First Clinical

[futurepsychrn, ADN]

Just a small rant lol. This weekend I had my first clinical at a LTC facility. While feeding in the dining room, I noticed a fellow student with a resident, the student had a horrified look on her face (she's very young). I went over and asked what was wrong. She said the resident wouldn't stop crying. I stepped in, took the woman's hand and asked what was wrong. Her exact words were "It hurts". I asked where it hurt, she couldn't tell me (dementia). The very rude nurses aide said "She has to eat". I encouraged her to eat and after every bite she told me it hurts, I'm going to throw up. She took several more bites and a few sips of OJ and cried the whole time. Then she said "I'm going to faint". I immediately called my instructor over and explained the problem. The instructor said "The aides say she has to east 75% of her food, and she cries all the time". I told my instructor "I have a gut feeling something is different this time". The woman then said straight out "I'm going to die". The instructor simply said "not today", and walked away. After a few more minutes the aide came to take her back to her room. I literally had to pry her hand out of mine. Less than 5 minutes later the aide came running to the nurse's station and said the woman was on the toilet throwing up and unresponsive.

I feel so bad. All of my instructors tell us all the time to use your intuition and advocate for your patient. I tried to do that and nobody would listen to me. I went to them after and asked what I could have done differently. They told me nothing because it was probably her time and there wasn't anything I could have done. It makes me so mad that I listened to my intuition and nobody listened to me. My classmates tell me to let it go but I'm having trouble doing that.

Am I wrong in thinking that my instructor showed incredible insensitivity? Just because someone has dementia doesn't mean you should ignore what they say. After all, they keep telling us pain is subjective and you have to go by what the patient says their pain is even if you don't think they're in pain. Why do they tell us one thing then do another?

[Brink91]

It sounds like you did everything you could have done. Being a student, there wasn't much you could have done besides informing the aide and your instructor. I would have done the exact same thing you did. It's in their hands after that if they want to take action on it.

Good job!

[NurseGirl525, ASN, RN]

You did what you could. I'm sure it was her time to go. It happens especially in the nursing home.

Last semester I was also in a LTC facility. A normally chatty woman suddenly became very sick at dinner. The other residents called me over and told me there was something wrong. I asked the resident what was wrong and she was in tears. She just didn't feel right. I escorted her back to her room. I got her in there let the nurse know she wasn't feeling well but had a very bad feeling about it. I inquired about her the next week and she was actively dying. I was worried that I should have done more, but realized there was nothing. It was simply her time to go. I don't know what death is like but I'm sure a person doesn't feel well going into the process. It took me a few days to get over her death. But I did. I will never forget the first one, just learned to move past as we will see much death in this field.

[mirandaaa]

I think you did what you were able to.

I have 3 years of experience as a CNA in LTC facilities and to be honest, the staff that work with these residents know more about the habits than the students or new employees. So although it may seem like your intuition was ignored, you probably heard that resident say the same things she says every day but it just happened to be the day that things went wrong for her.

I don't feel like what you said was ignored but I do feel that this was something the normal staff members were accustomed to hearing so it wasn't anything they felt was alarming.

As far as her stating she was in pain and the instructor seeming to be insensitive, maybe she wasn't being insensitive but knew the resident had already had her pain medication and wasn't allowed more. Or maybe her care plan only allowed simple pain medication like Tylenol and it wasn't working for her.

There are many different factors to take into account here.

It's great that you were persistent in stating something was wrong, even when you were told otherwise. It's always good to be persistent when your intuition is telling you to pay attention to what's happening. It's frustrating to feel like what you said was ignored but today is a new day and a new opportunity to show you know what you're talking about.

[futurepsychrn, ADN]

Thank you for your kind words and support. I know everyone is right, it's just really hard to deal with, especially on the 1st day of clinicals. It's a hard lesson to learn.