Bending and Breaking the Rules in Nursing - page 6

I believe rules can be bent at times. Heck, I feel that some rules can even be outright broken as long as doing so has brightened someone's day. Billie is a pseudonym for the septuagenarian... Read More

  1. by   TheCommuter
    Quote from ktwlpn
    After hospice came on board why in the world were her diet restrictions continued?????
    The dietary restrictions were continued at the insistence of the resident's slightly overbearing daughter.
  2. by   NutmeggeRN
    Quote from TheCommuter
    The dietary restrictions were continued at the insistence of the resident's slightly overbearing daughter.
    Those are the folks who make want to stick pokers in my eyes!
  3. by   NurseKatie08
    Quote from NotFlo
    I think it's great that you did that. I just find it ridiculous that the facility maintained stringent dietary restrictions on a hospice patient. What could possibly be the rationale for that?

    Our CMO/hospice patients can eat whatever the heck they want in our LTC facility. I can't imagine any of our MDs insisting on dietary restrictions under these circumstances. I've seen "food for comfort" quite a bit. Even in pts that aspirate. Fluid and sodium restrictions DCs, etc.

    Even in non-terminal regular elderly LTC and/or dementia patients...these diets need to be as liberalized as possible. If I'm 90 in a nursing home I'm eating what I want.
    Agreed. More than once I have had security open the main kitchen for me at 0200 so I could retrieve something as simple as a Coke for a patient on a restricted diet with poor PO intake who was just jonesing for one. We do what we have to do!
  4. by   NTICURN
    Interesting how the daughter was so insistent upon what her dying mother ate, but couldn't be at her bedside for her last days.
    Last edit by NTICURN on Apr 18, '16 : Reason: Attempted to respond to a specific comment
  5. by   NTICURN
    Quote from cienurse
    I applaud you!! And isn't that what its all about-the resident??? You did nothing wrong and I admit I've done it myself! Especially with someone on hospice-the special diets should go out the window! I've been known to sneak in a few "special requests" for residents, even though we aren't supposed to give them anything we cook at home, I just couldn't resist a resident when she had a hankering for some New England clam chowder but couldn't have it because it was "too chunky." Well, I brought her some and I sat right by her every minute and she didn't choke once! And the thanks I got far outweighed the chastising I got from the Speech Therapist who thought I was just horrible to "tease" the resident with the chowder, knowing she could not have it again. But if she asks me, I'll bring it in as many times as she wants!
    My only issue with this is that she can silently aspirate. And especially in a nursing home, you don't have the capacity to intubate your patients. And if she had died as a result, your license, and her life is on the line. I'm all for sneaking burgers and cupcakes that aren't on someone's diet to patients to make them happy, but this one I feel is a direct safety concern.
  6. by   katdan1026
    Sometimes we have to bend the rules a little to provide compassionate care for our patients. Well done!
  7. by   Garden,RN
    I am glad you did, you made someone happy at the end of their life.
  8. by   walterh
    You and many of us have enrolled in " The National Nursing School of Common Sense. "
  9. by   pfongk
    I got permission from the CN the other day to give a resident on a minced diet pancakes and maple syrup for breakfast. I ended up cutting them up as small as I can so that they were essentially minced and feeding them to her. Our facility is fantastic when it comes to food though as one of the philosophies of the place is that it's their home, and they can eat what they want so long as it's not going to cause major injury. This means that I've pureed or had the kitchen puree all sorts of foods, I've thickened alcohol and soft drink and even sat there whilst someone has munched on crushed ice.
    I do make sure that I run anything I do like this past the CN though.
  10. by   Tenebrae
    Great article.

    I remember a lady called A. I was doing the monthly weighs in my wing and saw that A had lost approx 7kgs in the previous month. Thinking it must have been a blip on the radar I reweighed A and found that in the previous 6 weeks she had lost almost 17 kilos.

    A was an incredibly unwell lady amoung other things NIDIM and most likely the extreme weight loss was down to some form of CA, however did not go for investigations as she would not have been a candidate for surgery and unlikely to stands up to treatment

    A was still on a diabetic diet with diabetic snacks. So I immediately changed up her diet and put her onto a high calorie, high protein diet and made it very clear that what ever this lady wanted to eat, give it to her. Didnt manage to get any weight back onto A but managed to slow the weight loss.

    My other bug bear is when we have residents on moulied diets (pureed) and the lovely CNAs who really mean well sit there and mix up everything so its a plate of brown goop which can not be remotely appetizing. I decided to take it on and have started asking the CNAs not to mix up the foods so when Nana gets a mouthful its a mouthful of mashed potatos, or a mouthful of stew etc
  11. by   Tenebrae
    Quote from TheCommuter
    The dietary restrictions were continued at the insistence of the resident's slightly overbearing daughter.
    I had one of those once. She got angry at me because I gave her mum PRN oxynorm liquid against her wishes. (Bear in mind the daughter had no medical/health training what so ever)

    The mum had chest pain which didnt respond to paracetamol, GTN spray, or mylanta (just incase it was refered epigastric pain) as well as her charted nocte sedation. This lady was in pain her face was tense, her shoulders hunched and grimacing and just not moving and was certainly not sleeping.

    I gave the oxynorm liquid and with 20 minutes the lady was visably relaxed, and sound asleep.

    The helicopter daughter accused me of medicating to keep her mother quiet. I smiled sweetly and said "for that to be true your mother would have to be noisy and shes one of the quietest residents on this wing, I gave the medication because your mother was in pain with extremely good effect, the night staff report that she slept through for the first time in ages"

    Fortunately the charge nurse was brilliant and had my back
  12. by   SerenityKris
    Halfway through nursing school I found myself in the hospital with a cancer diagnosis. I was in denial that I was going to have to take at least the rest of that semester off. I can remember calling my instructor and explaining to her that I was going to delay treatment until Christmas break so I'd be back in class soon and her telling me that she was withdrawing me from her class so that I wouldn't wait. I was devastated.
    I remember the nurse that came in that night better than any other nurse. She took one look at me and said, "You need a shower. You'll feel better after a shower." She then wrapped everything up so it wouldn't get wet and told me she was going to sneak me into the shower, since I wasn't supposed to be allowed.
    She was right. I felt like a new person. It didn't make everything all better- but I felt like life might get back to normal some day. Later I ended up doing my clinical placement on that same unit. She didn't remember me, but I sure remembered her.
    Sometimes that's what makes the difference between a good nurse and a great one - the ability to know when to bend the rules.

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