mercurysmom, RN 7,733 Views
Joined: Jul 25, '11;
Posts: 165 (72% Liked)
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Here's my perspective...
I lost my hearing in 2006 due to aminoglycoside ototoxicity. Unlike the majority of Late Deafened Adults, I chose to return to school and earn Certification in Deaf Studies. I am fluent in ASL and am an active member of my local Deaf community. I use Video Relay Service to make all of my phone calls and am usually happy with the quality and availability of VRS operators. I've also used video interpreters and live interpreters in medical settings. When I'm in a stressful situation and my DH or teenage kids are not around to interpret for me, I am lost without a live interpreter. There are just too many places to look, and if more than one person is speaking , moving, gesturing, even showing reactive facial expressions, I have no clue what's going on.
There's another HUGE issue here: many members of the Deaf community have very low to low health literacy. I work with Deaf adults in Adult Basic Education, mainly teaching English literacy and numeracy, but I do as much as I can to work in as much health literacy as possible. I've talked to certified Medical Terps in great depth, and heard lots of horror stories. For example, a Terp I know professionally accompanied a 40-something yr old Deaf man to a post-op appt. The man had no idea what surgery he had, or why he had it. He was unable to read the pre-op consent forms and post-op discharge instructions...but he was capable of signing his name. Apparently, that was enough.
I had 3 C-sections, so I can't answer this myself: if a woman is in labor, how well would she be able to watch TV and follow the story line? How about skyping to a friend and actually process what they're talking about? Touch is VERY important in Deaf culture. Knowing basic signs is definitely not enough. ASL is NOT like French, Spanish, Russian, etc; people who speak those languages are able to listen to an interpreter, live or over a phone, with their eyes closed. Deaf patients can't do that. Info can only be processed visually and through touch. The Deaf patient's responses are likely to be non-manual signs or gestures/classifiers rather than true signs. (How often do laboring women speak in full, articulate sentences while in labor?)
Certified Medical ASL Interpreters are pricey, but definitely worth it. Hospitals are required to provide all necessary ADA accommodations, not just the cheap ones.
Mercury's Mom, RN
"1700: Pt A&Ox4, steady on feet, independently amb in hallway q15min, denies discomfort or anxiety, states "I'm waiting for my boyfriend, the ********** said he was on his way."
2010: pt not in room. unit searched, security notified. Pt discovered in ambulance bay, escorted back to floor. Pt drowsy, pinpoint pupils, Pulse 55 reg, Resp 12/min. Clave missing from saline lock, tubing tied in a knot. MD notified, new order rec'd for narcan if resps<8 or LOC, remove PIV. Pt remains on 1:1 supervision. "
I hope I'm the off-going shift!
This was one of my Mom's stories, but since we both worked at the same LTC at one point and had "experiences" with the same Dr, I believe her 100%...
One night, Mrs. Smith, a pt who was DNR, comfort care, with family at the bedside, finally passed away. Mrs. Smith's Dr routinely wrote orders for "No RN Pronouncement" on all of his patients and refused to refer them to Hospice, either, no matter what their primary Dx was or their current medical condition. (Mrs. Smith was admitted 5 days earlier, with CA mets to everywhere, sub-q morphine pump, scopolamine, etc.)
So, Mom called "Dr. ImInChargeDontForgetIt" to inform him that's Mrs. Smith's respirations had ceased, no audible apical pulse, no BP, etc. and reminded him that she needed to be pronounced, since he ordered "No RN pronouncement." It was just before midnight, and the family wanted to call the funeral home ASAP. Dr. I said "what the h*** is their rush? I'll be there at 8am.
Mom politely reminded him that the policy of that particular LTC was that patients who expire before midnight need to be pronounced within 4 hours of the next day, which meant he had a four-hour deadline to come in and pronounce her. Otherwise, she would have to call to have her transported to the ER to be pronounced, since he specified "no RN pronouncement."
Dr. I pauses, then says...
"Are there any stab wounds?" "Any bullet holes?"
Mom says "Of course not!" So Dr. "ImInChargeDontForgetIt" says, "Then leave her in bed, continue all care, and open the damn window. I'll be in at 8!" And slams down the phone.
Mom called the DON, who came in, did her own assessment, and called to have poor Mrs. Smith transferred to the ER, where the hospital's medical director was waiting for Dr. I to meet her as soon as she arrived (which he did!)
I worked a few days later...all of Dr. I's DNR/comfort care patients had orders for RN pronouncement andHospice consults! [emoji6]
Fire retardant bibs for smokers.
The way the test tube would heat up after you put in the clinitest tablet to check sugar in urine. Not really something one should multitask...I don't know how many test tube I dropped and broke because I held it too close to the bottom.
Cleaning inner cannulas of Jackson trachs. Brush and bowls were from sterile supply closet and H2O2 and sterile water came in big jugs.
Harris drips for post-op gas relief
milk and Molasses enemas...and the smell going in vs coming out (gag)
Being reprimanded for wearing gloves while bathing a newborn because "What will the mother think if you see her baby as "dirty" and refuse to touch it?"
"Pouring meds". The med room had communal bottles of pretty much every tablet and meds were prepared in soufflé cups nested into a green tray with holes. The med cards for each patient went into a slot above each corresponding cup. Pray like heck that the patient didn't ask what meds they were getting and what each one was for. And heaven help you if you slip and fall while carrying the tray!
This probably sounds a bit strange, but losing my hearing has actually improved my career as a Nurse Educator.
In 2006, I developed pneumonia (multi-drug resistant pseudomonas) and required an extended course of IV Tobramycin. I have a maternally-inherited progressive neuromuscular disease, and my medical team knew that I was extremely sensitive to the ototoxic effects of aminoglycoside ABX. I had to make a choice between risking my hearing or my life, so what could I do? Anyways, six months after that, I had a profound bilateral SNHL in the 100 dB+ range in all frequencies. However, I was alive! Can't complain too much about that.
What can a person do when given a six month life expectancy and they exhibit "failure to die?" Return to college and start a business, of course! I became certified in Deaf Studies and started taking classes towards my MPH. Unfortunately, I had to give up my goal of becoming a Public Health Nurse because I'm technology-dependent (power chair, vent, long term PN and IV hydration, etc.). So, I'm working towards a M.Ed focusing on Technology and Distance Learning in Adult Basic Education, specifically as it affects individuals in the Deaf community. While receiving Hospice services, I let my teaching license lapse, so I'm retaking the licensure exams this fall. Fortunately, I kept my RN license active. There's no way I would be able to complete a refresher course with a practicum in my condition.
I'm self-employed educator and advocate. I am contracted by area colleges as a guest speaker. I lecture about communication, disability awareness, and health literacy. In addition, I offer on-site continuing Ed workshops for Early Intervention programs, primary and secondary schools, and LTC facilities. I have been contracted by several non-profit groups to provide information about a variety of topics through webinars, articles, and lectures. I am fluent in ASL, and I teach English literacy and numeracy to Deaf adults. Sometimes, I'm contracted through my state Voc Rehab to provide short term tutoring for Deaf HS and college students, or clients involved in vocational programs, including CNA courses. I have experience with assistive technology that could help d/D/HH nursing students succeed in the classroom and clinical sites. Feel free to PM me for info regarding AT and scholarships.
This is from a LTC facility: "tonic water 4oz PO PRN per pt request to burp or fart." This was for a LOL who had a bowel obsession and was on at least 4 scheduled stool softener and laxatives and had a fit if she went 12 hours without a "movement." With all those bowel meds, I'd be afraid to fart!
In homcare? I wouldn't chance it. The first time anything lands on a wet surface and a spot goes through the page onto someone's kitchen table...
There are so many quirky aspects to home care (visiting nurse or private duty) that could end up with your supervisor calling you in to discuss some inconscionable act that the client/parent complained about, like...oh, I don't know, using more than 4 squares of toilet paper during your 12 hour shift, mixing formula at 4:59 instead of 5:00PM on the dot, re-dressing a child in pants that didn't come with the shirt because the pants got wet but the shirt is still clean, getting a microscopic spot of betadine on a disposable chux after straight cathing...
The super duper important and life-threatening stuff. Obviously. ;-)
Why add even a theoretical catastrophe to the list if you don't have to?
My kid was drawn to the nurse's office like a moth to a flame. He received meds every day and also had snacks available (metabolic disorder). He never faked actual illness, fortunately, since that usually ended with stuff that he avoided at all costs. Boredom often became hunger, so he needed to take a leisurely trip down to her office. Math made him particularly hungry. When we amended his IHCP, we sent cans of Pediasure to the math classroom, and he could only go to the nurse's office if he had anything going on besides hunger/thirst. His visits dropped by more than 50%. Imagine that!
So Hubby and I are [I]those parents [I] who worked with the school to keep his butt in his seat and cut down the social visits. :-D Meanies!!!
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