expose it, like it's some dirty little secret? Why does having a bad day and needing to vent to those who can relate make a person uncaring? If you think this is bad, you are going to be shocked when you get into the real world of nursing.
    canoehead likes this.
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    Quote from Aurora77

    Why? Why can't a nurse be a human being and be frustrated with a patient? Are we supposed to hold in that frustration and never expose it, like it's some dirty little secret? Why does having a bad day and needing to vent to those who can relate make a person uncaring? If you think this is bad, you are going to be shocked when you get into the real world of nursing.
    You have a point.

    But I can't help seeing a difference between expressing frustration over an incident and expressing that one does not like a patient because his condition is his own fault.

    One more thing, this "once you get into the real world of nursing" crap has to stop, it's a weak veneer meant to cover up and justify all manner of hard heartedness on the part of nurses who, for whatever reason, have never really come to grips with the disconnect between the ideal and what they actually see.

    I am so grateful that I came to the profession late in life. I won't have to go through this. I'm already pretty well individuated in this matter of idealism vs reality.
    Last edit by Anoetos on Nov 15, '12
    lemmyg likes this.
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    Quote from Anoetos



    One more thing, this "once you get into the real world of nursing" crap has to stop, it's a weak veneer meant to cover up and justify all manner of hard heartedness on the part of nurses who, for whatever reason, have never really come to grips with the disconnect between the ideal and what they actually see.

    I am so grateful that I came to the profession late in life. I won't have to go through this. I'm already pretty well individuated in this matter of idealism vs reality.
    You will have an advantage over your younger peers, but the reality vs the idealism of school is very real, no matter the age. I, too, came to nursing later in life so I've got a bit of experience here. I'm a realist when it comes to the work world and dealing with other people and I still (gasp!) get frustrated with patients occasionally. Maybe you'll get lucky and you won't have to go through the process of going from student to professional nurse but I doubt it.

    I suspect that most of your shock at the OP comes from your personal experiences. If she was venting about a non-compliant diabetic frequent flyer making her frustrated, would you have been as angry?
    Anoetos likes this.


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