Sorry folks but I really feel the need to blow off a little stress today. I just have to wonder if any of you have found yourself suffering healthwise because of a patient? Here is my problem. I have posted previously on the lady that yells constantly, the one we sent to a psych unit for evaluation. Well she's back and even louder than ever. My blood pressure is starting to climb, I think because of her. Normally it runs 122 over 76, not bad. Last night she was very loud and constant. We had a Mother's Day party for the residents and there were many guests. All of them were looking at her then they'd look at the staff and whisper like they just couldn't believe we weren't doing anything to help her. So, seeing this I started a 2 hour repeat conversation with the resident. She would yell "Help me!" I would say, What can I help you with?" She would say, "Nothing." I would say, "Why are you yelling then?" She would respond, "I don't know." I would ask her not to yell unless she needed something and then we would do whatever we could to help her. She would say, "Okay." and then immediately would yell again. I couldn't take her to her room because that isn't safe, also that is considered isolation and state says that's a no no. When I left last night my bp was 167 over 98 and I had a headache that was about to bust my head wide open. We even tried one on one, taking her for walks and talking to her, of which she yelled the whole time. I am very upset with myself that I am letting this situation get to me so badly. I take pride in what I do and it really upsets me that the visitors thought we were just ignoring her. I had to keep repeating this converstaion because the stream of people was constant and I wanted them to know we were trying. We have an order now to admit her the a permanant psych. facility as soon as one can be found that will accept her. I'm not sure my health will hold up that long. I woke up with the same nasty headache I went to bed with and my b/p is still very high. Yesterday the MD gave orders to change her meds with the intentions of "snowing" her until she leaves. So far, no effect BUT I have to tell you that goes against all I have come to believe in as a nurse. This is not how we are supposed to treat our residents but this choice was made because the other residents are starting to threaten her and even the quiet ones are getting in on it. I am afraid for her if she doesn't quiet down so I can see logically that increasing her meds is OUR only alternative since we have tried everything we can think of. I am starting to get upset with myself because yesterday I found myself thinking that I couldn't wait till she was gone. I have never had such thoughts before and I feel ashamed for thinking this. I am starting to cry at the drop of a hat and am not handling things very well. I have thought about asking my doc to put me on something to calm my nerves but really don't want to do that. Last night my hubby was on the hall with me as my QMA. He is so great and tried so hard to help the situation. He picked up a lot on my treatments and paperwork, just so I could sit with her. I'm not sure why I felt the need to post this. Maybe to confess my bad thoughts, or to try and blow off steam. I'm not sure. No response is expected, I guess I just needed to vent. I promise not to make a habit of my whining. Thanks for listening.
May 10, '01
although many beleive "snowing" the patient is unacceptable, it may be the only choice. I am not agrreing with it, certainly not 24 hours a day. However, there comes a time when it needs to be done, even just at certain times of the day.
One other thing???? You never said, does her family come visit her? Does she have any family??? What do they think about her actions? Just some thoughts.
Hope ya feel better!
May 10, '01
Duckie, When you've utilized every trick in the book and nothing is working, chemical restraints are acceptable. Don't get down on yourself. If she has prns, use them. Obviously she just can not help what she does therefore she needs the medication. A nurse who is burned out is worthless and can not take care of the other pts and eventually her health is jeopardized. Try not to "snow" her, just try to control her. You'll feel better and so will the other pts.
May 10, '01
Duckie , I have been reading some of your posts for a while now . Just want to say I am so sorry you are feeling this way .You usually sound so positive .It does come through in your post, that you must be a very caring person . It sounds as if you have tried every thing with this lady . You are human so don't feel guilty for having feelings . You have probly tried harder than most people would .Hope you are feeling better.
[ May 10, 2001: Message edited by: ucavalpn ]
May 10, '01
Duckie- First- excuse my curiosity- tell me what is a QMA?
Second- you did everything a good nurse would do. At this point meds are called for due to the fact that her actions are bothering the other residents, not to mention that when someone is agitated, even slightly, don't you think they are uncomfortable? If you are uncomfortable(stressed), then I'd venture to say she must be too, therefore to administer meds is very appropriate, esp in light of the fact that you have tried EVERYTHING first! Good luck, hope for a transfer soon, as your patient deserves appropriate, safe placement. Don't feel bad!
May 10, '01
arms....me.......arms....A hug for you Duckie. No patient is worth an aneurysm. Into a patients world, and little snow must fall Sounds like this one needs abit of a blizzard. That incessant noise would drive me crazy too. If she has family it would be great for them to take her out now and then. Dreaming?Haldol is nice, especially if the patient is sundowning.Try not to get worried try not to hold onto problems that upset you, don't you know everythings alright everythings fine, it's cool and the ointments sweet for the fire in your head and feet close your eyes close your eyes think of nothing tonight.(Jesus Christ Superstar) It may have been off key, but if I could sing I wouldn't be nursing.
I must admit my initial thought about a patient making me sick was when the cough RIGHT in your face, or hit you with toxic gas when you are cleaning up their bank deposit. These things seem miniscule compared to your problem.
[ May 10, 2001: Message edited by: leesonlpn ]
May 11, '01
I wish I could just give you all a hug, thanks so much for your support and kind words. I didn't really expect responses but each one has meant a lot. Some of you have asked questions I would like to address. Rick: Yes, she has 2 sons but they both live out of state. I did find out today that one of them is trying to have her moved near him after we have her admitted to the psych. facility. I'm glad because this way at least she can see one of her kids. Who knows, maybe that will help her some. NurseTami: A Q.M.A. is a qualified medicine aide that is trained to assist the nurses and can pass meds, but not controlled drugs, also do treatments, no open areas, and assists with some of the paperwork. Not all states recognize them. My husband is a real sweetheart when we work together. Folks don't understand how we are together 24 hours a day and I'm his supervisor at work too. It works for us and I enjoy having someone with me I can trust 100% all the time. I asked him to go to nursing school but he won't, says he likes what he does and don't want all the responsibility and stress that I have. My female residents all love him, good thing I'm not the jealous type. LOL It's odd that they do cause he has real long hair and a beard and tatoo's. I guess maybe it's because they can see inside his heart. To respond to one of your comments, yes we did consider that pain could be an issue and we are giving her pain med around the clock, so far not effective. leesonlpn: Thanks for the hug, and I'm sending you one right back. As for your song, it was absolutley perfect. It's funny because I listen the the sound track from Jesus Christ Superstar all the time, so I'm very familiar with those words. ucavalpn: I do try to be positive most of the time, it's better for my health. I'll get it back, I'm workin' hard. Thanks again to all of you, you were just what the doctor ordered for this "ailing duck". I'm trying very hard to get myself pulled back together. I am concerned about my B/P because today when my head started pounding it was 169/110. I took "lots" of Ibuprofen and the headache is a little better. I work tomorrow but am off this weekend and hubby has told me it will be all R & R, so maybe that will help. Tonight I decided to keep her in her room most of the time and kept alternating staff, myself included to go in and talk to her and try to calm her. One of my residents threatened to hit her so I felt in order to keep her safe this was my best choice. The medications they said would "snow" her, haven't even touched her, so I'll try and get a good nights sleep and face tomorrow when it gets here. Thanks again everyone, you're all TERRIFIC!!!!!
May 11, '01
In my opinion, too much emphasis is put on the fact that when we have a patient that is having problems dealing with reality, that medications to help these patients, are called restraints!! Let's be realistic and understand the fact that they are having many psychological problems that don't allow them to deal with things in a NORMAL way. Are we really restraining them or do we find the right medication to help them through their own frustrations or psychosis? I look at it as they are extremely frustrated and do not know how to deal with stimuli. It may mean a change in medication and the physician needs to be more involved in solving the problem and aware how it is affecting the patient and the others, including staff. With many psychotic patients it is also a way of getting the needs of their psychosis met, by acting out. I believe then, that the medications are not working and you are being stressed out unnecessarily to the point that it is affecting your health to stroke point!!! Continue to document up the whazoo!!! No physician wants that in the chart, that he or she isn't meeting the needs of this patient or any other. Document, Document isn't that we are taught and taught and taught!!!? Good Luck!!! Take care of yourself!!!
May 11, '01
Hi Duckie, I totally agree with the general opinion here. You have tried everything!! and the fact she is still yelling has to be controlled for her own safety as well as for her comfort. I probably don't know the situation or person well enough to make suggestions, and I am certainly not a psych nurse, but for what it is worth, sometimes distraction works for our totally confused and loud or "picking" patients. Is she safe to have something chewy like a carmel or gum to keep her mouth busy? Would TV distract her? If she is constantly picking at things like IV's, tubing etc., I have occasionally wrapped tape loosely around a couple of fingers, (not as restraints!) to give them something acceptable to pick at and occupy them. It sometimes worked for a little while.
These probably won't work in her extreme case though but I just thought they might be worth a try. Don't feel badly about using medications at this point. It sounds like she needs the relief as well. One more thought, what is the hospital you will be sending her to going to do any differently? Maybe the ones being looked into have a suggestion if they handle a lot of these cases? Have a relaxing weekend!!
May 11, '01
If I was that resident I would prefer to have some medication to calm me, and a caring staff around me than to annoy fellow residents and staff. Just think- if you were so confused that you had the same behavior what would you want the nursing staff to do for you at this point. It seems cruel to deny her the meds at this point, as she would be extremely embarassed by her own behaviour if she was in her right mind.
May 15, '01
One trick I learned, a couple years ago. Is she yelling rhythmically?
AAhh AAhh AAhh AAhh, or AAAh ah AAAh ah, whatever, does it sound like a pattern?
if it does sometimes tapping out a different, slightly more complex rhythm, can help. I had one woman actually thank me after I interupted her yelling this way. It works a short time, but in the long run its another tool.
May 15, '01
We thought this resident would be locating to a psych. facility, but they refused to accept her. The meds that we have tried have not helped in the least. We tried routine pain meds for a week, with no effectiveness and she continues to deny pain. I am going to my doctor to try and get my health under control because every day I feel worse and my B/P and pulse continue to climb. I am actually thinking about taking a short leave of absence to try and get my health under control. I have mixed feelings about what I am doing but I don't want to drop over dead at 44 so something has got to give. I did find out more about this dear lady and it makes me hurt inside even more for her. It seems this only occurred about 7 months ago when she had brain hemmoraging (sp?) so she has not been this way long. We will continue to do all we can and hope we can somehow make a difference.
May 16, '01
What about taking care of you? Is there a quiet office where you can go meditate for a few minutes to regain your calm? Take a headset with some soft music, put your feet up and just count your breaths over and over to ten. Get a massage, soak in a hot tub and remember, you can't carry the world on your shoulders
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