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

[Koyaanisqatsi-RN]

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.

[UM Review RN, ASN, RN]

I hope I don't sound unkind, but until you are the patient's nurse and you get a complete report on a patient, you do not have enough information to judge the staff.

I have given enough Ativan and Haldol to drop a Clydesdale, yet that 80 pound granny keeps trying to get out of bed. When the med finally kicks in, she'll sleep for 12 hours. Until then, restraints. Our hospital would only allow for a sitter if certain criteria were fulfilled -- and 99% of the time, the criteria were not met. It really ticked us off because there were a lot of folks who we felt would do better with a sitter rather than meds or restraints. But it's difficult to articulate the difference to someone who doesn't "know" the patient, and every patient is different. And of course, no one in admin gives a hoot about nursing judgment.

Would it have been possible for you to sit with her and talk to her for a little while and take the restraints off for a few minutes? Sometimes even fifteen minutes of attention can make a difference. Unfortunately, the heartbreak of Alzheimer's is that too frequently, it makes no difference at all.

[eldragon]

I think you are jumping to conclusions about many things. Here are a few of my thoughts:

• the patient may be taking "chemical restraints" already
  
• the patient may be allergic to "chemical restraints"
  
• the patient is probably a risk for falls, and therefore keeping a soft belt on her in bed is for her safety. Yes, it's a restraint, but it's there so she doesn't get up and fall. Chemical restraints only make a confused person more confused and more apt to fall.
  
• The woman may be on fluid restrictions. You can't give water to patients unless you know what their orders are.
  

The list goes on and on. Things are not always what they seem to be at first glance. What may be viewed as cruel or unnattentive care for this woman might really be the best solution to keep her safe. Hospitals cannot provide sitters for every patient. Also, I am wondering why "chemical restraints" would be viewed as more humane than a simple soft belt. And how sedated would a patient have to be to keep them from trying to get up?

And just because a patient is asleep, doesn't mean they gave her ambien.

Compassion for a fellow human being is a wonderful thing. When you become a nurse you will be able to see the broader picture and know that a patient is not being restrained because caregivers are cruel, but that is it necessary to keep a confused patient from falling. Chances are she has already fallen before, which is what prompted the order for a restraint.

[deftonez188]

Did she have dementia? Alzheimers? did you check the chart? Imagine someone who forgets who you are everytime you walk in the room. She may have been previously told about her condition, or the reasoning for the ordered restrictions, but can't remember it. Restraints save a patient from undue harm to themselves and others - imagine she has a daughter who visits regularly while she is hospitalized and because it isn't nice for mom to be in restraints she is left to attempt to get up to the bathroom where we find her with a broken hip on the floor requiring immediate surgery...liability, yours and mine. You do need to evaluate if the need for restraints if still necessary with each interaction - but you need the information regarding the placement of the order first.

It is good to care for your patient, but becoming overly emotionally attached is counterproductive to healing. Nursing school offers a glimpse of big picture, but just a glimpse.

[Delirious]

As a Med/Surg nurse, my biggest problem with the situation you described was the nurses calling this patient a "crazy old lady." The other issues you described were quite possibly the best choices for this particular patient regardless of how it appeared.

[canoehead, BSN, RN]

When reorienting patients keep in mind that although they may not remember the answers to the repetitive questions they ask, they know on some level that they've been asking for a long time. They feel frustration and fear, and answers that don't solve the problem make the fear build. I find that no matter how nicely you answer them they still get frustrated, and can frequently get angry, yelling, and some lash out physically. I would too if no one would untie me or I felt threatened.

If you leave them alone they may settle themselves, or be distracted by roommates or what they see out the window. If you stay and they keep asking the same questions they are kind of wearing a rut in their thought processes, and will get stuck on that one thing. They'll be harder to distract, and won't be able to focus on other issues (like PT, or family visiting).

None of that is documented, just my experience with confused individuals. If they keep thinking about the restraints, they will keep trying to get out of them, and eventually will be successful, and get more restraints, and get more frustrated/angry.

Distract them, bring them out in a gerichair to the nurses' station so they can watch the fun. Feed them, or give them a magazine with bright pictures. Anything you can think of, but repeated explanations usually make things worse.

[sicushells, RN]

Nursing isn't always a "soft" profession. We can't always be nice and happy and do everything the way we would like to... You might find when you're a nurse and have been working for a while that you have just enough energy for your patients. That's it. No extra patience for the crazy cousin who insists that your patient can only eat Activia, or the XRay tech who gives your confused, aspirating patient some gingerale, or even, sadly, the nursing student who thinks that the care you're giving your patient isn't good enough. (That's another common theme- everything and anything is your job, but everything you're doing is subpar) It's bad enough when the physician, the family, the patinet think you should easily be able to do 20 more things 60x's faster and with a cute-sassy bounce. Should the nursing students, who are supposed to be learning from us being giving us attitude to?

Doesn't mean their attitude towards you was nice, or professional (you don't seem to think so anyway...), but I imagine when you're a little more experienced you'll understand better.

[meluhn]

Nursing isn't always a "soft" profession. We can't always be nice and happy and do everything the way we would like to... You might find when you're a nurse and have been working for a while that you have just enough energy for your patients. That's it. No extra patience for the crazy cousin who insists that your patient can only eat Activia, or the XRay tech who gives your confused, aspirating patient some gingerale, or even, sadly, the nursing student who thinks that the care you're giving your patient isn't good enough. (That's another common theme- everything and anything is your job, but everything you're doing is subpar) It's bad enough when the physician, the family, the patinet think you should easily be able to do 20 more things 60x's faster and with a cute-sassy bounce. Should the nursing students, who are supposed to be learning from us being giving us attitude to?

Doesn't mean their attitude towards you was nice, or professional (you don't seem to think so anyway...), but I imagine when you're a little more experienced you'll understand better.

You put that so well, I just had to tell you.

[MGN3978]

ok, i'm taking in all this information. i'm not a nurse yet. i will start in the fall. i did get a certificate in patient care tech. we had clinicals in the nursing home and the hospital. i completely understand your feelings. the places we went were the same way, no one seemed to care. it was definitely heart breaking.

this can change one person at a time, stick with it. that is truely one reason why i decided to go into nursing........the care.

ttyl

[Lovely_RN, MSN]

I had a similar experience with a resident. My facility uses restraints as a last resort and I spent all morning long watching a resdient in a wheelchair. I literally had to keep him directly in front of the nursing station and a one to one is an extremely rare occurrence where I work. All management will tell us is to keep re-orienting residents and to keep re-directing inappropriate behavior. Well I went downstairs to grab some lunch and while I was downstairs the CNA had to answer a call bell. Long story short that man fell out of his chair, broke his hip, and died during the surgery to fix it. I know that visitors to our facility don't like to see resident's restrained and probably think that we are lazy and mean but maybe if he had a lap belt that man would be alive today.

Here is a story about what can happen if you DON"T restrain a patient.

A few months ago I was floated to the medical floor. There was a very confused elderly woman in a room right across from the nurse's station. Even though she was not "my" patient, everyone on the whole floor was doing their best to keep the woman from getting up on her own.

All day long this woman was getting out of bed, out of the chair. She was reoriented to her location about every 15-30 minutes. This went on all day, and the woman was not restrained.

About five pm, less than three minutes after I had left her room after giving her a snack, we all heard a big thwack and crash. The patient was lying on the floor. Her head was banged up, and she was found to have a broken left hip as well.

The patient died a few hours after her hip surgery.

Restraints might have, or might not have made the difference, but sometimes they ARE for the patient's safety.

[heron, ASN, RN]

The OP ... google "compassion fatigue".

As sicushells has pointed out, we cannot always "use happy sunflower words" (as a burnt-out daycare worker once put it). We cannot mandate our emotional responses to always conform to the Mother Theresa paradigm of caring ... and it would be unhealthy to try. "Calling" or not, we are human and get tired, impatient, angry ... all the icky negative stuff that will come up when dealing with life/death situations with other all-too-human people.

I must say, I have a lot of respect for the willingness to question your own assumptions you have shown in your responses to this thread. You have the makings of one fine nurse.

[marmsgirl]

You ladies and gentlemen have answered great. Restriants are a last resort. Yes we all wish we didnt have to use them but sometimes they are necessary.

I just have one more thing to add..find out the whole story before jumping to conclusions because sometimes things are not what they seem.

[Pepper The Cat, BSN, RN]

just have one more thing to add..find out the whole story before jumping to conclusions because sometimes things are not what they seem

i agree. Remember - as a nursing student you are only seeing the pt for a few hours about of an entire day. The pts behaviour can really change throughout the day.

We had a pt who was pleasantly confused during the day - but was a terrible sundowner - exit seeking, hitting, resisting care, etc. After several weeks of trial and error, we found the right med mix at the right time would keep him pleasantly confused even into the evening. This included a small dose at noon.

Students came in, saw the med at noon and decided to hold it (without checking with the nurse0 because "he wasn't agitated, or aggressive". Well - evening came, students were gone and pt sundowned. The next day the students were polietly told NOT to hold any of his meds. They were all upset because they felt we were just sedating him to make our life easier - they didn't see that this type of behaviour was upsetting to the pt, his family and took staff away from other pts as everything 10 minutes we were either re-directly him or helping the nurse care for him not get hit.

We have another pt right now. He yells whenever he is left alone. We can go in there, speak to him, he'll stop yelling. 2 mintues later, he starts again because he doesn't remember the nurse coming in. After 6 months of this, we now just close the door when he starts because we know that nothing else will work.

So - find out the whole story before jumping to the conclusion that the nurses don't care.