Terrible clinical day, nurses don't seem to care.

Nurses General Nursing

Published

I may get a lot of flack for this from the more experienced nurses, but I would like some help in understanding this situation.

Today, I walked by a patient's room in the hallway. Keep in mind she is not my particular patient today. She calls out to me in a frail voice for help, and sounds like she is in very bad shape. I go in to see her and she is crying, and very frail. She must have been in her 80s or even higher. She stated that she could not move her arms, and that she was desperate for some water. My first thought was that she might have been having acute MI or something similar because she couldn't move her arms, I really didn't know. I held her hands quickly and asked if she could feel my hands in hers. She said she could, but that she can't move her arms, and continued to cry and beg for water. She kept saying that she did not know where she was or why, and to please help her.

At this point, I noticed the restraints. She was strapped into her bed, this is why she couldn't move her arms. I was horrified. This is a med/surg floor, not a pysch ward. I asked one of the tele people what was going on and they stated 'it's just some crazy old woman, she's weird don't worry about her'. I asked her nurse and this was the same answer I got from her, again. She stated this woman had previously tried to pull out her IV and so they restrained her.

So...

Help me understand. They clearly had to get an order for these restraints. Why did they not choose a chemical restraint or sedative instead of strapping her into the bed? Why does no one care about this woman, writing her off as a crazy old lady; when she is, in reality, a frightened human being who was strapped into her bed in a strange place and scared to death. Not to mention thirsty, as she was apparently NPO and no one would explain to her why.

I went into the stairwell and cried for about 5 minutes. This is not why I wanted to go into nursing. I see things like this every day, but never this bad before. Restraints! They strapped this poor woman down and wouldn't explain anything to her. I spent some of the rest of the day talking to her and trying to help her relax even though all she wanted was to get out of bed and get some water.

It broke my heart. And if this is what nursing means, that eventually you become so burned out that a fellow human being suffering in one of the worst possible ways becomes just some 'crazy old lady', then I want no part of it.

The OP reminds me a little of myself when I was starting out as a CNA.

I was 21 and had never set foot in a nursing home or hospital until my training.

The world of the disabled and isolated elderly is a hidden world for many healthy young people.

Altzheimers and dementia were things I had only read about.

It took me a while to understand what it is like to have a patient unable to retain information due to a lack of short term memory.

I tried to soothe anxiety and fears that were incomprehensible to me.

Specializes in LTC, Memory loss, PDN.

I read most of the responses and I'm so happy that I did. Lots of great advice and explanations. No one got defensive or aggressive. I salute the op for seeking answers rather than condemning. It occurs to me that the same great nurses who post here are the ones who work on the floors, so I believe there just wasn't enough time for the floor staff to give all the great responses we've seen here. I was fortunate enough to have had this kind of scenario extensively discussed in school, by and with my instructors, before ever setting foot on the floor.

I don't have time to read all the posts here right now, so I apologize in advance if I'm repeating anything:

First of all, before I was a nurse, I volunteered at a local hospital bringing books and magazines to patients. I offered my selection to a woman in restraints (not seeing them at first), and she started to beg of me...let her out, bring her scissors or a knife (very common request you hear from restrained patients). I just stopped and stared--I wasn't on a psych ward, what was going on? When I saw the nurse in the hallway, she said to me "oh, don't even bother with her. She's all restrained and everything"

I was mortified. And one thought prevailed-- "I will never be that nurse"

And I'm not. Though I've been in similar situations--and I don't always offer a detailed explanation as to why my patient is in restraints. For one thing, I need to protect the patient, so I'm not going to go into detail as to why they are confused (withdrawal, dementia, delirium, opiates, benzos, anaesthesia--those are the big ones). I conduct myself professionally if an individual is inquiring or showing concern, but unless they need to know, they won't. I smile and nod and say "yeah, she's not herself today" or "you may want to come back later" or "if you have the time I feel that she would enjoy your company".

I also might not give a good explanation to someone who might benefit from better understanding (ie, a student) because I don't have the time, and for that I'm sorry. If the patient's nurse deems it appropriate, she or he may let you look at the patient's chart so that you may better understand what is happening with her.

Another thing--chemical restraints are psych meds. They are not recommended unless absolutely needed in elderly patients, and even then you can't give them if the patient can't clear them or have certain cardiac conditions. And, as someone pointed out, they may worsen (or often initiate) an acute delirious state. For example, in my experience Ambien is one of the worst medications to give--I have seen loopy beyond loopy with Ambien. If a patient hasn't taken ambien before, I will avoid giving it as much as I can (even if they're young). A time to consider chemical restraints is when a patient is at risk of harming themselves with the physical restraints. Chemical restraints don't improve the mental status of a delirious person--they just make them sleepy and sedated.

One thing you will see as you gain experience in this profession--many people recover from this state. I take care of a lot of post-op elderly patients, and there have been times when more than half the floor can't name the president. They are asking you pleasantly for scissors, or dialing 911 (that's always fun). We keep them safe, we do what we can to provide reassurance to the patient and the family. And usually post-op delirious patients recover in a day or two--and thank you for keeping them safe. Some patients are afraid they'll get loopy from narcotics--but they need them because they are in pain. I tell them, while their minds are still clear, that we will hope the medication doesn't have that effect, but that if it does, we are experienced with helping patient's through those times. I tell them why I'm putting their bed alarm on, why I'm opening their door, or why I'm leaving a light on. If they get to a point of needing restraints, I will make them comfortable and provide as much comfort as I can.

Finally, a sitter can provide a false feeling of safety. Strangers sitting at the bedside might frighten the patient. A sitter can't always prevent bad things from happening--they often exacerbate the issue (not their fault, it's just the nature of the process of delirium).

Anyway, this is too long. I'll end by saying--you're doing good. Allow yourself to feel the pain and frustration of your experience, but continue to investigate why and how these things happen, and you'll come to a greater understanding.

Cheers!

-Kan

actually erik touched on this but, you really had no right to an answer....she was not your patient, and perhaps when the nurse answered you that way it was her way of deflecting the question, since you werent that patients student nurse?

where was your instructor?

as soon as you figured out the patient was safe, ie not on the floor or something, the appropriate thing to have done was back out of the room and go on with your day,

then in post conference have this discussion with your CI and fellow students....

actually erik touched on this but, you really had no right to an answer....she was not your patient, and perhaps when the nurse answered you that way it was her way of deflecting the question, since you werent that patients student nurse?

What would have been wrong with simply telling me that? No one did. I agree that I didn't have the right to know her full history or anything, but someone telling me, "she's fine, that's all I can say" would have helped a lot.

Well, if you'd asked me about it with the accusing attitude that I didn't care, I'd have not bothered to waste "the literally 3 minutes it takes" to explain it to you either. Someone DID tell you she kept pulling out her IVs, but that wasn't good enough for you. How were they supposed to know how long it would take to explain that facts of real nursing life to you? Especially if you're coming in with the attitude that they just don't care?

I'm not sure why you assume that I came in with the attitude that they don't care. When did I say that? I'm saying that it was the perception I had aftertalking to them. I can promise each and every one of you that I didn't give any nurses attitude. I don't work that way, never have. I was just worried about the patient. Someone saying, "yes it's a shame, but she isn't safe unrestrained and, being elderly, chemicals would be a bad idea" would have more or less completely allayed my concerns. I wasn't trying to ask for a dissertation of restraints and nursing behaviour.

I think my true problem was not so much the restraints itself (although it was extremely emotional to see it), but rather the lady being called, by multiple staff, a crazy old lady. She used to be someone's mother, sister, daughter, etc. I guess I just think it wouldn't be too stressful or take too much time out of the day to refer to someone as an actual human being.

Another thing--chemical restraints are psych meds. They are not recommended unless absolutely needed in elderly patients, and even then you can't give them if the patient can't clear them or have certain cardiac conditions.

I definitely understand this now better today than I did yesterday. Thank you everyone for explaining this. I looked up some more information and i'm a little surprised we weren't taught that in school. We were pretty much only told that there were 'physical restraints, and then chemical restraints'.

I was 21 and had never set foot in a nursing home or hospital until my training.

The world of the disabled and isolated elderly is a hidden world for many healthy young people.

Altzheimers and dementia were things I had only read about.

It took me a while to understand what it is like to have a patient unable to retain information due to a lack of short term memory.

I tried to soothe anxiety and fears that were incomprehensible to me.

This describes me exactly. Prior to this I had only ever been in a hospital as a patient or visitor. I had no idea.

As sicushells has pointed out, we cannot always "use happy sunflower words" (as a burnt-out daycare worker once put it). We cannot mandate our emotional responses to always conform to the Mother Theresa paradigm of caring ... and it would be unhealthy to try. "Calling" or not, we are human and get tired, impatient, angry ... all the icky negative stuff that will come up when dealing with life/death situations with other all-too-human people.

I know what you mean. I guess I've just seen some nurses attempt it more than others, and that's the type of nurse I would like to be, at least to try for. Even just this semester alone I've gotten some good perspective on why things are the way they are.

We had a pt who was pleasantly confused during the day - but was a terrible sundowner - exit seeking, hitting, resisting care, etc. After several weeks of trial and error, we found the right med mix at the right time would keep him pleasantly confused even into the evening. This included a small dose at noon.

Students came in, saw the med at noon and decided to hold it (without checking with the nurse0 because "he wasn't agitated, or aggressive". Well - evening came, students were gone and pt sundowned. The next day the students were polietly told NOT to hold any of his meds. They were all upset because they felt we were just sedating him to make our life easier - they didn't see that this type of behaviour was upsetting to the pt, his family and took staff away from other pts as everything 10 minutes we were either re-directly him or helping the nurse care for him not get hit.

I completely understand this situation, and I would hope I wouldn't be one of the upset students. However, from a student's perspective, can I just make one plea? You are completely right about what should have been done with this patient, but did someone explain to the students calmly why things were the way they were? I can't tell from your post, other than that they were told politely not to hold meds, but where they also politely and rationally told WHY? I think so many issues (including the one I brought up here) could be taken care of much better if just a few minutes are set aside to answer questions. Everyone was a student once, and remembers how frustrating it was to not be explained some very important things. It helps you become a better nurse, and the nurse herself can feel better about truly helping someone.

I hope to continue learning like this (if maybe a little less emotionally :( ), and despite how terrible I felt yesterday, I think it was a good experience, because I definitely learned a lot about restraints and why they are used, and how people react to them. Thank you everyone for your help and encouragement.

OP, you sound like a nice person, and I am sure you will be a terrific nurse. That being said, once you start nursing and have your own license, you will realize that sometimes nurses have to do things that are unpleasant in order to protect patients. I have chemically and physically restrained patients before. Why, you may ask - well, I didn't want them to pull out their femoral arterial line, or self-extubate, or do one of the many other ridiculous, very dangerous things that some patients seem to like to do to themselves. It doesn't mean that I didn't care - those patients were turned dutifully, restraints removed and ROM exercises done with regularity, were fed, watered, and toileted appropriately, etc.

Don't judge a nurse until you have walked the walk, that is all I am saying. You don't know that that nurse doesn't care about that patient. When I was a student I had plenty of grandiose dreams about what things I would and wouldn't be doing for/to patients - once I was in the real world I had a much more realistic picture of what I had to work with.

Yeah, well, nursing definitely has its ugly side. But is just turning your back on the "system" and saying you don't want to be part of it the best solution? Who's going to take care of the crazy old ladies if you're not there? You think there is someone better than you (obviously not, because you care and have a good head on your shoulders -- good enough to ask all the right questions). But remember, hospitals, nurses and doctors can only help people as much as they can with the resources they have. It's not always pretty. Just like you will see festering, gangrenous wounds, you will see mental and spiritual distress (yes, some of it brought on by the "treatment"). You will learn to look it right in the eye and do your best to help however and whenever you can, while still preserving your own sanity (and your job heh heh). And, hopefully, when you learn more, you will try to make changes in the system if you're really as bright, ambitious and caring as you seem.

Every time I think of the lobotomies that were performed, I remember that there was probably a nurse there who helped prep the patient and assured them that "everything was going to be all right." Don't ever stop asking, is this the best course of treatment for this patient, do I want to be a party to this? There may come a time when you need to say, "no."

After making sure the patient was safe, I would have ventured out to her nurse and let her know what you witnessed in the room. Then I would have ask her if she was possibly a falls risk? I would have thought if she was 80, frail and confused she surely could have been at a "high risk" for falls. The top priority is the safety and well being of that patient. If you hurt someones feelings about questioning what was going on, is just proof they were probably being lazy and neglectful. I know when it clinicals we try not to casue any problems, and I underdstand that. But, you should have notified your instructor so she could have seen what was going on and if there were any problems.

Specializes in Hospice.
After making sure the patient was safe, I would have ventured out to her nurse and let her know what you witnessed in the room. Then I would have ask her if she was possibly a falls risk? I would have thought if she was 80, frail and confused she surely could have been at a "high risk" for falls. The top priority is the safety and well being of that patient. If you hurt someones feelings about questioning what was going on, is just proof they were probably being lazy and neglectful. I know when it clinicals we try not to casue any problems, and I underdstand that. But, you should have notified your instructor so she could have seen what was going on and if there were any problems.

:banghead::banghead::banghead:

Did you even read the thread???

Specializes in LTC, Memory loss, PDN.
After making sure the patient was safe, I would have ventured out to her nurse and let her know what you witnessed in the room. Then I would have ask her if she was possibly a falls risk? I would have thought if she was 80, frail and confused she surely could have been at a "high risk" for falls. The top priority is the safety and well being of that patient. If you hurt someones feelings about questioning what was going on, is just proof they were probably being lazy and neglectful. I know when it clinicals we try not to casue any problems, and I underdstand that. But, you should have notified your instructor so she could have seen what was going on and if there were any problems.

I know you are concerned, but please do notify your instructor (before anything else) given such a situation, so your intsructor can explain the five errors you made.

Specializes in Hospice.

I know what you mean. I guess I've just seen some nurses attempt it more than others, and that's the type of nurse I would like to be, at least to try for. Even just this semester alone I've gotten some good perspective on why things are the way they are.

And that's why I suggested you look up "compassion fatigue" ... some of us get all "tried out" after a while.

Specializes in LTC.

It's the nurses who've never fallen prey to compassion fatigue that I worry about.

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