A Lesson well learned "One size does not fit all"

[phdeha777456]

Working in a Geriatric Psychiatric Hospital, a lot of our patients are awake at night which requires the staff to do a lot of interactions with them to help promote sleep. This particular night, my lady was awake at the beginning of my shift, loudly talking and pacing in her room; unsafely preventing her roommate from sleeping. We questioned her as to what was wrong and what could we do for her, we were unable to pinpoint what was wrong therefore a staff member was assigned to stay with her until she calmed herself or went to sleep,

Unfortunately, this did not work. She was adamant that she wanted to walk up and down the hall. We decided that maybe this may relieve some of her anxiety. Due to her unsteady gait, we applied a gait belt as it is recommended by PT or all patients that may have unsteady gaits or difficulty transferring. The belts are applied around the patients' waist while the staff js positioned close near the patient so they are able to grasp the belt if needed as a means to provide safety for the patient.

After applying the gait belt she let out a piercing scream and began to cry...... her reaction stunned us all causing an instant pause. Tearfully she pleaded for us to take the belt off and began telling us how as a child her father would beat her with a belt then use the belt to tie her to a boiler while he played cards and drank with his friends.... it made her feel just like a dog. We immediately removed the belt and walked her to her bedroom. She continued to cry repeating over and over how she could not believe this is happening again. After assisting her to bed we sat with her for a while, looking up at us but not focusing on us, she began to say how much she loved her father but could not understand why he did this to her. She recalled her mother telling her how her fathers' drinking was the reason he did these things and he did not mean to do it.

Listening to her story saddened all of us. There was not a dry eye in the room after her revelation. She looked at each of us and proceeded to tell us how she thought she had gotten over it and really she felt she should have but when we put the belt around her it brought back those painful memories she thought she had long ago tried to forget. Noticeably calmer now, as she lay in her bed just as we about to leave her side speaking in a soft voice, she wanted us to know that it was not our fault she failed to tell anyone what had happened to her.... it was just too painful but next time please listen when someone is trying to tell you something.

Even though we were not aware of the traumatic experience she had, we should have realized that something was wrong. We must not only take the time to listen but listen with empathy and compassion using all of our senses to be able to individualize patient situations as they arise. She was referred to our Psychologist who scheduled weekly counseling sessions. All staff were alerted to the non use of a gait belt for her. This was one lesson well learned and will forever have an impact on us. As for my self, I will never forget this incident and it has encouraged me to look at my patients differently. I will from now on ask more questions, pay more attention to changes in behavior and focus on body language.

There are times that small things are overlooked when you are very busy and or dealing with difficult patients. That saying "One size fits all" when it comes to Psychiatric nursing should be "One size does not fit all".

Phyllis

[Emiliano]

Dear Caroline,

I already know you have quiet experience in this branch of nursing,I am a freshmen in nursing,so pharmacology is giving me a very hard time,specially some drugs used in your field.Could you ,please give me a hand and answer the following question? Should we use the remainder doses of thorazine contained in a multiple vial after reconstitution, for the next doses of the patient?,thank you,Emiliano

[stslpn]

Phyllis, thats why u r my mentor! Excellent article! I need a daily reminder as to why i stay and u just gave me the most important reason of all. OUR PATIENTS need us!!!! Thank You

[hopefulnurse84]

tears in my eye. just goes to show you never know someone's story. I will be more open with my patient's thoughts and listen to them more carefully.

[1EmergencyRN]

At the ER I work in, there are people who loose sight of the reasons why many patients may act out, there are certain personnel who repeatedly fault and blame the patients for erratic behavior indicating that it is a choice they've made to be difficult vs. remembering the need for compassion and holding the knowledge that we are and have the responsibility to be these patient's advocates. Even and often times especially for the ones that seem "difficult". Judging has no place in nursing, but caring hearts such as yours are what makes this profession so important. Thank you for sharing, I hope many more read this and are compelled to work with a little more compassion.

[TangoLima]

I just recently read the original post.

Then on my last shift, I had this little 91 yo lady who came in with R leg weakness. She had a hx of spinal cord tumor, so they were trying to r/o return of the tumor. She also had a hx or dementia/delirium, was disoriented and agitated.

Each time we took her BP, she would start screaming at the top of her lungs, asking us to stop and take it off. We ended up taking the BP on her leg and having to hold her leg still until we got the BP. Of course the more she struggled, the longer it would take to get the BP! Then, in the morning, it took 3 of us to hold her still so that the lab could draw her blood, and she still managed to pull out the needle and had to be stuck again.

I don't know what else we could have done differently, but I just felt so bad, and this thread stuck in my mind making me wonder if the pt hadn't had some traumatic experience in her life. Thanks for sharing.

[jessesgirl13]

thank you for your story. I'm in a nurse's aide training class right now and they told us to always us a gait belt when ambulating a resident, and your story reminded me that just because it's what you're supposed to do, doesn't make it the right thing to do. I think that i'm going to recommend this site to the other people in my class. There's so much that they don't tell you in class. Things that you learn from experience, whether it be your own experience or someone else's. Thank you.