Am I *Too* nice?

[crispix]

Hello all,its me again with another question about nursing home nursing.:)

I have been at odds with the day shift nurse for 3 days now,because she insists on making one of the residents walk,who fell on the 7th.Her hip/left thigh is very painful,getting steadily worse.She had portable xrays done which were negative on the 8th.

Last night,she could barely walk,and we ended up getting her a bedpan and using it.I was going to let her stay in bed this morning,just because it is so painful for her,and I tink she may have a fracture of her femur,or something that didnt show.Just so ya know,I did call her doc when she wasnt able to bear weight,he ordered another xray,of her femur.Shes already on Darvocet for the pain,and Tylenol.There is no deformity,shortening,rotation of the leg,good pulses....

.The lady is in her late 60's and has Parkinsons also.Her husband and she share a room,the husband has Alzheimers.She is worried about him,as she takes care of him,makes sure he gets dressed right,helps him do things around the room,etc...

Anyway,the day shift nurse came in and had a fit because she was still in bed.I explained top her that the lady was in tears and could hardly bear weight on the leg,so I had said she could stay in bed.She said she needs to walk on the leg.I said,she cant!She said,why.I said because it is too painful for her.She insisted the lady is just trying to get sympathy,and that theres nothing wrong with her leg,except a bruise.I said,well,when I got her up to the bathroom,she was in tears,and couldnt bear weight on it.She then asked me what we were doing for her leg.I said,Darvocet,and I called her Dr and got an order for another xray.She asked why.I said,because of the increased pain and decreased ability to bear weight,she may have a fracture that didnt show up the other day.She said,well,maybe,but she needs to walk.I still think theres notthing wrong.I said,well,if you want her out of bed,you go tell her,because Im not going to.She's in pain.

So,she did.My question is...am I being too nice thinking this lady deserves to lie in bed,not putting weight on her leg,yes,she does have some history of being anxious and a bit over dramatic at times.But,Im sorry,she was crying when she walked on her leg.I cannot bring myself to force someone to walk when theyre in taht much pain.

This has happened with other residents recently,theyve had a respiratory virus,and are weak,but the day shift insists on getting them up and going to the dining room for meals.They tell me these people need to not lie in bed and get down before their time.I feel it is cruel,and a bit lazy,perhaps,to make them go to meals,when they can just barely sit up.They dont do room trays often at this nursing home.Not sure why.

Am I just bein' a big ol softie???

Christine

sorry so long

[spineCNOR]

No Crispix, you are not being just a softie--this lady needs to be evaluated by an orthopedic surgeon. She also needs a better quality X-ray than a portable, read by a radiologist. Forcing this lady to walk when she feels she can't put weight on her leg, WHEN SHE HAS NOT HAD A PROPER MEDICAL EVALUATION, seems cruel to me. You are right to pursue this issue to help this poor lady, and to determine if she needs further treatment.

[Aussienurse2]

There are a lot of reasons this nurse may want her residents to get up and walk about. Unfortunatley this can go a bit too far with some people, but on the whole the more normalcy we maintian within the residents environment the better off they are. Warding off depression is a big reason we get people out of bed, maintaining they're self reliance, ensuring that limbs don't stiffen and weaken. Lots of reasons, if the joint isn't swollen, the bruising not excessive then I would probably walk her too, especially if she has a history of depression. If we leave someone in bed indefinately we run the risk of them never getting out of bed again.

[plumrn, BSN, RN]

I think you have to take everything into consideration, of course, but if she was in that much pain, I would not have made her get up. I've seen our ortho docs order C T scans when they are questioning a neg. hip x-ray. If I was in that much pain, it wouldn't matter whether it was broke or not, I wouldn't get up either. Maybe a morning, or day of rest might be just what she needs. I'm sure, (I hope), the day nurse just had her best long term interest in mind, but the resident shouldn't have to suffer so.

[shabookitty]

Oh gosh...you sound so much like me...I am not a nurse "yet" I merely go into the homes to draw blood...but I know where you are coming from. I see it from both point of views. Yes, I have seen those that feed off of sympathy and attention...it usually works with me :) And I have seen those that are truly in agony. I have learned that those that have cared for them the longest can be the best to assess them. Typically they know there moods and personalities. I have been doing this job for a little over a month now and I stay anxious for the very reason you write about. I am terrible judgement on leg pulling and the real thing when it comes to some of these guys. I watch nurses be so forceful with some patients and it will fluff my tail feathers...yet in the long run they really knew what was best all along. But, you go with your instinct. You did the right thing...if the nurse is right than chalk it up as a learning experience and understanding this patient...if the nurse is wrong than "Way to go!" My motto: Better to be safe than sorry!

Just keep doing the great job you are doing. I admire knowing that you are concerned than just dismissing a situation.

[P_RN, ADN, RN]

Another suggestion for evaluating her may be a bone scan. Occult fractures are often dx this way.

[dianah, ASN]

Ditto what plumrn said, about the X-rays. They don't always show a fx, even with the best of images (cf portables). A friend (male, walkie-talkie, exercises and takes care of himself, is 50-ish) fell @ work, had X-rays, all neg, continued to have pain, got a CT and voila: a stable (but nonetheless painful) hip fx. And he'd been walking on it . . .

Ortho eval and poss. CT seem to be in order in your resident's case. With traumas (to draw a parallel) even if the films are negative, the pt is still kept in spinal precautions if s/he c/o pain or has point tenderness - then do CT. JMHO. How many times can you say ADVOCATE? Good for you.

[ancella marie]

Bless you for your kind heart!

You're the kind of nurse that patients would want to care for them.

I can see that you considered a lot of information about the client before you decided to let her stay in bed and that doesn't make you a softie - but somebody who's using reasonable judgement in giving care to the patients.

I still believe that pain is what the person says it is and occurs when the person says it does and when it happens it requires prompt nursing action.

Keep up the right attitude. What you give your patient is something of value and something that would bring a feeling of fulfillment to you at the end of the day.

[Tim-GNP]

I used to work with a nurse like that. She was always right. I used to remind her that she could run her shift her way, and I would run my shift, my way. Not very productive, but it used to end the argument.

You may also want to remind your colleage, that if the resident says "NO" the answer is "NO"---- otherwise, it is resident abuse.

I would encourage the resident to cough & deep breath frequently to prevent pneumonia, and encourage extra fluids and fiber to prevent constipation. But if you suspect something more ominous than a 'bruise'--- I wouldn't go ball room dancing down the hall with her.

Maybe some day your colleage will be in a similar position---- I hope she gets a nurse who is every bit as compassionate as she is.

[bagladyrn, RN]

Another thing to keep in mind - it sounds as though this woman is mentally competent? If so, she has the right to refuse anything - including ambulation - and to force her to do so may qualify as abuse.

[bagladyrn, RN]

Tim - parallel thoughts here.

[Burnt Out, ASN, RN]

I agree with you 110%-you did the correct thing! You were acting in your patient's best interest-A TRUE PATIENT ADVOCATE!

:kiss