Not enough attention to BMs in nursing today! - page 3

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I think that nursing today is often forgetting the basics. I had a patient this weekend who I transfered from a stepdown bed to med/surg. I followed the patient and floated to Med/Surg. By the end of... Read More

  1. by oramar
    Dec 10, '07
    Occupation: returned nurse Joined: Nov '98; Posts: 7,097; Likes: 5,236
    :yeahthat:
    Quote from TheCommuter
    Perhaps nurses could place more focus on the basics of nursing care if only they had reduced patient loads, less repetitive paperwork, minimal interruptions, less "customer service" duties, less phone calls, more understanding hospital administrators, and so forth.

    When you're trying to cater to too many patients, the basics tend to be bypassed in favor of simply keeping the patients breathing and pulsating for the next shift. Patients should be walked to the toilet if they're physically able to, but some nurses take the easy way out and insert catheters without any medical justification to do so. Showers, back rubs, oral care, and all of the basics simply become lost in the sea of madness that we call the healthcare facility.

    Give me less patients, and each one will have more of my time. Then, I can go back to the basics.
    It is sad to say that before I quit my work loads were getting so heavy that I was praying the patients didn't poop.
  2. by smk1
    Dec 10, '07
    Occupation: CDU nurse Joined: Sep '03; Posts: 4,001; Likes: 542
    I had a patient at clinical a few weeks back that had been in the hospital for a week and a half post surgery and I noticed he seemed a bit distended and asked when he last pooed and it was before he had the surgery! No wonder! He was on a ton of narcotics and was not drinking a lot of fluids or walking.
  3. by JaredCNA
    Dec 10, '07
    Occupation: CNA Specialty: ICU. Med/Surg: Ortho, Neuro, & Cardiac. ; Joined: Jan '07; Posts: 281; Likes: 82
    I work nights on a med-surg floor. As I go and do vitals (everyone at 0400) I am supposed to also do qshift I/O. If the pt doesn't have a foley/no hat in bathroom/no urinal and they aren't too confused to answer, the three questions are:

    How much have you had to drink since 11 O'clock last night?
    Have you used the restroom since 11?
    Have you had a bowel movement since 11?

    Unfortunately, most aides skip the third question altogether. Some aides (and nurses) don't even ask about I/O...they'll either just chart something and move on or chart nothing at all.

    It's bad enough on ANY floor, but med/surg?? Most of our patients are elderly, and the possibility of an ileus or SBO is very likely.
  4. by scattycarrot
    Dec 10, '07
    Occupation: lady of leisure at moment Specialty: 10 year(s) of experience in ITU/Emergency ; Joined: Jan '06; Posts: 362; Likes: 192
    I only worked as a floor nurse for a year but I developed a bit of a reputation amoung by co-workers as being bowel obsessed. I was always dosing my patients up and would be determined to have them all pooping! In fact, when I left my leaving gift was a basket of enemas, supps and other things bowel related..heehee, not that I used it on myself I might add!
  5. by RN1989
    Dec 10, '07
    Joined: Aug '07; Posts: 1,399; Likes: 1,956
    Check out the other thread on You tube and net surfing being taken away from nurses at the hospital. Perhaps they are too busy surfing the web to worry about talking to their patients about BMs.
  6. by ebear
    Dec 10, '07
    Occupation: RN, BSN Specialty: 37 year(s) of experience in Med-Surg/Peds/O.R./Legal/cardiology ; From: US ; Joined: Sep '07; Posts: 988; Likes: 1,182
    AMEN!! Whatever happened to the nurse asking the patient (usually at the most embarrassing time ie:visitors) "have you had a BM today?"
  7. by Ms Kylee
    Dec 10, '07
    Occupation: RN Specialty: 4 year(s) of experience in Med Surg, Hospice ; From: US ; Joined: Oct '06; Posts: 845; Likes: 690
    Lord... Last night I swear I was the Sergeant of Poop Patrol... Everyone and I mean Everyone was pooping... and some more than once. One suppository was ordered for one patient, and he pooped before the nurse could give it to him. It was not a pleasant evening.. but the results all got charted and I'm sure all of the patients felt better.
    Last edit by Ms Kylee on Dec 10, '07
  8. by Ms Kylee
    Dec 10, '07
    Occupation: RN Specialty: 4 year(s) of experience in Med Surg, Hospice ; From: US ; Joined: Oct '06; Posts: 845; Likes: 690
    Quote from ebear
    AMEN!! Whatever happened to the nurse asking the patient (usually at the most embarrassing time ie:visitors) "have you had a BM today?"
    I am soooooooooooooooo guilty of doing this....
  9. by leslie :-D
    Dec 10, '07
    Joined: Apr '00; Posts: 24,611; Likes: 35,453
    Quote from Kylee45
    Lord... Last night I swear I was the Sergeant of Poop Patrol...
    did you write a SOAP note? (Sargeant Of All Poop)

    ok, ok, i'll go first.

    *groan*

    leslie
  10. by FireStarterRN
    Dec 10, '07
    Occupation: Freelancing Specialty: 15 year(s) of experience in LTC, Med/Surg, Peds, ICU, Tele ; Joined: Jun '07; Posts: 5,292; Likes: 7,635
    Or, did you clean the patient with soap???

  11. by FireStarterRN
    Dec 10, '07
    Occupation: Freelancing Specialty: 15 year(s) of experience in LTC, Med/Surg, Peds, ICU, Tele ; Joined: Jun '07; Posts: 5,292; Likes: 7,635
    *groan*

  12. by Ms Kylee
    Dec 10, '07
    Occupation: RN Specialty: 4 year(s) of experience in Med Surg, Hospice ; From: US ; Joined: Oct '06; Posts: 845; Likes: 690
    Yinz guys are funny...
  13. by EmmaG
    Dec 10, '07
    Occupation: R.N. Joined: May '07; Posts: 3,228; Likes: 3,680
    Quote from jlsRN
    I just think there isn't much emphasis any more placed on passing on BM info. We don't get any JCHAO edicts, or QAs on BMs. Management recently instituted a rather useless fall precaution sheet that really doesn't change how we deliver care, but only gives us another form to fill out. But we have nothing in place to cue nurses on the value of making sure the patient's bowels are moving each day.

    I agree with Leslie that we shouldn't use that as an excuse, my point is that current nursing culture seems to have forgotten some of the basics of nursing that go back to antiquity.
    Perhaps if JCAHO realized that the majority of the falls occur when someone is attempting to go to the bathroom (strictly anecdotal admittedly, but from my own experience).

    My 'brains' have a check-off for BM. It's part of my assessment.

    We had a patient die some years back because of constipation. That is truly what killed him. No BM for >2 weeks, developed a megacolon which compressed his diaphragm to the point he simply couldn't breathe.

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