Emergency Measues criticized by Pt's mother.

  1. Ok here we go again... New case different story but same old stuff on a different day...

    It is 0400 am... working with homecare pt I notice that the vent circuit is leaking somewhere. I can't find the scource... Pressures are hitting 10 at best and the low alarm sounds like Beethoven's Fifth.... No vent circuit ready in the closet... bagged pt and grabbed stuff to make new circuit,... continue to bag pt using Knee with gentle pressure and never missed a beat while I cut pieces off and applied pieces to the new circuit...Had that buzzard together in less than 90 seconds.. like Vents are my living.. I cannot count how many of them I have changed circuits on the last 10 years... I was taught if you don't know the exact scource of the low pressure CHANGE THE CIRCUIT! Better safe than sorry.

    Feeling rather proud of myself I told aforesaid pt mother what happened,,,, " Oh well I have NEVER had that happen to me" and "Oh this piece is backwards"...( forgot to turn a inhalation tube right side up) GEEE! SHoot Me!

    Well get this... the PEEP on this circuit ( mind you we have a CUFFLESS trach here) is set a 4. Mom notices on a test lung that PEEP is hitting 8. I got yelled at for having it set too high... I was accused of turning the PEEP up to "blow" his lungs. I NEVER touched the dang thing. I too checked it with the lung not 5 miutes before she walked in the room it was hitting 4.

    Ok... am I out of line in being angry??? Am I being over paranoid because 10 years of vent experince are being sliced and diced.


    After she walks out of the room I get the old circuit and tear it apart peice by peice. I found out the Exhalation valve had split down a side. When I showed her that a bit later like 30 minutes ago she said that was impossible"I have NEVER in my life seen that happen"... Now tell me am I crazy or can wierd things ACTUALLY happen that a pt's family hasn't seen before???

    Well I'm open for diplomacy and rason so Shoot....
    Beth
    Last edit by billssisbeth on Aug 17, '02
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  2. 22 Comments

  3. by   l.rae
    this is PRECISELY why l quit pedi home care....the parents!...UHG...l have been treated worse by parents with issues than l have most MD's with issues....l couldn't take it any more...they have issues about their sick children...there are control issues...and the nurse is the loser in the long run....l had a few good parents to work with...of the good ones...all but one were foster parents....which says to me my theorie about issues is true true true..........sorry this is happening to you.........LR
  4. by   billssisbeth
    Whew... I'm NOT ALONE! LOL
  5. by   kids
    Poop happens that the parents have "never" seen all of the time...because the PDNs are taking care of their kids 14-24 hours a day. As for the PEEP valve...when you retest a valve that is in use to test it on a rubber lung you have to give the lung a couple of good squeezes before you try to get a reading...
    besides the number with the test lung doesn't mean anything...it doesn't match the patients lung compliance.

    Hopefully you have a Clinical Coordinator who will back you on it all (if not come to work for me...I have a knack for backing off freaky families and making them think it is their idea).
    Last edit by kids on Sep 4, '03
  6. by   kids
    Maybe I should mention that at right this minute I am having a HUGE problem with parents who know more about their kids nursing care than the nurses who have been on the case since day one...when said parents have never been alone with the kid for more than 4 hours at a time in 4 years.
  7. by   Fgr8Out
    Received a complaint from the S.O. of a patient... the patient themself did not make the complaint. I was accused of everything from not facilitating interdisciplinary conferences, to failing to be an advocate for my patient. The comments in the complaint were out and out lies... no "perception" here... just blatant factual untruths.

    Steamed?? You bet... I'll settle down though, eventually....

    Funny thing is... the S.O. was apparently a "nurse" of some sort... who never once made mention of any complaints or concerns... the patient was reportedly a physician. Why on earth would anyone in this profession sit idly by and say NOTHING when (from the way they present it) reportedly we were among the worst examples of nursing the drafter of this criticism has ever seen?

    Stupidity and mean spiritedness apparently knows no bounds....

    Peace
  8. by   Enabled
    I worked with an adult at home on a vent. On 11-7 I was required to switch everything out for a clean set up and there were only two, one on the patient and one that had been cleaned. Wouldn't you know it even with working with this type of patient I would drop the filter on the floor no less. I tried to get family to bag but they were so sound aslieep it was pointless anyway so I hyperventilated and ran for the solution and put the piece in the solution and continued to bag for awhile giving enough time for the solution. I then hypered him and put everything back together. What a scare as something like that hadn't happened in years. Then three nights a week and it was always on my shift that I would have to do the bowel regimen and bath. The patient was from the same area in New England I was and we had much to share as it was no time after I had met him that we were able to communicate verbally as he had a device made to cover so that he could talk for a few minutes at a time. His last Christmas with us I had found out that he was a New England Patriots fan and I was able to obtain a tee shirt that we cut down the back so he could "wear ir" and he was so pleased. My brother has a real Santa suit and at the time had the physical attributs for it and went over with a special pie he liked and hadn't had it in years. I like doing little things like that as they can make all the difference in the world. Not too long after that we lost him. It was strange as it was the first time there were actually 2 nurses at the time. One was being trained and he coded. He loved to dance before he fell through a roof. Unfortunately, he had been drinking at lunch so that the family had all the care costs because work comp said absolutely not. :roll :cool: :confused: :confused: :zzzzz
  9. by   MollyJ
    I used to do Case Management on high tech home care cases... L.rae is right, control is the main issue.

    Beth, if you can let some of this roll off of you (and get backing from your clinical coordinator, like Kids-r-fun said) you may find that these people will turn out human after all. They have, over time, seen the worst and the best that private duty home care has to offer. They're not going to readily trust you or hook into you for a while. Some of the parents get so perfectionistic, that they become hard to staff cases indeed. They often hold nurses to a higher standard than they hold themselves, I would say candidly. (ask yourself, what kind of a mother of a high tech home care patient would i Be? Answer: I'd have my hell on wheels moments)

    I personally think home vent cases, especially where there are other children, deserve 12 to 18 hours/day BUT this is getting to be less and less of a practical reality especially in low pop density areas or areas of alot of cases or friend, burned out families. I had a vent case living in a low pop density area and whenever the mother chewed up and spit out the batch of nurses du jour, the agency would advertise for more nurses, which would be met with resounding silence. EVERY nurse in the immediate area knew about this mother. This mother had done plenty of nights, plenty of 16 hour shifts with her kid. As her sleep deprivation and family dysfunction worsened, staffing the case got worse and worse. Sometimes it was just a vicious cycle.

    I frankly don't think I could do peds home care because of the loss of nursing camraderie and because you are so totally at the mercy of the family. However, for those of you who do it well and love it, you are ANGELS!

    POLITICALLY, I think that peds home care cases are a classic example of cost-shifting and care shifting. The intent is to make the parents/care givers primarily responsible for the care of their child and to make them bear personally a greater responsibility for the cost of the patient's care.

    Some of this is a stark and necessary reality. Some of it is just painful to watch. Some of it is outrageous.

    One of my cases, the parents were tired, exhausted, checked-out, dysfunctional. This child needed institutionalization in a pediatric care home. But there was no such alternative in our region. At one point, I thought the parents meant to kill the child to end their own and the child's misery. Though the parents were all I said, they were also victims of the system (not to mention their helpless child).

    Some families cope with peds high tech home care better than others. For those that don't their should be a full range of alternatives, including that rare gem, respite care.
  10. by   traumaRUs
    I have done home care (adults) and I too know I would be just awful. I have a 22 y/o son who was tubed x3 for asthma as a youngster. Talk about horrid parents - I was the worst. Believe me, this has been over 12 yrs ago and I still feel awful about the way I treated the staff. I'm no an ER charge nurse and we see lots of home-care pts on vents, LVADs, etcs., and I always try to put myself in their place - it is very difficult for these parents. I'm not excusing their actions, mind you, just glad I didn't have a home-vented child.
  11. by   adrienurse
    Ah families. Can't avoid them, can't shoot them. What's a nurse to do.

    Although not on the parent-to kid side of things, this is all making me flash back to a family situation years ago.

    I was caring for a nice old lady whose health was quite fragile and would go into rapid CHF on a monthly basis. Poor thing had no family in town, but had family who lived in Florida who would parade into town every few months and turn the whole unit upside-down. Resident was FULL CODE although very frail and brittle. Grand-daughter in florida was a surgeon (an opthamologist!) who felt she knew everything there was to know about geriatric nursing. Everytime this poor little thing went into CHF and had to be transferred out, I seemed to be the charge nurse. I would have to call the family in Fla. and notify them. Each time I would get supremely reamed out by the surgeon granddaughter about some point in my decision making. Once had a very memorable phone call in which I had both daughter and granddaughter screaming at me (who ever invented conference calls anyway?!) at the same time over the phone. They then hung up (on me!). Always I was criticized for waiting too long before sending her into the hospital, or else they felt I was sending her there unnecissarily. Once they had poor "mother" d/c'd back to us AMA. Where we had to deal with the fact that she was not yet medically stable (this was a PCH!).

    So glad that I don't work there anymore.
  12. by   billssisbeth
    Well I'm NOT alone!!! I Feel SO much better... I have a few more stories about this family but... they are better left unsaid.. LOL
    If I didn't LOVE this kid I'd be gone in a heart beat.. LOL

    Go Figure.

    Beth
  13. by   Town & Country
    I can't say I would never do pediatric home health again, but I doubt it.

    The last one I had was an adorable toddler boy on a vent 24/7 whose MOTHER was a CCURN.
    The father was a "minister" who, for some reason, had no church, no job, and basically hung around the house to harrass the poor LPN who was orienting me.
    I ultimately didn't take the case because of the friction in the home.
    After I left, the "father" tried blackmailing the home health agency ~ he wanted his wife to be PAID (by Medicare or whoever pays for that sort of thing), to stay home and take care of their son. He threatened them that, if they didn't fix it up he would "report them."
    The LPN finally quit because she couldn't take their abuse, poor thing....
  14. by   mattsmom81
    I used to teach home health aides and nurses and constantly heard talk along these lines : that they were getting into healthcare so some agency would pay them to stay home with an ill loved one. Many were here from foreign countries and were very upset when I told them I felt this was against the law.

    Sounds like it must be going somewhere...can't be just coincidence...or can it?

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