Nursing Student's breakdown moment

  1. Hello everybody. I'm a second semester nursing student. I am currently having clinicals in the SNF unit. Today I had my breakdown moment....I gave a PRN pain med after the PT told me my patient was feeling pain. I told the RN. She instructed me to give a Darvocet. Now, on the patient's notes, it saids to give 1 Darvocet for pain scale 1-5, and 2 pills for pain scale 6-10. It crossed my mind to ask the patient what was their pain level. But the RN said "Just give her one, she doesn't need two" and I stupidly did that.

    Then my instructor came to grill me. "So you gave the PRN med?" yes. "How much did you give?" One. "What was your patient's pain level?" *me standing there looking stupid* i don't know. "Did you do a pain assessment?" *feeling stupid-er* NO.

    I just feel so stupid for doing that. We've been told...YOU are the one giving meds, YOU do the assessment. That was my breakdown moment when I felt so incompetent and questiong whether I'd make a great nurse, or even a good nurse.

    Then, I couldn't get my patient to let me bathe her. She insisted she got a good one yesterday and wants one tomorrow. But not today. I told her I have to give her a bath. She just kept telling me to leave her alone and if I tried to touch her with the wipes, she'd try to move away. So I gave up.

    As a student, we are expected to do the AM care, including bathing and brushing. But what do you do if your patients just refuse to even after I persisted? The instructor always says "You should've been more assertive" . What else could I do, suggestions anyone?

    Thanks for listening to my complaints.
    •  
  2. 28 Comments

  3. by   catlynLPN
    Patient's rights to refuse any or all part of their care.
    You can't force her to do it if she doesn't want to.
    However, you might suggest just a quick washup....face/hands, mouthcare, perineal, feet, lotion to her feet and back, or any part of that, and maybe she would agree to it, and that would satisfy the instructor.
  4. by   snowfreeze
    You sound like you will be a wonderful patient advocate. You respect your patients wishes. A patient has the right to refuse treatments and procedures. Patients manytimes simply need to be further educated on why the test or procedure needs to be done.
    With dementia, psychotic and delusional patients simply approaching them later when they are in a more receptive frame of mind helps.
    You are still a student and are learning, I bet you will do a better assessment of pain for the rest of your career.
  5. by   crnawant2be
    If the patient is A&O x 3, they have to right to refuse any part of care including AM care. but donot used this to just get out of doing it. the other students will see it if you start a pattern
  6. by   sandys
    This is sort of a peeve of mine anyway. Why MUST they have a daily bath? This was an expectation of mine during clinicals as well and sometimes became an issue when the patient would refuse. I agree that next time if you say, "well, let's just wash your face and hands" that may be the best you could do. If they are incontinent you might push for peri care as well. Most elderly people do not do a full bath on a daily basis at home, so why should they in a SNF or hospital?

    I sympathize that it can be hard to convey that to an instructer though. They just want you to get the experience while you have the chance, even though sometimes it's not entirely practical. Hang in there!
  7. by   FireStarterRN
    You did fine. If you don't actually wrest a number out of a patient in real life, you can always guessimate for the stupid charting. You'll find that a goodly percentage of patients don't really care for the pain scale. When you're a nursing student sometimes you're caught between your 'by the book' instructor and the nurse whose patient you're caring for, who's more acquainted with reality.

    I agree with your patient, why does she need a bath everyday? It's her body, and she's probably not sweating too much in a SNF. Just chart that your patient refused her bath. I love it when my patients refuse their baths, it's one less thing for me to do! Touching someone who doesn't want to be touched in legally considered assault.
  8. by   CC918
    thank you everyone for your support and advice.

    I'll continue to work hard and find a balance between doing what the instructor wants and what the RN wants and what I want/can. I'll eventually get used to things within the hospital. It's just so scary since it's my first clinical semester!
  9. by   suzy253
    I agree with the others; sounds like you are doing just fine to me and you'll make a great nurse.
  10. by   kcalohagirl
    You did fine. I may be wrong in assuming that your patient is elderly. Or I may not. I know from talking to my grandmother, that daily baths were not common for people of her generation. I know that a lot of patients I have cared for do not feel that it is necessary to have a daily bath. (Of course, we are taught that it is necessary to give them one.)

    People also don't always give us the "pain scale" as we would like to hear it.

    We would like to hear 1-10, but the patient functions better, with "a tiny bit, a little, just a bit, quite a bit, and OH MY GOD THAT HURTS!!"

    You're doing fine.
  11. by   bakpakr
    Hi I am going to chime in here. I am about to finish my CNA program. We graduate on friday. I can't comment on the administering of the meds as it is not in my scope of practice. But assessing pain is part of of what we have to do to report to the RN. In clinicals I am working with allot of demented residents who are unable to reply to the number scale of pain so we are taught to base our assessment on the facial expression. As for refusing any and all care they are well within their rights to refuse and you have to respect their wishes. Yesterday morning the lol I was assigned flat refused any and all AM care. So I just changed tactics I stopped pushing to do her care and spent a few min just talking to her. Then after a few minutes I just slipped in a request to wash her face and she let me. In the end I was able to convince her to allow me to do most of her AM care. She still refused to allow me to do her mouth care. I find that it mostly boils down to the fact that you are a new person to them and they are a bit uncomfortable with you. It is nothing personal but they don't know you. Once they get to know you and realize you care they will allow you to care for them. I had a lol on tuesday that would let noone care for her. I spent a few minutes just chatting with her and it ended up that I was the only one in our class that she would let care for her. One of my classmates tried and she spit at her. Oh and I am the only male on the floor at the moment. I had no problems with her and she ended up being such a sweet lady. I just talk to them and respect them.
  12. by   nyapa
    If the patient refuses care, you are going against their consent. Your instructor should be aware of this. Perhaps you could have said to the instructor "Can you help me convince the patient? I'm having a bit of trouble here". Of course, some educators wouldnt appreciate this, because it might make them think that they were wrong...

    Re: the pain issue. Sure you should have done an assessment. But you were following the guidance of your RN, so she should also have some responsibility.
  13. by   fultzymom
    A patient has the right to refuse any part of her care that they do not want. I usually try a few times to get patient to do whatever, then I always document their refusal and my attempts to get the task accomplished. You can try to be assertive as you wish but if your patient refuses you can not force them to do what you want them to do. One thing to try though is ask the staff members if there are any tricks you should know about that will get that particular person to get into the bath. Sometimes they known little ways to get something done that students do not know about.

    As for the pain med, yes you should have assessed. But chalk it up to a learning experience. I bet next time you will go to the patient to see what they want and take things from there.

    You are doing fine. We all make mistakes. Learning is a process. And that is why you go to school. Good luck!!:spin:
  14. by   rn/writer
    You could have asked the patient to rate her pain. 1-5? No problem with giving just one, and you would have been able to answer your instructor's question. You might also have mentioned what the RN told you and asked what you should have done had the pain number been higher.

    If the initial rating had been, say, a seven, you could then go to your instructor and present the conflict. You know what should be done, but it's nice to have the official okey-dokey when you're caught in the middle between two authority figures.

    Remember to document both the pain rating and the follow-up an hour later (if it is an oral med).

    Experienced nurses are not perfect. Exercise your best judgment about your practice and don't let yourself do things that you know are wrong. "She told me to do it," is not an adequate defense if you know (or should know) better.

    File this under learning experiences. Clinicals are not only for honing your skills, but for sharpening your thinking as well. You're right on schedule, and I'll bet you'll never make this mistake again.

close