i have a pt ,incomplete quad who has been started on q other hs bowel program of suppository and dig stim...some nights bowel program was not effective, so t was changed to q hs; then to our surprise the pt demanded that supp be used as prn and said that dig stim worked better for him wthout the supp; per docs approval we did it; and now this pt wanted dig stim not only q hs but twce a day when he wants it...and to our greatest surprise :yeah:our nurse manager and primary physician approved it...even though hell have result w the dig stim he would want it again and agan during the day...sometimes he had like 3-4 dig stim done; he does not want to do it himself saying he is still weak on upper ext; family is visiting and he does not want them trained doing dig stim...
how frustrating can that be???...i dont know if im wrong but sometimes i would think that dig stim is giving him "another kind of satisfaction":angryfire..why else wound he want a finger up his orifice that frequent????
Thank you for your observations. For the sake of not starting a debate I will not address each of the personal attacks listed here. However, I would like to point out that I was simply making a statement based upon personal experience with quads. These are not facts I have read in books or studied in nursing school. I have personally observed very manipulative behavior by some quads. Because they have very little control over their own circumstances they seek to control others around them. That is actually quite natural. I'm sure if anyone of us were in a similar situation we would likely behave in the same way.
I hope if nothing else this thread may make any one of you think twice before you generalise and marginalise people again who, much to their displeasure, have to rely on so called care professionals to survive.
Digital stimulation is a procedure that many but not all people with SCI need for proper bowel management. So need it several times daily. Some need it only every 3rd day. The person with the SCI knows their body and needs better than anyone else, including nurses.
Manipulative people often have learned that skill from working with health care "professionals" who don't listen, don't understand, and don't want to.
I too disagree with the generalizations but I also want to focus on the situation the op was describing. I think there is a lot of learning that can come from this thread. I personally had little if any training on SCI.
I too frequent carecure and KLD is a nurse and leading expert on SCI care (for those that dont know).
In my opinion, I still feel that most likely there is some problem if a person is requiring digital stimulation 3-4 times a day. In all likelihood the bowel program isnt being done correctly but there could also be other issues as well. I think it would be very rare (although possible) that someone needs digital stimulation this often). I hope you can respond KLD.
I want to make one more observation. I know there are hurt feelings but I truly do not believe that was the intention. Constipation or impaction is a horrible thing for patients with spinal cord injuries. Despite being paralyzed often it does cause nausea or even abdominal discomfort. It can also lead to AD which can be life threatening and horribly frightening for the patient.
So I think it is normal to become so concerned or "fixated" on your bowels. I think most nurses just dont understand the consequences of not having routine bowel movements. Instead of being controlling or manipulative it may be more fear or another issue.
I also wish I would have added more to my original post. I should have explained things much better.
Specializes in Day Surgery, Agency, Cath Lab, LTC/Psych.
Digital stimulation is a procedure that many but not all people with SCI need for proper bowel management. So need it several times daily. Some need it only every 3rd day. The person with the SCI knows their body and needs better than anyone else, including nurses.
Manipulative people often have learned that skill from working with health care "professionals" who don't listen, don't understand, and don't want to.
I believe that I have treated all of my quads/paras with a great deal of respect and care. However, the "quad personality" that I mentioned is an observation that I and other rehab nurses that I have worked with have made. If you will notice this website is loaded with "categorizations" of people. ER frequent fliers, OB patient's with "fluff my pillow syndrome" and other offensive remarks. No it is not right to stereotype any patient. I was certainly not trying to. I was just trying to state my observations.
I have a masters degree in rehab nursing. I work full time in SCI care and have for the last 30 years. I don't work with "paras and quads". I work with PEOPLE with spinal cord injury which has resulted in tetraplegia (quadriplegia is a long outdated term) and paraplegia.
Specializes in Case mgmt., rehab, (CRRN), LTC & psych.
Although it is perfectly acceptable to disagree with the viewpoints being expressed in any post, personally attacking another member is a totally unacceptable TOS (terms of service) violation. Please play by the rules.
*80% of respondents were not satisfied with the bowel care they received in
hospital
*70% of respondents were not involved in any discussion with healthcare staff
about their bowel management
*60% of respondents were refused a manual evacuation of faeces by staff
whilst they were in hospital
for some people with a sci who use manual evacuation as part of an established bowel care routine being refused a manual evacuation can be severe and potentially life threatening. a number of anonymous vignettes are included in appendix 2 that demonstrate the extent to which people with a sci are affected by lack of appropriate bowel care when admitted to general healthcare settings and they are unable to continue with their established, routine bowel management.
i receive many referrals from magee, moss, bryn mawr rehab along with local hospital rehab units and paraplegia/ quadraplegia still being listed as a diagnosis in philadelphia area.
from a homecare persepective, bowel program management is one of the key patient care needs identified and and taught by our staff. having cared for many sci patients over the years, and seeing a few cases of autonomic dysreflexia due to fecal impaction, i understand my patients fears when bowel program not properly carried out.
what can best be accomplished for the op patient?
having a care plan meeting with the patient, rehab team, dietary, charge nurse and physician to develop a realistic plan that meets your patients needs. at some point in near future, patient will be going home---if they are unable to perform procedure, caregiver needs to be identified and taught as home care is periodic and intermittent.
some patients do not respond to glycerin supp, others do well with biscodyl type. exploring fears and concerns along with patient education needed here. use the above links to guide you in suggestions for best program.
re digital stimulation for sexual pleasure only, rarely have i seen this be a sci patients sole purpose...more so side effect due to loss of voluntary control. patients newly adjusting to spinal cord injury maybe demaning and controlling ---------i've seen same behaviour however with advanced copd patients who often fight for evey breathe too.
it's great when a united front in caring for patient, educating them over choices they have in their life, setting goals and encouraging informed decision making and responsbility for decisions they make, helps the pateint regain sense of themselves and maxamize self care/ well thought out future care needs.
Specializes in Vents, Telemetry, Home Care, Home infusion.
re autonomic dysreflexia:
december 1, 2006
applied neurology.
rehabilitative management of complications of spinal cord injury
the most common symptoms of ad are significant hypertension, pounding headache, bradycardia, profuse sweating and flushing of the skin above the level of the injury, blurred vision, nasal congestion, and anxiety and apprehension. hypertension, in particular, can lead to intracranial hemorrhage, seizures, myocardial infarction, and death. ad therefore should be treated as a medical emergency. the patient who is in a supine position must be immediately seated upright and all constrictive clothing must be removed or loosened. cause of noxious stimuli should be identified, beginning with the urinary system.
if the patient requires bladder catheterization, an instillation of 2% lidocaine should be introduced through the urethra before catheterization to avoid additional stimuli caused by advancement of the catheter. if the patient has an indwelling catheter, it needs to be checked for kinking and blockage. if it is not draining, it is best to remove the catheter and catheterize the bladder.
in management of fecal impaction, the rectal wall should be lubricated with lidocaine gel, allowing up to 5 minutes before performing a gentle rectal examination. if stool is present, it needs to be gently removed.
if symptoms of ad continue and blood pressure remains elevated, pharmacologic management should be considered. antihypertensive therapy using agents with rapid onset and short duration is useful while additional causes of ad are being identified. topical and sublingual nitrates and nifedipine are the initial drugs of choice. in using a topical nitrate, apply an inch of 2% nitroglycerin paste to the chest above the level of injury. topical application of nitroglycerin has the advantage of easy removal if blood pressure falls precipitously. when using nifedipine, administer as a bite-and-swallow 10-mg dose. if needed, the dose can be repeated in 15-minute increments until blood pressure is controlled. other agents, such as phenoxybenzamine (dybenzyline), diazoxide, mecamylamine (inversine), and hydralazine also can be used. for severe episodes of ad, intravenous drip of sodium nitroprusside under close monitoring is effective.12
since this thread was started four months ago, first poster has not been back to respond/update us. i am hoping these resources will be helpful to others in similar circumstances.
Establishing the importance of routine bowel care was one my main goals. I still feel that many healthcare providers fail to realize the importance of this in patients with SCI. It is obvious by this thread and that is a problem in itself. It seems like many on here almost immediately assumed the problem was that the patient was controlling or doing this for sexual stimulation, when in reality this is rare. I think it is extremely concerning as a nurse to see rehabilitation nurses and a moderator seemingly confirm these opinions.
What further adds insult to injury is when bogus terms such as "quad personality" are used. There is no such thing and it is horribly insulting and demeaning. As Karen alluded to, anyone suffering a loss will display a wide range of emotions.
I read all of KLD's posts and did not see her directly attack anyone. She is outraged, as are many people with SCI. KLD is an expert on SCI, one of the top SCI nurses in the country. She is part of the carecure.org community which is led by Dr. Wise Young. (I hope the link will be kept, it is such an important site to gain knowledge on SCI).
I still feel that a lot of good will come from this post. I think this is one example of how allnurses.com allows for professional and personal growth.
I read all of KLD's posts and did not see her directly attack anyone..
Most of the time those posts aren't allowed to remain out of respect to the one being attacked. So just because you didn't read it doesn't mean it didn't happen.
I still feel that a lot of good will come from this post. I think this is one example of how allnurses.com allows for professional and personal growth.
I certainly agree with you.
We are a moderated site, unlike other forums, including the one you posted. Unfortunately the profanity posted by some of the members there is very off putting to me. That's o.k. I have this site and accept the moderation (of course now I'm a mod myself, so that's a moot point). Others who want a more free-speaking forum can have that site, or other sites too.
This certainly is a good thread with plenty of education, our plan for now is to let it stand. Unfortunately there might be others from others sites that are trying to sabbatoge things here.
My post is off topic and made to clarify a few points. Please stick to the main topic if you don't mind. Thanks
I did read the posts before they were edited. Again I did not see any personal attacks. I did see views that were challenged. I guess what is so frustrating is that few are seeing how offensive some of these posts are to patients with SCI.
The other site is moderated and also highly respected among the SCI community. Again it is run by nationwide experts in SCI care. Wise Young along with the SCI nurses are among the best in the country. Actually I will go further and state that Dr. Young is known and respected around the world. If you have ever taken care of a patient with acute SCI injury in the ER chances are you have given high dose steroids which was due in part to his research.
But again a very important question was raised and perhaps this is actually somewhat on topic. Why arent terms like "quad personality" edited out?
My intent for this thread was to inform healthcare providers who I think were making a rush to judgement. By explaining how important bowel care was I think it allowed me to also to challenge the views that "there are control issues" and that they somehow get enjoyment out of this. As someone who has taken care of patients with SCI injury those views are really off base.
Disbelief
2 Posts
I hope if nothing else this thread may make any one of you think twice before you generalise and marginalise people again who, much to their displeasure, have to rely on so called care professionals to survive.