Crossing the line of Caring - page 3

I was in clinical the other day and my patient had a spinal cord injury asked for a sip of water before my nurse and I left the room. The nurse said "No, Speach Therapy can do it in a few minutes... Read More

  1. by   IMustBeCrazy
    It's easy to focus on the physical illnesses of our patients and forget entirely about the psychological ailments that they may possess. Many nurses believe that they will never encounter 'psychiatric' patients on their floor, but the truth is, behavioral health patients break hips, arms, legs, have spinal trauma, heart attacks etc. like all other patients. In fact, because of their decreased judgement and cognition, they may actually experience an increase in hospitalization for various reasons over the non-psych population.

    This is not to say that just because a lonely patient uses their call bell a few extra times a shift they are 'borderlines' or behavioral health patients. The truth is, you won't even know due to HIPAA regs since behavioral health records are the most highly secure H&Ps in the hospital. They are only behavioral health patients if their axes indicate such, and these records would not be found on a regular medical floor.

    However, when you get that 'gut feeling' that you are being played, it's time to set limits. Because you are either dealing with a behavioral health patient on your floor, or one that is having situational crises i.e. "ineffective coping" due to their injury. At this point, it is THERAPEUTIC to set limits, and poor nursing judgement to ignore the behavior.

    The more you buy into the drama, the bigger headache you are creating for yourself and, more importantly, the poorer outcome for your patient.

    Last edit by IMustBeCrazy on Nov 6, '05
  2. by   NurseyBaby'05
    Yes, yes, yes! It's poor nursing care not to care for that aspect of the patient's health. Nursing is holistic care. It's like only treating the physical trauma of a rape victim. There's more than physical that needs addressed. The other thing that is important with setting limits is to try to be consistent from shift to shift, staff member to staff member. If you allow yourself to be manipulated not only can it result in a harder day for you and worse outcome for your patient, it makes it harder for the next nurse to come in after you and have to start from scratch to help the patient correct his/her behavior.
    Quote from sfcardiacrn
    her answer was idiotic but watch yourself when second guessing an rn's care. speech therapy + spinal cord injury is a warning signal to me of possible dysphagia. last thing you want to do is cause an aspiration. i do think a mouth swab would be in order.
    this nurse probably was worried about possible aspiration precautions...but she went about explaining it incorrectly. i agree mouth swabbing would've been more appropriate. she should've may be had you carollmarsden do it for the experience? she could've had a yankour (sp?) at the ready while you swabbed the mouth with the yankour in the mouth while swabbing to prevent the fluid from being swallowed.

    she was out of line with not wanting to give the patient relief simply because she'd already washed her hands. she needs to be reminded that she is the patients' advocate & if she can't do something as simple as comfort care...than she really needs to re-think doing bed-side nursing....period. however...if limit setting was what she was doing...she should've explained this to you as well. i agree with tweety & others that limits must be set with manipulative patients...especially when your nurse patient ratio is 7:1. but if that were the case...this nurse should've asked the patient if there were anything she could do for them prior to exiting the room.

    i hope things do get better where you are - good luck!

    Last edit by SKM-NURSIEPOOH on Nov 6, '05
  4. by   sjrn85
    Quote from Tweety
    I can take a good flame, doesn't bother me. I stand by my post. I agreed that it probably didn't apply to this case, but I reserve my judgement of the nurse, just the same.

    I also think you missed the point entirely. Setting limits on a manipulative patient isn't about denying them their basic human needs, nor controlling them.
    ITA, Tweety. Yes, the nurse could have explained her rationale better, but it is a fact that there are pts. who will always have "just one more thing." (Kind of like Columbo, with his, "Just one more question...")
  5. by   BabyRN2Be
    As someone else said, the nurse might have had a reason why she wanted Speech Therapy to work with him. The reason she gave wasn't a good one. Maybe she was hiding fear about her lack of knowledge about dysphagia and came up with a stupid excuse not to give the pt a sip of water. Maybe she was really afraid of the person aspirating it. Still it wasn't a good excuse even if she had a reason for wanting speech to do it. As a new nurse (sorry I can't remember what you said you were) it would have been best for her to explain that to you. I think that this is falling under "passing the buck" because "I just washed my hands" is not a good enough excuse not to give a thirsty pt a sip of water.

    What if speech is delayed somewhere? What if they are working up a new pt and can't come for a while? Meanwhile that person is sitting there thirsty?

    Not right..
  6. by   VintageGAdog
    I want to thank you all for your candid and wise insight. I have learned a lot from this forum. I believe I will be a better nurse because of your input.

    Best regards, Carol, Student Nurse