Comfort

[newlpn08]

I am a student, and during clinicals last week I helped take care of a dying patient. When the patient arrived she was very cold, only 34.5 degrees celcius, and warm blankets did not help. While we stabilized her, we put a bear hugger on her, because warm blankets was not enough to warm her up. During the hours that I helped take care of her, she went through some very uncomfortable and invasive procedures. We got her stabilized enough to move her to another department, and while we were getting her ready to move she asked to keep the bear hugger. That was the only thing she asked us for. So we moved her, and I told the new RN that she wanted to keep the bearhugger. My supervising RN also said that she really liked the bearhugger. The patients temperature was up to 35.5 at this time. The new RN shrugged it off and said we will use warm blankets on her.

I realize there are 2 totally different perspectives here. The new RN is focused on what she has to do to keep the patient stable. She has not seen what the patient has been through that day, and is more concerned with blood sugar levels, heart rhythm, all things that will keep the patient alive. I am not saying that the new RN's focus is incorrect, she is doing exactly what she is trained to do. Also, I am just a student, so my perspective is different. I'm more thinking that this is a patient with a end of life disease who has deteriorated to the point of needing hospice if she recovers. And I am more concerned about her comfort, which is probably wrong in this scenario. I just wanted to pull the RN out of the room and tell her the bearhugger was the only thing that the patient has requested, and I felt really frustrated that I could not convey how important this was to the patient. I am also thinking that I did not advocate enough for the patient to keep the bearhugger.

Here are my questions. What would you have done in this situation? Did I fail this patient? I feel like I failed her.

[NurseCard, ADN]

You could have, I suppose, argued with the new RN and insisted that she let the patient use the bearhugger.... but I think that informing the "new" RN that the patient had been using the bearhugger and that the patient liked the bearhugger and had requested to keep it... I think that was probably enough for you to do. After that, the RN that is taking over will use her own judgement to decide what is best to do for the patient.

I don't understand myself why the new RN couldn't let the patient use the bearhugger, unless... well, I don't really know what a "bearhugger" is, but I picture something thick and snug that wraps around the patient. Perhaps the new RN just doesn't want to go to the trouble to unwrap the patient from this "bearhugger" in order to assess the patient. Personally, if it were me, and I had a dying patient, and I were taking over their care... I'd want them to be comfortable; that would be MY main concern.

[Fiona59]

Bear huggers provide warmth to the patient, kind of like a warm air duvet.

Currently, our hospital only has a couple and priority is give to pre and post-op patients for their use. Could it have been, the bearhugger was required elsewhere and the student was unaware of that fact?

Was the patient in fact classified as "compassionate care" only? Usually when this designation is on the chart all invasive procedures are withdrawn, yes, even vitals and blood sugars. From what we've told it sounds as if the patient is still a full code and is wanting all efforts made to prolong life.

[Simba&NalasMom, LPN]

I do agree with YOUR rationale. Comfort is important. If your role was as a fellow nurse, I feel it would have been perfectly appropriate to mention to your coworker the importance of her having the bear hugger and why. Unfortunately, since you are still a student, your options are limited.

Fiona also has a good point; there is more involved including family wishes, MD orders, etc.

It is so frustrating being a student and knowing that you are right but not being able to do much about it. Had you questioned the RN, you would have run the risk of being complained about to your instructor and having to deal with a tense clinical environment. When I was doing my clinicals, I had a situation where a resident went very hypoglycemic and the charge nurse was too busy passing meds to do anything about it. To this day I cringe at this nurse's poor judgement, not to mention she had 17 years experience but did not have a clue how to give a glucagon shot (it had to be done by the nurse practitioner who was in the building, thank god).

Long story short, I was overheard venting to another student about the situation and of course it got back to her. The rest of the rotation was not pretty.

Sounds to me as if you did the absolute best you could by your patient and that you have the caring, giving heart that can be the difference between being a competent nurse and an outstanding one. Never lose that!

[Altra, BSN, RN]

Bair huggers are, as a previous poster noted, like a duvet which is inflated with heated air circulating through it. It is used post-op and for hypothermic patients, not for comfort per se. Equipment like this generally stays within the department and does not travel with the patient to different units. If she required a bair hugger, she would have been transferred to a unit where one was available such as a critical care unit.

For those who may be unfamiliar with their use: http://www.arizant.com/us/bairhuggertherapy

Sounds like a septic patient - hypotensive & hypothermic.

OP, no, you did not fail your patient. You'll gain more experience and become more skilled in reassuring patients, "They'll keep you covered and warm" (they meaning the nurse in the unit where the patient is being transferred) rather than focusing on the "no" as in, "no, I'm sorry, I'm taking the bair hugger away."