Am I off Base? or mentally unstable?

  1. Hello everyone,

    I need your help. During a meeting with my Clinical AdvisorI was brated for a writing a paragraph in one of my reflections.

    I wrote about a violent patient that I had one night that was admitted. He had to be placed in 5 point restraints and was trying to bite and spit on us.

    I wrote that I preceived the expsure of salva, to be a risk to the staff and that I had asked my nursing preceptor if it was appropriate to put a OR mask on him. My preceptor said that it was not the policy and I fully accepted this. It was an aside comment to her and I made no attempt to do this.

    My Adivior told me that I was completely out of place to even ask this. she state that salvia pose absolutely no risk to us and even thinking up such a thing meant that there is something fundamental wrong with my thinking and perceptions. Since i am not able to judge the risks I put the patient in danger. I told her that I did not accucually put the mask on the patient I only asked the nurse about it and as a student its my role to ask questions. I also repeated that this is my first mental health rotation.

    I told her that I in fact do feel that the pt salvia posed a risk for infections like Hep B, herpes, conjuctaivsis and more. Espesically if it came in contact with my eyes or an open wound. She said that no such risk exisits and that my ability to realistically assess risk is suspect.

    She then told me that under no curcumstance do we ever put anything on a pts face except a O2 mask. While this I can accept, am I not allowed to ask question as a student?

    She then told me that my entire topic (violence in the workplace) was of concern to her as it is not a typical focus of a mentally stable student.

    I felt like I had been hit in the stomach, all i could do was nod and hope this meeting ended asap. she says that I may fail if she doesnt feel that I can practice safely.

    What I need to know was I out to lunch for (1) considering that spit exposure puts a person at risk, (2) asking a nurse the question about the OR mask, (3) choosing my topic.

    or is my preception so outside the norm that I do in fact pose a threat to my patients.

    thank you all.
    Last edit by Zhakrin on Mar 17, '02
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  2. 43 Comments

  3. by   mattcastens
    1. You are not out of line in your thinking. While the chances of contracting a serious illness from the patient's saliva is very small, there is the possibility of contracting colds or flu, which can put you and future patients at risk. There is also the possibility of contracting TB, which I understand to be bad. (Whether or not the patient had TB is another issue.)

    2. You were not out of line in your asking. Had I been the nurse I would have been thinking the same thing. Whether or not the patient poses an infection risk, no nurse deserves to be spit upon.

    It sounds to me as if your instructor was on a power trip. It happens, unfortunately.
  4. by   amy
    I have been in the position with pts needing to be restrained who resorted to spitting. I admit openly that I have put a mask on pts. and told them "if you want to spit have at it, and if the spit runs down your face it can stay there." Although I am not sure of exactly everything that may be transmissable through saliva, it is considered an exposure if the staff is bitten by a patient, especially if blood is drawn. It is considered a 2-way exposure, meaning pt exposed to staff and vice versa. What if this person spit in your eye or mouth? No one could covince me that that would not be considered an exposure. If saliva is not considered an exposure risk why does the CDC have droplet precautions listed as an isolation precaution? I would ask if that would mean that all droplet precautions (or respiratory isolations) were unnecessary and should be elminated altogether. Might as well give out TB cocktails to everyone! Of course, my mouth has been known to get me in trouble!
  5. by   amy
    Oh, I almost forgot, make SURE you monitor respiratory function during this. Aren't those mask made especially to ensure adequate oxygenation during wearing? I don't think all staff in OR would waer them if they caused the wearer to be hypoxic...(mouth again, gotta learn to be a little less brutally honest)...
  6. by   thisnurse
    your advisor should have a mask on her face to contain the crap that spews from her mouth
  7. by   fergus51
    LOL! I am with thisnurse!

    My psych teacher also liked to diagnose students on her rotation. We all learned very early on not to put anything personal in our journals, but I don't see how you could ever predict this one!! If you ask me, it's your teacher who's a little metally unstable.
  8. by   SICU Queen
    I HATE psych. HATE it.

    There is NO way on God's green earth that I WOULDN'T put a mask on a spitting patient (and monitor appropriately, of course). Give me a break! Your instructor sounds like she's the mentally unstable one for even making you think that you're out of line for your questions. There's no "wrong" question to ask, and in fact yours was entirely appropriate.

    If something comes up regarding your passing or failing again, I'd go to the program's director with the facts. Meanwhile, keep your mouth shut and just get to the end of this rotation as best you can, and when it's over, thank your lucky stars...

    Did I mention that I HATE psych??
  9. by   Mary Dover
    No way were you off base. Had the same incident and my first thought was to find a mask and monitor the pt. with its use of course. The pt was spitting at everyone in the room, none of which were medical staff but me. Others were law enforcement etc. In my opinion, it was my duty to protect them as well as myself. Your teacher must be a real study herself.
    By the way...I LOVE PSYCH.
    Mary
  10. by   babynurselsa
    Personally I always prefered a washrag and some of that 2 inch tape over a mask.........
  11. by   hoolahan
    lol, I am with thisnurse!!

    Fergus, relax, you are in no way mentally unstable for your line of thinking. Your instructor is nuts.

    Actually, if I were not allowed to put the mask on the pt, I would get an isolation gown to keep spit off my clothes, a mask w face shiled to keep it out of face, mouth, and eyes, and and OR cap and show covers. If he is allowed to spit, I will at least keep it off myself.
  12. by   JMP
    Zhakrin

    You are in a bit of a tight spot here, on an American board as a Canadian nursing student asking for advice............ two things to remember, you are a student and therefore, subject to instructors opinions and bias...... I am a recent Canadian grad myself and now that I am in THE REAL world, am finding out how much my teachers DID NOT KNOW.......but heh, it is great learning all over again. THE OTHER THING TO REMEMBER- as a Canadian in (Ontario?) you will be governed by the College of Nurses and I would suggest, if you have not done so already, read their policy regarding restraints and pts. THE HOSPITAL YOU ARE LEARNING AT should also have a policy regarding restraints. IN MOST CASES, a Dr.'s order is needed and as far as the mask in concerned..........have not seen it myself, I HATED PSYCH rotation..........I work in ICU now. WHEN IN DOUBT always check your institutions policy manual AND if possible ask a EXPERIENCED working nurse what they normally would do with a pt like this one- I am sure it is not the first pt who spit at someone.
    Nurses do not deserve to spit on, true, BUT IN ONTARIO pts have LOTS OF RIGHTS- be careful how you guide yourself....... we are neighbours with the US but ARE DIFFERENT!!!!!!!!!
  13. by   Cascadians
    The Clinical Advisor is uninformed, WRONG, a jerk, a bully, and a perpetrator of Vertical Violence.

    Please read thru the info on this Link and understand what just happened to you:

    http://www.nursingassistant.org/HorizV1.html
    Horizontal Violence

    " ... Workplace violence has now been listed as an epidemic by the Centers For Disease Control. ... "

    http://www.workdoctor.com/home/def.html
    Workplace Bullying Defined

    Also, know that for no reason EVER does a health care worker have to be subject to ANY of a patient's body fluids without protection.
  14. by   Teshiee
    I agree with the nurses! I don't see any problem seeking knowledge unfortunately your instructor was being ignorant. When they can't answer your question they don't know the answer. For instance when we were learning the respiratory system the whole class couldn't understand what peep pressure her response was read the chapter again. My rational thinking was this the heffa didn't know the answer so I went to work and sought out a respiratory therapist. Sometimes you have to go to alternative resources than you instructor. They are there to get a paycheck. They could care less. I say about in every rotation there is an instructor that is not on top of the game he/she thinks. Hang in there! I am not to fond of psych either just get through and learn later! :roll

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