Crossed the line... or expected behavior?

[traceyw]

As an LPN to RN transition student, I had a patient who had to have a thoracentesis done in Radiology. During the procedure, I was placed in the supportive position for the patient and made sure her shoulders were in the proper position. As the procedure was taking place, I began to inform the patient of what was happening and what to expect (pin stick, etc.) HOWEVER... the radiologist later complained that I "talked the whole time." Um... nobody was providing inforormation to the patient and I felt it was my role to be the patient advocate and give her information about what was taking place to her during this invasice procedure.

Can someone PLEASE tell me if I acted inappropriately?

[latebloomer74, LPN]

Another one of those things you are just supposed to magically know:rolleyes:

Lesson learned I suppose.

I think it's unfair of them to try to kick you out of the program over that:(

Hope everything works out good for you and you don't get kicked out. Good luck!

[decembergrad2011, BSN, RN]

with the scenario you provided i some critiques. you were very well intended and did the right thing...in the wrong way. yes the patient should have been cleaned, if she truely was not cleaned for hours then as the patient's advocate you needed to step up and intervene before the soiling went from minutes to hours.

for cleaning a standing patient i would say you were in the wrong. if she needed to be cleaned your duty would have been to have the patient sat back down and cleaned in bed in a safe and prudent manner. the transfer is the single most dangerous activity that patient and staff will do (pt wise). most injuries occur during this time and that should be respected and acknowledged. when a patient is in movement do not interfere with that patient or the pt. take the time to sit her down or lay her down. does not matter if it was 2 seconds, 15 seconds, 15 hours...let pt do what they do or have them come back after she is cleaned (in bed).

the part in blue should have been obvious to you. a 350lb women is a high injury risk, even if batman and captain america were holding her they would have gotten tired. they most likely did not say anything so as to not embarrass you, or the patient.

touching you was very inappropriate but if you came within the 1 foot ring of sterility i would have snapped at you too to make sure you were aware of the sterile field. if you have to "squeeze by" you were way too close. breaking the sterile field, which you did not, could have cost the hospital/patient/insurance hundreds and delayed the procedure. it was prudent to bark at you to back off...if not entirely professional.

i think you missed the part of my post where i was asking for help and could not get it. my nurse ignored me, my ci had 7 other students who were doing iv's and catheters (so she told me to get help from my nurse or the cna), and there was only one cna on duty because the other called in. what am i supposed to do in that case? "listen to me, there is a woman laying in her own feces and i've been here since 7 am, it's now 9 am and it hasn't been resolved - help me now!!" oh, well i did that, and like i said...it was ignored.

i had removed her chucks, changed her sheets, bathed the patient and cleaned her up the best i could alone, including getting her to lay on her side and hold the rail on each side and do the best i could to clean her bottom after my first request (when i first got there) was ignored. however it was impossible for me to do it properly alone due to her size and the amount of skin folds. i did not leave her there without interventions. i asked pt if i could take a couple of washcloths to her bottom when they stood her up, they said yes. that was it. they could have said no, they could have said they needed a break, but they did not. however, even if they were trying to maintain professional face for the patient, the least they could do is inform me after the situation rather than simply tell my ci. i would have respected that, and i can definitely understand why holding up a 350 lb woman is no easy task. also, not that it should matter, but i did feel more comfortable with them holding her up because the team was a tall, strong man and a stout woman and they had her right in front of the side of the bed, so they could easily sit her down if necessary. i probably would not have asked with smaller pt people or a different situation, but the real world is not ideal, and i made it work the best i could because i did care about my patient.

i didn't ask for advice and getting my post torn apart like that with the assumption that i just let her lay there because i was lazy or incompetent is rather frustrating. also - i'm aware of sterile fields entirely, but a small or room at a large university hospital normally has enough people in it that "squeezing by" is the norm. one foot ring of sterility? that's impossible in the smaller or rooms at my hospital with even only support staff in the room. again, i was well aware of my body placement - i did not come near as close as many other professionals in the room who weren't sterile themselves. she said something to me because i was a student and felt she had the power to scold me, not because i was doing anything particularly unsafe for the situation.

i will never treat students the way i have been treated in the past, and i'm thankful that these experiences are not normal for my clinical experiences. most of the nurses and other staff i've encountered are not mean, uncommunicative or looking for a power trip, but the ones that are should still be given respect and worked with as much as possible. these frustrations and venting that i'm doing here do not reflect on the floor or in my patient care. i personally sought out the pt team when i found out what had happened and apologized. i apologized to my nurse as well, even though she didn't deserve it, because it was the professional thing to do.

[bradleau]

I certainly would want to be talked to during a procedure if I were the patient. But as a nurse I would ask the patient if they would like me to talk to them and ask the practioner if they minded me doing this. You know as a part of my nurse education.

[johnnybravo8802]

Man, you guys need to go back to nursing school and take nursing 101 again. Pt. advocacy is the first thing they teach you. I think maybe you need to have an 8" needle coming at you with a couple of zombie's doing the procedure and see if your anxiety hits the roof. It's the nurses role to keep the pt. informed of all procedures and explain as it's taking place-What you you think they're paying you for?!!!!!! It's your PATIENT!!!!!!!!!! This joker radiologist is just doing a procedure and it's just another procedure on his list. Now, if an MD wants to be quiet, that's another thing. I usually explain things before they happen and then keep quiet when the actual insertion is taking place. Otherwise, screw what the MD is complaining about-Most are just a bunch of 3 yr. old whiners anyway:yawn:. Also, your instructor isn't much of an instructor for not backing you up and you can quote me on that one-Been there and done that and there's a nice shiny app. at Burger King waiting on them!!!!!

[jvman]

Just a few words to help you digest your "mis-deed and pt. (well intentioned) advocacy", since you were "placed" in a supporting role by someone you didn't know, or not know well, and didn't have prior COMMUNICATION, with or know firsthand about his communication or lack of with the patient... You really didn't know, if that practitioner had not already communicated with the patient on what he would be doing, what to expect, feel, ect...

besides, Any Thoracentisis patient I ever had, it was NOT their first time ( or last, either ) they KNOW what is going on, your role is to hold them, keep them still so the proceedure will be as safe as possible..

You would have been best advised to just be the supporting role and encourage the pt mid-way, with, " you are doing fine, or squeeze my hand / fingers, if it's hurting too much", let me know if you are feeling weak, or faint" ect, ect...

So, let this be a learning tool for you, PATIENT TEACHING IS (when possible) BEFORE, not during the proceedure; what is going to happen, how it may feel, what behavior you expect from them, and what they may even hear, smell, ect...

Now, should you be thrown out of class, school... NO, that's alot of overkill and just plain power tripping and people being way too ugly. Keep on learning, and be the great, wonderful Nurse that is your future. Careing comes from the heart and interest of promoting safe goal directed results. The blow by blow descriptions of a proceedure usually can only add drama and highten an already anxiety laden situation, rendering it possibly unsafe. Share all of your knowlwdge with your Patients while at the bedside prior to and after the proceedures. Your patients will love being informed and be less bothersome because they will know you KNOW your role and that you care and that you will include them in their pre-post proceedureral care.

[E I Adeosun]

i think ydid the rigth thing depending on how you say it and allowing the doctor to carry out his primary function. Let your clinical instructor know what happen .Hummmm thats what we nurses under go atimes

[benr98]

I believe the radiologist was wrong in this case. The hospital system that I am currently trying to get a nursing job with would have had a talk with the radiologist. From what I have been taught you did the right thing. However, not being there the radiologist may have taken it differently.

[gardengal1, ASN, RN]

Lots of side-notes from everyone on this. My belief is you don't have to DESCRIBE what is being done but ask your patient "are you doing OK" when you see the needle going in. As the radiologist moves it around, as "is the pain tolerable for you"," is your breathing OK", etc rather than describing everything. Concentrate on the system that is being affected and closely assess this system for changes. And, the radiologist SHOULD have been giving cues to the patient "you're going to feel some pressure now" , "I'm withdrawing some fluid", etc so that the patient has come comprehension that the procedure is going OK. By the way, radiologists do not have the best bedside manner since they spend most of their time alone in a viewing room so I personally feel you did nothing wrong, other than the possibility of too much EXACT information to the patient. Next time, more general terms, supporting them through the procedure and close monitoring of the body system that will be affected by the procedure.

[~Mi Vida Loca~RN, ASN, RN]

I'm sorry but a few people keep posting as if the Pt. had no idea what was going on. I have a very hard time believing a procedure like this was preformed with no explanation of the procedure or consent obtained prior. During consent the procedure would have been explained. I have never seen it happen like that at my facility in this particular procedure.

Now it might have been quiet during the procedure, which doesn't mean that was wrong and not advocating for the patient by allowing the quiet. (when I am in pain I want it quiet), other people might be different. But I can't believe this Doc just walked in, started an invasive procedure like this and the patient had no clue what was going on.

[grap19d]

Just from what I briefly read over in posts and based on experience where I work, any invasive procedure requires a consent form to be signed by the patient after the practitioner has explained the procedure/risks involved before the procedure occurs so depending on if a consent was signed or not the practitioner may have explained the procedure already previous to it occurring. In saying that though it is always important to be a pt advocate but be sure that you are also doing what the pt wants, it would have probably been more professional to check first if consent was given by the pt for the procedure then ask the pt if they would like a description of the procedure while it is occurring or before it occurs. Hang in there nursing is all about rolling with the ups and downs, you cant satisfy everyone all the time.

[JakeOff]

I know that if I was the pt. I wouldn't want someone explaining to me what was going on. I think it would only increase the anxiety. "Get ready we're about to puncture your pleural cavity." Not reassuring. The pt. should do their due diligence and learn a little about the procedure, be this asking the practioner or doing a little research.

[decembergrad2011, BSN, RN]

Can't we just accept that this might be one of those situations where there isn't one best practice? Some patients might be comforted by a play by play, others might want absolute silence. It's a patient preference, and I think that there is not one right or wrong answer for all situations. Let's also be real: informed consent doesn't mean the patient is entirely sure of what's going on, especially if the person obtaining it intimidates the patient and uses medical jargon, or the patient is so nervous or preoccupied that they simply don't listen fully.

I think the more pressing issue here is that the OP is facing the possibility of getting in serious trouble, without the guidance and support of her CI, and that just seems wrong to me. Being a little too overzealous in describing the procedure or not, I don't think this was an offense worthy of being kicked out of nursing school. This wasn't a patient safety issue, and it sounds like the radiologist was more annoyed than the patient.