opened up a case I have a bad feeling aboutRegister Today!
This is a discussion on opened up a case I have a bad feeling about in Home Health Nursing, part of Nursing Specialties ... I've been in the HH field for a whopping 3 months now for hospice and palliatve care. I volunteer...by MomRN0913 Jul 4, '12I've been in the HH field for a whopping 3 months now for hospice and palliatve care. I volunteer to work the holiday because they said it was a nice slow day with good money. I also worked the weekend......
besides the point. They found a SOC care for me for the homecare district and had me open and said I should probably keep it because there were a lot of pain issues.
What a disaster. IN the home for 4 hours. patient in lots of pain, won't go to hospital. Has been on MASSIVE doses of pain meds for 20 years due to illness. He self adjusts. His father helps him. He looks doped as hell, but says he pain is a 12, legs are bery swollen, just had a huge amputation 4 days ago. let him go home yesterday. Says his breathing
"feels funny" although RR 16, no SOB noted.
After helping him ambulate and practically hopping in bed with him to change his dressing and injuring my already injured back, I decide to sign him on.
I had encouraged him to go tot he hospital to check out the swelling, pain and breathing and he refused. I called the MD, who was covering, he agreed. But I don't think he wants to go. This was after I left the house (very strange family dynamic too)
Now I am sitting here crying in back pain, literally, and wondering if I should have signed this guy on.......
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- Jul 4, '12 by emilysmom,RNIn my company we do not have a choice. Sounds like you did everything you could. I have many non compliant Pts. I have called 911 and the pt refused the EMS had him sign a waiver that he refused care. I kept going back educating calling the MD with updates and documenting almost word for word each visit. In home health that happens alot at least for me. Good luck.
- Jul 4, '12 by MomRN0913Thanks for making me feel a little better. I educated out of the wazoo, instructed to use the meds as prescribed, reiterated about a million times to go to the hospital for uncontrollable pain and SOB. We have a choice, but its got to be pretty bad not to open it. Oh, he used to be on lasix, I told the dad not to give it, to get evaluated because he may actually be dehydrated not overloaded (clear lung sounds too) and i called back to tell him to go to the ER and found out he gave it anyways....
Document, document, document, that's all I can do.
I come from the hospital. I was always rest assured my patient was endorsed tot he next shift and cared for. Now,. I feel 24/7 ersponisble. My preceptor/supervisor is the same way, but she says if you dont let it go and just know you did the best you could do, you'll get burnt out fast. So, I'm going to just hope I did the best I could in there today.
- Jul 4, '12 by emilysmom,RNYou did the best you could do. Just make sure you also notify the MD that you instructed him to go to ER and he refused. Home health is 24/7 at least it is for me. I lasted 2 years. Good luck.
- Jul 4, '12 by caliotter3I don't see anything wrong with what you did. Your supervisor gave you good advice. Let it go. You can't do for the patient what he refuses to do for himself. Do your education, make your recommendations, make your phone calls, and document. When all of that has been done, take care of your own mental health. You don't want to end up sick and out of work because you could not draw the line.
- Jul 4, '12 by merleeYOU NEED TO PROTECT YOUR BACK. FILL OUT AN OCCURENCE, SPEAK W/YOUR MANAGER, GET YOURSELF SEEN.
Your back is your LIFE.
This family will never listen to you, or anyone. But I will bet that he gets infected and ends up back in the hospital soon.
Nice of you to work the holiday!
- Jul 4, '12 by amoLuciaFirst things first - I hope you filled out some kind of incident report re: you back injury. Absolutely must do it! Don't even NOT think about it. Do it.
Secondly - Your gut reaction about this case is most probably correct. I don't do HH but it sounds like your supervisor is aware of your concerns and you've well-documented. Just remember that people make their own decisions re health care, good or bad. You did what you saw best.
- Jul 4, '12 by MomRN0913Thanks!
This is a preexisiting injury which I got an MRI for just last week. 2 herniated discs, one right on my spinal sac that I have been recieving chiropractic care for. Couldn't afford not to work, so unfortunately I aggrevated it big time doing this dressing change. So, my supervisors know all about my back already. I'm just screwed, gotta work, gotta pay the bills.
Yes, you are right, people will do what they want. I can teach until I am blue and reinforce, but he'll do as he pleases, just like me who is not taking it easy on her back.....
I worked 4th of July for selfish reasons..... the money is good and I took a paycut taking this job, so I have to beef up the paycheck a little!
- Jul 4, '12 by amoLuciaPleeeeeease! It doesn't matter that your mgt knows all about your pre-existing back status. Just make sure you've made out a report for this injury (and keep a copy). Papers get lost, people coveniently don't remember, etc etc. Remember your own words...document, document, document