Under All, is the Human

This is journal entry of my recent experience as a senior nursing student in the CCU with an intubated patient, labeled as combative and confused. After doing all of the clinically appropriate nursing interventions, I learned re-learned some basic skills. Giving a bed bath taught me an unexpected lesson about the human response. Labeling a patient with derogatory terms can be detrimental to nursing care. How, as future nurses, can we be mindful and caring of a patient with no voice? Nurses Announcements Archive Article

Under All, is the Human

A male patient, age 66, had been admitted to the hospital for heart failure and sepsis. He had been in the hospital for over a month and had recent CABG2 when I came to the Critical Care Unit clinical day for my first experience as a senior nursing student.

The patient had an extensive medical history including hypertension, diabetes mellitus, and coronary artery disease with lesions more than 75% occluded. The patient had been extubated two days prior to my clinical day, due to some improvement of his condition. However, his O2ox had started to steadily fall again and the doctor re-intubated the patient a couple hours before my arrival.

The patient also had hand restraints applied due to past attempts of tube removal. Hospital policy was that restraints were to be removed for at least 5minutes every hour. It was obvious from the moment I met the patient that he did not like the restraints as evidenced by pulling, attempting to furtively gesture and overall restlessness. He looked very uncomfortable and fearful. His eyes were darting around and he continually pushed the call bell for pain medication. He had been documented by previous shifts as being combative and confused.

Aside from medication administration during my shift, I had the opportunity to have quite a bit of spare time, as the census in the CCU was lower than normal. Having just one patient, who was relatively stable, is a luxury not normally experienced! With that spare time I rediscovered the skill of a complete bedbath and skin assessment.

I explained to the patient that I was going to remove his restraints and get him washed up. He nodded his head in understanding and was extremely cooperative. He could not talk, of course, due to intubation, but he could nod or shake his head. I kept up a steady stream of conversation as I went along. I noticed he had quite a few tattoos, which I commented on -- knowing that normally tattoos are a source of personal beautification and pride. I also noted that above his TV, which was not turned on, were a few hand-made construction paper cards with words of encouragement. "DON'T GIVE UP!" "WE LOVE YOU!" in very large letters. I remarked on those as well, asking if the cards were from grandchildren. He nodded yes and closed his eyes.

The patient noticeably relaxed during the bed bath, skin, cardio and neuro assessments. His heart rate had dropped a bit as well. I remarked that the incision on his chest was healing well. By the end, an entire hour had gone by! The patient was getting a bit drowsy. I asked him if he had any pain and he shook his head no. I let him know that I was going to re-apply his restraints and he just closed his eyes.

After I tied the restraints and adjusted his sheets and blankets, the patient grabbed my hand and did not let go. He looked me right in the eye. My first reaction was to let go after about five seconds, but he did not let go. He held on for (what seemed like) quite a while. I just let him do that. He then closed his eyes and breathed a deep breath. We stayed like that for quite a while.

I wondered why this patient had been called combative and confused. Granted, my time on the unit was short and rather "special", being a student, so perhaps it could be chalked up as a mere exception to the norm.

Shortly after, a respiratory technician came in to do a nebulizer treatment with the patient and immediately started shouting at him to CALM DOWN CALM DOWN! What was going on! I popped my head into the room, drew the curtain around us and asked what was up. The technician said that this patient was known to fight his treatments and he was just helping the patient to relax. His voice was not at ALL calming! I looked at the patient, who was looking at me, slightly bewildered and DEFINITELY confused and said to the technician, "he seems pretty calm to me -- why don't I stay here and give you a hand in case you need it?"

I stayed in the room, close by, not hovering but just being present. The treatment seemed to go well but the silence from the technician was uncomfortable as he went about his work. After the technician left, I again fluffed up the patients' blankets, wiped his face from sweat and gave him a smile. I gestured to the pretty construction paper card that advised: "Don't give up!" He gave a small smile in return.

As nursing students, we do many nursing diagnoses about Anxiety and our interventions include helping the patient to relax, utilize visualization and deep healing breaths. To my shameful admittance, I have never actually done any of my own interventions prior to this 5thsemester of nursing school.

It appears that a lot of seasoned nurses do not truthfully have time to acknowledge the human beneath the tubes and machines. Workload and required documentation seem to now define the patient in the bed. Words like "combative and confused" can lead to a correct diagnosis of compensatory shock but can also be an incorrect assessment of someone who is terrified, uninformed and shut off by the inability to speak.

What ways have you attempted / succeeded in treating the human response in a critical care situation?

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Andi777

About Andi777

I'm an ADN, RN from New York who specializes in Psychiatric Nursing.

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It appears that a lot of seasoned nurses do not truthfully have time to acknowledge the human beneath the tubes and machines. Workload and required documentation seem to now define the patient in the bed. ...

This is the unfortunate truth. I have found on the rare occasion when my patient load is light, I am better able to actually care for the patients instead of just getting tasks done.

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While I do not have clinical experience yet, I do start my 3rd quarter in April and finally start my clinical rotations. Your story put together everything that I have only verbalized during simulations. Thank you for sharing!

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Specializes in Ortho, CMSRN.

I loved this! So true! I am a new grad nurse on a med-surg floor, and though they are not loading me up at the moment with a full load of patients, I am kind of grieving the impending reality that with 6-7 patients on nights, I will not be able to give the kind of care that I truly want to. I think with time and proficiency we can shorten the time that it takes to do our nursing "tasks" so that we have more time to focus on the person behind the patient. I think your attitude matters so much as well. In orientation, I've gotten report from a nurse who has tended to talk down about her patients (they were all "drug-seekers", "whiny" "too needy", etc...) but when it came time to give report and we were asked if patient X was horrible as expected, all we could say was "no... he was great". I think that patients pick up on your true attitude, (no matter the forced smile on your face) and oftentimes will reflect it right back to you. As a newbie, I am trying to make an effort to take time to be calmed and in a good mindset before work. For me, that's prayer and bible reading, but for others that might be yoga, or just a quiet cup of coffee in the car before work. It helps though.

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Thanks for posting this article. I like it!

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Specializes in Orthopedics, Pediatrics.

As a fairly new nurse, with only three years experience, I can validate your experience. I have had dementia patients, scared patients, drug seekers and "tough guys" who have caused other nurses problems, but I have won the patients over and gained their cooperation with a serene calmness and kindness. I try hard to convey that I see their humanity in the brief time I have with them. That is the very least I can do, even though I never have the time for bed baths or back rubs.

I have also seen the reverse- on those shifts that nothing seems to go right and I am frantically rushing to get my "chores" done, when my patients see the stress I am under, I have inadvertently sabotaged my own efforts and the patients can only respond with more stress of their own. So now I try very hard to maintain a zen like calm while I am in my patient's room- and then rush like a madwoman once I am out in the hall! Never let them see you sweat!

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I'm a natural observer, and a nurse's true philosophy does become apparent over time.

People talk about yoga and meditation (not singling you out, andi7777, but you made me think of it) but all they do is talk about the "complete mess" in rm 8 and the "guy who can't push the call button fast enough" in room 2.

It never seems to go the other way as often (people are complete jerks at work, but saints in the community).

I think it has something to do with the fact that people seem to feel it is normal or expected to complain about work, and in healthcare, work = patients.

Don't be afraid to take time to get to know your patients. The human behind the chart is sometimes fascinating. And it helps keep you grounded too.

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Specializes in Pediatrics, Emergency, Trauma.

Don't be afraid to take time to get to know your patients. The human behind the chart is sometimes fascinating. And it helps keep you grounded too.

This...I always find time to get to know the human, my patients I am taken care of; it has certainly help them and kept me grounded.

I think there are many nurses who are grounded; some just vent more than others, while others remain objective, we also have to be cognizant of how our peers interaction with the pt previously may be different-that's why a HUGE part of our practice is to assess, assess, and assess-I'm sure you get the idea. ;)

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You did very well, very emtional I would say, you have positively affected this patient and he will remain grateful all his life.

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This is so sad, but very true. Although nursing in General is very task oriented, we as nurses who joined this profession to help others need to remember that our patients are human beings. With that being said, taking even a few minutes to talk to that person can make such an amazing difference. By taking just a bit of time can actually improve the patients behavior resulting in less "problem patients" or time consuming tasks related to behavior problems.

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Sometimes all it takes is a minute of just listening and letting the patient know you heard them. You are so right!

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I work at a psychiatric hospital and the best compliment I ever received is "you treat us as human beings, not just a patient".

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