Terrible clinical day, nurses don't seem to care. - page 12

I may get a lot of flack for this from the more experienced nurses, but I would like some help in understanding this situation. Today, I walked by a patient's room in the hallway. Keep in mind... Read More

  1. by   nursemike
    Quote from ctconn35
    how sad is that. we are talking about a 80 year old woman. Are you telling me that the chemical restraint wouldn't of helped her settle down. Ridiculous!! It was a easy way out for lazy nurses so they don't have to be bothered. That is against the law. I hope and pray to God I never become a nurse like that or I am done. Unacceptable. I feel bad you had to deal with something like that. Nurses let's not forget they are human beings. Treat them with respect. I would of turned them in.... sad and angry.
    We are, in fact, telling you that a "chemical restraint," may have made her much, much worse. Haldol, benzodiazapines, and even diphenhydramine can have paradoxical reactions, especially in the elderly. Even if they're effective, they can mask mental status changes from other causes. Are they lethargic due to the meds, or are they having a stroke? And is it safe to assume that keeping a patient snowed is more compassionate than mechanical restraints?

    The OP has shown a commendable willingness to learn from the views of more experienced nurses. Some of the nurses' actions and words in the situation described may have been wrong, or wrongish, or at least not very right. But I, for one, saw nothing to indicate the nurses were lazy, and I hesitate to assume they were as uncaring as they may have appeared to the OP.

    My hope and prayer for every student nurse is that they will gather facts and make reasoned assessments instead of leaping to conclusions, that they will be open to learning, and that they will show proper respect for other nurses, who may just know what they are talking about.
    Last edit by nursemike on Apr 29, '09
  2. by   sicushells
    NurseMike,
    Thanks for your response. It was well thought out and conveyed everything I was thinking when I first read ctconn's message.
  3. by   Fiona59
    I've been punched and kicked by seniors having bad reactions to Ativan, Morphine, and Haldol. Restraints are there for the patients and the staff's protection.

    Families coming in to sit with their relatives? Yup, when that is needed, suddenly they are all busy. Sometimes they know what Mum/Dad is like and just want the nurses to deal with their parents.

    After many miles in my white shoes, I'm ready to hang them up due to the violence in the hospital setting and the total disrespect of hospital personnel from the patients and their families.

    I was once fresh and idealistic. Then I was bit by an 82yo female who wanted to go out for a smoke and didn't have anyone to take her. Changed my views completely.
  4. by   cherrybreeze
    The personal restraint story (thank you for that) reminded me of a friend of mine:

    When he was in his very early 20's, he was in a bad, one-car wreck. Severe head injury, extensive brain surgery for bleeding, multiple facial fractures, etc. Was in the neuro ICU, in restraints. His sister's fiance came to visit him. This fiance was a piece of work, but that's a whole other story. Anyway, when visitor was alone in room with my friend, he was appalled by the fact that he was restrained, took it upon himself to decide that since he was sitting right there, my friend would be fine, and took his restraints off. My friend, due to his head injury, promptly pulled out his foley, feeding tube, and central line (thank goodness he wasn't intubated any more!).

    A bit off the original topic (I seem to have a tendency to do that, I'm sorry), but just a little more food for thought on the restraint/circumstances concept.
  5. by   tkane
    To use a physical restraint you have to have a physicians order & the restraints have to be checked every 15 min where they are loosened, so it doesn't sound like someone was being lazy to me. Also the use of chemical resraints can be contraditory in elderly patients because they can react adversly. It sounds as though you were being subjective which is ok but you don't know the history of the patient. Perhaps she has a medical condition that causes her to have a poor memory. I'm sorry you were heart broken but sometimes you will find yourself in situations that tug @ your heart strings.
  6. by   Aquamarine
    Quote from Koyaanisqatsi
    I may get a lot of flack for this from the more experienced nurses, but I would like some help in understanding this situation.

    Today, I walked by a patient's room in the hallway. Keep in mind she is not my particular patient today. She calls out to me in a frail voice for help, and sounds like she is in very bad shape. I go in to see her and she is crying, and very frail. She must have been in her 80s or even higher. She stated that she could not move her arms, and that she was desperate for some water. My first thought was that she might have been having acute MI or something similar because she couldn't move her arms, I really didn't know. I held her hands quickly and asked if she could feel my hands in hers. She said she could, but that she can't move her arms, and continued to cry and beg for water. She kept saying that she did not know where she was or why, and to please help her.

    At this point, I noticed the restraints. She was strapped into her bed, this is why she couldn't move her arms. I was horrified. This is a med/surg floor, not a pysch ward. I asked one of the tele people what was going on and they stated 'it's just some crazy old woman, she's weird don't worry about her'. I asked her nurse and this was the same answer I got from her, again. She stated this woman had previously tried to pull out her IV and so they restrained her.

    So...

    Help me understand. They clearly had to get an order for these restraints. Why did they not choose a chemical restraint or sedative instead of strapping her into the bed? Why does no one care about this woman, writing her off as a crazy old lady; when she is, in reality, a frightened human being who was strapped into her bed in a strange place and scared to death. Not to mention thirsty, as she was apparently NPO and no one would explain to her why.

    I went into the stairwell and cried for about 5 minutes. This is not why I wanted to go into nursing. I see things like this every day, but never this bad before. Restraints! They strapped this poor woman down and wouldn't explain anything to her. I spent some of the rest of the day talking to her and trying to help her relax even though all she wanted was to get out of bed and get some water.

    It broke my heart. And if this is what nursing means, that eventually you become so burned out that a fellow human being suffering in one of the worst possible ways becomes just some 'crazy old lady', then I want no part of it.
    Your comment is interesting and not being there I will focus more on your feelings after finding this situation. I have been a nurse for only 5 yrs. I am older, also worked in a hospital in another area of health care for 20 yrs. So I am familiar with health care. When I got my first job...I was in shock in relationship to the lack of compassion from nurses to certain patients. When you ask a patient is there anything you can do, would they like some juice, etc. and they ask why all of a sudden the special treatment? or a nurse that talks about a paitient like they can't hear, restraints, etc.
    I thought with the first job...what the heck did I do, become a RN to join this group of cold hearted nurses? I stayed at that job only a yr and a half. I helped them through a national disaster right before I left, bringing clothes, food, comfortable shoes and bags or candy for each floor as all supermarkets ran out of real food. I still didn't get a good review from the hospital. I care about people. fellow employees, patients, bosses also. I will never compromise the kind of person I am to join anyone in mistreating a patient, and that would include talking nasty about her to another nurse. DO NO HARM...nbot even to each other.....
    Florence Nightingale would be disappointed.
    If you feel like you can't be the nurse you want to be GET OUT now.
    I finally found a place where patient care comes first.
    It is heavenly.
    Hang in there, you are not trapped, complain when you need to....but if there isn't any plan to make things better get out. You will be surprised....good luck. Nurses can go anywhere and get a job now...so do it.
  7. by   RN1982
    I find that the elderly react badly to Ambien, ativan, and haldol, so sometimes restraints is a better option when the patient is trying to pull out lines and tubes when you have told them not to. Like Mike said, there are families who claim that you can call them to come sit with mom and dad and when it comes to that point, they are too busy to come in so we have to do what is best for the protection of the patient and the staff in the meantime.
  8. by   I RN A
    Do you know for sure there wasn't an order? Did you look in her chart? It sounds bad but she seemed to be confused and pulling her lines out. In this situation she is harmful to herself, and this is why she was restrained. Putting restraints on without MD order is illegal and the nurses probably had an order. But they should have assessed the patient's skin Q2h,and release the restraints for 30 min. Restraining patient is the last resort intervention, but depending on patient's condition it should be done instead of chemical restraints:she is confused and probably has problems with her CNS and if you give a downer med to her, it could depress the CNS even worst and she would go into respiratory distress. The way the nurses talked to you about this patient, addressing her as an old crazy lady is not appropriate.
  9. by   Susan9608
    I read all 16 pages of this thread. I'm very proud of myself.

    Maybe I've just got "nursing student burnout" but had I been the nurse in the OP's situation, I probably would have said something along the lines of, "Not your patient, not your business," and I probably would have asked the student nurse to leave my patient's room, if he/she wasn't actually assigned there. Because, of course, all the time that was spent with my patient was time taken away from the patient the student nurse was actually assigned to. <sigh> I guess I'm just mean that way. Oh well ...
  10. by   nursemike
    Quote from Susan9608
    I read all 16 pages of this thread. I'm very proud of myself.

    Maybe I've just got "nursing student burnout" but had I been the nurse in the OP's situation, I probably would have said something along the lines of, "Not your patient, not your business," and I probably would have asked the student nurse to leave my patient's room, if he/she wasn't actually assigned there. Because, of course, all the time that was spent with my patient was time taken away from the patient the student nurse was actually assigned to. <sigh> I guess I'm just mean that way. Oh well ...
    Uh, well, yeah, that does seem a little mean. I didn't see any indication that the OP's time with the patient wasn't after the formal clinical experience was completed, so I don't think it's safe to assume time was taken away from the assigned patient. And yeah, I'd want to be sure the student wasn't providing inappropriate care--doing nursing interventions without authorization. But I wouldn't include just sitting and listening as one of those interventions. And, truthfully, I think I'd have taken some time to explain to the student what was going on, and why. At a busy point in my shift, I probably wouldn't have taken "three minutes," but I think I'd have spared the better part of one. I mean, it's important for students to understand that nursing care means a lot more than just caring, but I think our goal should be to add knowledge and skill to compassion, not instead of compassion.
  11. by   Cobweb
    Well....actually, my first thought was that this is a student, not a nurse assigned to the patient, and going in her room would be construed as an invasion of privacy by some of my residents' families. I didn't want to say that because I think kindness should be encouraged, but I see a whole lot of potential for hot water in this situation. In fact, I have a family now who, if they caught a stranger in the room with their confused relative holding their hand without their permission, might call that assault and battery, and would certainly kick a fuss with the DON about an unknown non-staff person being in there. I kid you not.

    But if you take your instructor with you, you'll be gold
  12. by   WalkieTalkie
    Seriously, this thread is getting old...
  13. by   newlygrad
    Well for me, restraining is the best way to avoid patient's from destroying themselves. Because sometimes patient does not respond even if you tell them things what to do and what not to do over and over. Because some of them are confused. And chemical is a bad choice for me because it is not the least invasive procedure to do. Chemical will always be chemical for me. If you patient is shouting let him/her get tired and sleep naturally. Always put in mind that restraining is a nurse and patients bestfriend at the worst situation. Based on my real life experienced.

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