Cruel and Animalish treatment to patient

4theBetterGetter, RN · Dec 19, 2008

What a powerful and brave confession! You have learned much! Don't ever forget! Thank you!

yousoldtheworld · Dec 19, 2008

Thank you for this.

Flare, ASN, BSN · Dec 19, 2008

Thank you for sharing your story. We have probably all had patients that have been a challenge like that. I can see that you carry Joe in your heart each day.

I can remember going to see a play that a friend of mine was in. There was a scene where a hospitalized patient was in extreme slow motion trying to water a plant while the nurses hustled and busteld around her, busyinng themselves with performing interventions without giving any actual care. One nurse finally noticed that the patient is trying to water the plant, takes the water out of her hands and dumps it on the small fern. The look on the actors face left a permanent sting. I had seen this look before. Though this was a dramatic interpretation, I could see myself - a new nurse at the time more concerned with getting home on time than making sure that all the tasks for the day are hammered out. It changed me immensely. It took seeing this played out in front of me to realize that we are not just performing a laundry list of tasks. That compassion is more than just peeking my head in the room and asking the patient if they need anything while praying that they say no. I was thankful that this mirror was put infront of me by the fates so early in my career.

gonzo1, ASN, RN · Dec 20, 2008

Your story made me cry. It was beautiful. It is a scary and awesome responsibilty we have when we realize that during our career there will be many people for whom we are the last person they see or interact with before they die.

I know that you are a much better nurse now because of Joe. He gave you a valuable gift.

Thanks for sharing

flightnurse2b, LPN · Dec 21, 2008

wow.... this blog is very powerful and you are very brave to share it. i think we all learned something from it. thank you!

xlilchatonx · Dec 21, 2008

]Thank you for sharing this. I have not yet started nursing school, but I plan to get a job as a CNA while I wait to start and I'm glad that I was given the opportunity to read this before having that job, because I know that each day when I do go into work I will keep this story in the back of my mind and having that reminder will motivate me to always provide compassionate, loving care no matter what.

gigi1973 · Dec 21, 2008

I'm glad you sound remorseful and I do hope you learned something from this experience...But can I just say, I think this is horrendous patient treatment. Never in all of my years of nursing practice have I felt the need to treat a patient like this and I've dealt with my fair share of neurologically comprised patients that were confused and not all there. Furthermore, this is called assault, the way to confess to treating this patient and it makes me furious to even read the things you did to this man that needed your help. :banghead:

MelodyRNurse · Dec 21, 2008

I was moved that you told this story. I just want to add that you are not solely responsible for the care this patient received. Caring for patients like this does not only take compassion, but also some education or experience about the patients condition. Furthermore, the nurse should have used better judgement when loading him up with dilaudid, without assessing the situation, every time the sitter said he needed it. That is unbelievable. No wonder he couldn't communicate his needs!

When you have done something that you feel that remorsefull about you have to believe it was for a reason. A bad person would not care...and certainly would not cry or lose sleep over it.

cherrybreeze, ADN, RN · Dec 21, 2008

I was moved that you told this story. I just want to add that you are not solely responsible for the care this patient received. Caring for patients like this does not only take compassion, but also some education or experience about the patients condition. Furthermore, the nurse should have used better judgement when loading him up with dilaudid, without assessing the situation, every time the sitter said he needed it. That is unbelievable. No wonder he couldn't communicate his needs!
When you have done something that you feel that remorsefull about you have to believe it was for a reason. A bad person would not care...and certainly would not cry or lose sleep over it.

Dying can be a very painful process, and they give pain meds ATC to keep a patient comfortable...that is standard. Knowing he was a hospice patient, the use of meds doesn't surprise me.....the writer's interpretation of WHY they were givng it may have been off base....

I appreciate your sharing this story. I hope doing so relieves the burden you feel.

Virgo_RN, BSN, RN · Dec 21, 2008

Dying can be a very painful process, and they give pain meds ATC to keep a patient comfortable...that is standard. Knowing he was a hospice patient, the use of meds doesn't surprise me.....the writer's interpretation of WHY they were givng it may have been off base....
I appreciate your sharing this story. I hope doing so relieves the burden you feel.

Agreed. Someone with a brain tumor is going to have difficulty communicating their needs, period. The assumption that the nurses were using Ativan and Dilaudid as chemical restraints is just that, and assumption. To me, if a person is agitated and no amount of toileting, repositioning, or distraction is helping, then Ativan is appropriate in order to manage that sign/symptom of their disease process, and Dilaudid is also appropriate, because they could be in pain but simply cannot express that, due to their disease process. Keeping the person well medicated in order to control the s/s of their disease is not the same thing as using chemical restraints.

I remember when I worked in LTC, one of our residents had brain cancer. Her tumor was in her frontal lobe, so it affected her judgment and behavior. She could be very unpleasant to be around at times, as she sometimes became verbally abusive. After a while, I noticed that if I went into the room after a certain CNA had been in there, the resident was almost always angry and "combative" (I dislike the term "combative", because I feel it is overused, and many people with cognitive impairment only appear "combative" because they are either distressed or having difficulty making their needs known). I soon found out why; the CNA said to me one night "I can't stand that woman. She reminds me of my Grandmother, who was such a witch.". Obviously, even though the resident was cognitively impaired, she still had enough mental capacity to know when someone was not treating her right. One night, the nurse overheard such a comment and reminded the CNA "She is not responsible for her behavior. She has BRAIN CANCER.".

MelodyRNurse · Dec 22, 2008

Agreed. Someone with a brain tumor is going to have difficulty communicating their needs, period. The assumption that the nurses were using Ativan and Dilaudid as chemical restraints is just that, and assumption. To me, if a person is agitated and no amount of toileting, repositioning, or distraction is helping, then Ativan is appropriate in order to manage that sign/symptom of their disease process, and Dilaudid is also appropriate, because they could be in pain but simply cannot express that, due to their disease process. Keeping the person well medicated in order to control the s/s of their disease is not the same thing as using chemical restraints.
I remember when I worked in LTC, one of our residents had brain cancer. Her tumor was in her frontal lobe, so it affected her judgment and behavior. She could be very unpleasant to be around at times, as she sometimes became verbally abusive. After a while, I noticed that if I went into the room after a certain CNA had been in there, the resident was almost always angry and "combative" (I dislike the term "combative", because I feel it is overused, and many people with cognitive impairment only appear "combative" because they are either distressed or having difficulty making their needs known). I soon found out why; the CNA said to me one night "I can't stand that woman. She reminds me of my Grandmother, who was such a witch.". Obviously, even though the resident was cognitively impaired, she still had enough mental capacity to know when someone was not treating her right. One night, the nurse overheard such a comment and reminded the CNA "She is not responsible for her behavior. She has BRAIN CANCER.".

Here is an assumption, you must have skipped over this part of the story...

Joe begins to get restless...I get all tensed up ..i slip out in the hallway and tell the nurse, to come inject him with somthin to calm him down...and ...she does...she listens to me...why didn't she analyze the situation or ...try somthin else...why not sleepin pills or somthin..why listen to me and inject him with diladin..why why ..i don't know..they think the sitters know it all.....so joe relaxes and ...about 1-2 hours go by and the medication is wearing off...and joe is starting to get restless again, tryin to get out of bed, he would throw his covers off and.....i would ask him if he needs water or to go to the bathroom but ..he wouldn't respond anymore ..like he did 2 days before..

Or I misinterpreted it...

I was not indicating that the nurse was using chemical restraints, by any means. I simply thought it was unbelievable that she administered these medications based on the sitters assessment.

Oh, and thanks for the info, I had no idea that having a brain tumor could be painful.

Virgo_RN, BSN, RN · Dec 22, 2008

I did read the entire story.

I was caring for a patient going through alcohol withdrawal. He had a sitter. We have an AWD Protocol, which uses the Riker Sedation-Agitation scale to help guide the administration of appropriate medications. The sitter pokes her head out the door and says "He needs some Ativan!". It takes two seconds for me to poke my head in and quickly visually assess the patient to see his level of agitation. I can see, from the doorway, that he does need Ativan. I'm not administering the medication based upon the aide's "assessment". I have assessed the patient myself. But without any knowledge of the Riker SAS scale or our AWD Protocol, it would be easy for the aide to assume that I was giving that med based upon her request.

Given the OP's limited understanding of the patient situation, I find it highly doubtful that the nurse was simply following the sitter's instructions.