So frustrated!

  1. Today I walked into my rehab/LTC and found one of my patients totally confused and bleeding from "somewhere". The night nurse gave me a very quick report and went on her way. Myself and another nurse found this lady trying to get OOB- She speaks NO ENGLISH- Only Russian and she has dementia- She seemed as if she needed to go to the bathroom and,even though she had a foley in, perhaps a BM was on the way. We removed her brief and - OH MY- She had a completely prolasped uterus- Not a big deal,normally but I was not informed of it- AND she was bleeding from somewhere "down there"- She pulled and pulled on her catheter and, out of fear of her yanking it out, I removed it. After removing it, I noticed a "bloody mass" at the entrance to her meatus- I did not know what it was. I called the doc, and sent her to the ER. I called the family and finally got ahold of the daughter- who speaks broken english- then the granddaughter- who was wonderful and spoke perfect english. The ER calls a few hours later and says "We have a tampon holding in her uterus and the bloody mass is her meatus- she pulled it out by yanking on the catheter. We are leaving the cath out and she is really going to be in pain when she urinates, so be aware." UGH! I cannot communicate with this lady and even if her family translates what I say, she will more than likely forget what she is told. What if she has chest pain or just pain or some other problem?? How will I know? I know hand gestures but they don't seem to work with this lady- and the family cannot be there all the time. She was combative and resistant to care and redirection- It just seems like this facility takes ANYTHING off the street- not that this lady is off the street- but there are several others that have me at this conclusion. Anyone else feel like the admissions dept and soc services don't care who they admit since they don't have to deal with the patients?? We work short alot and unless it is the DON or ADON on a cart, then they don't really try to get us help. I used to love my job- lately, not so much. I hate not being able to give someone the care they deserve. I like to treat each of my patients like they are someones loved one- THEY ARE! Any words of wisdom- I am still a "young" nurse. I don't want to give up yet.
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    About geniann

    Joined: Aug '06; Posts: 39; Likes: 6
    Specialty: LTC, rehab, and now office nursing


  3. by   LoriAlabamaRN
    They don't have a translator service???

    OK, if there is no translator service, here's what I would do. I would get online, find a Russian to English website, write out several words or phrases such as "Pain" "Bathroom" "Pillow" "Hot" "Cold" etc in large letters on a paper or posterboard or something along with the English translation next to it. Then hold it in front of her when she needs something or is trying to talk to you, and let her point at what it is she wants. Maybe that will help for now.
  4. by   zenman
    Hospitals are required to provide translators.
  5. by   banditrn
    geniann - That sounds terrible!! And it sounds like the ER provided no real help - will you have to keep inserting tampons?

    I think you are right on about management accepting patients who they shouldn't - it happens at my LTCF - and they DON'T have to deal with them - just the complaints of the staff. Ours recently took a man who yelled constantly, and could not be kept in bed. The two of us at nite spent all our time running to his room when his bed alarm would go off, putting him back to bed. All the other residents on his wing complained about the noise.

    They tried Ativan, but it did nothing. His family said that at the hospital, he had had a sitter, but they couldn't afford to provide one at the LTC

    The DON's answer was that we should put him in a WC and wheel him around on rounds with us.:uhoh21:
  6. by   TheCommuter
    I work at a large nursing home that has two rehab wings. My facility will accept any patient into their rehab unit who qualifies for Medicare because these patients are worth plenty of money. Medicare payments are the total bread and butter of long term care.
  7. by   fleur-de-lis
    Altavista's website has a free translation service, Babblefish or something. I don't remember the exact website, but it is cool. You can translate words, or even entire paragraphs. I used to copy and paste client material to translate at my old job and it worked great. Sorry I don't have the exact website but you can google it.
  8. by   Ruthiegal
    Quote from fleur-de-lis
    Altavista's website has a free translation service, Babblefish or something. I don't remember the exact website, but it is cool. You can translate words, or even entire paragraphs. I used to copy and paste client material to translate at my old job and it worked great. Sorry I don't have the exact website but you can google it.
    This is the web site. It can be helpful.
    Good luck,
  9. by   Pepper The Cat
    Have the family make flash cards - on one side have her language, other side English. Like another poster said, you can have Pain, Bathroom, etc on it. But you can also have them write out longer sentances- explaining about her uterus for example.
    Another thing to remember - often with dementia, people lose their secondary languages, reverting to their mother tongue. So she may have understood English at some point in time and may be able to understand simple phrases. I understand your frustration about non-speaking English people - my unit gets a lot of Chinese speaking pts, and they are a challenge! But you really can't expect people to be turned away from health care just because they can't speak the language. If you are frustrated, just imagine how she feels!
    Finally, if you are getting more and non-English speaking pts, see what languages are most common and try and learn some simple phrases.
  10. by   CoffeeRTC
    Okay...I'm pulling my hair out with you. Went thru the same type of thing with an Italian only speaking resident. How about speech therapy? Maybe they can make a communication board for you to use?
    What I ended up doing was making up our own with a few words that we needed to use frequently.

    Nursing homes aren't required to have translators, but we are required to meet all of the res needs etc. The state loves to look at these res when they come to visit.
  11. by   Pepper The Cat
    One more thought - develop a picture board. Pts can point to the picture of what they need - ie a toilet, food, drink, bed, etc.
  12. by   geniann
    Thank you all so much for your help. Great ideas- I will be giving these ideas to the other nurses too. I know these ideas will be a great help.
  13. by   babynurselsa also has some translators. I have used it many times.
    Of course if the patient cannot read these are of little value.

    sorry for your struggles.
    Good Luck
  14. by   Antikigirl
    I like the picture board idea for people with dementia...sometimes words are a bit complex at times to figure out in these pts. Have one of a NURSE too so she knows when you are introducing yourself or in cases where a nurse is needed to show that you are there for her!

    My facility has a translation service via the phone, and we put it on speaker phone to talk with pts. In our area it is mainly Spanish, but we do have a large Russian population to our south and other facilities down there have a heck of a time...and we will get their patients too...

    A one on one would be great if they can afford it, one that speaks Russian...even if it is just part of the day. I mean, heck I feel for these patients...dementia and language barrier all at once and being in a facility? OUCH! Sometimes I really have to have a sit down with administration and pt family to explain the total utter necessity of these things! How can one be cared for if you can't communicate??? I see it as a HUGE liablity, and scary as heck for the patient!

    Family really needs to be involved here, as well as the administration to provide service to this pt! Someone needs to inform BOTH that!

    And yes, I will also agree that many places in LTC/ALF/SNF they take anything off the street with no thoughts to the services that are to be provided or needed! And once the pt is gets worse, and no one is willing to budge on newer services once in facility!