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

Meriwhen, ASN, BSN, MSN, RN · Apr 22, 2009

Depending on her condition, a chemical restraint or a sedative may have been contraindicated.

Also, chemical restraints are not necessarily the better or even "safer" choice, as it's unfortunately been proven in the past.

I'm sorry you had a rough day.

Koyaanisqatsi-RN · Apr 22, 2009

Depending on her condition, a chemical restraint may have been contraindicated.

Would it be possible to have a sitter in there? Or at the very least, someone explaining to her where she is and why? Maybe someone already tried and she forgot. I don't know. But at the very least, I figured that some compassion could be displayed. And perhaps an effort to get her moved to a more appropriate setting for her. Med/Surg is NOT where she belonged.

ybq2008 · Apr 22, 2009

I'm so sorry you had a rough day. I sure hope some more experienced nurses can offer some insight. This makes me sad and nervous too...

Atheos · Apr 22, 2009

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.

A) Someone may have already tried a chemical restraint and it was ineffective.

OR

B) Someone may have just been lazy.

Maybe someone wanted to sit with her but didn't have the time? Maybe everyone is burned out? Maybe she's been there for awhile and they are used to her and nothing they do works? Maybe someone explained why to her but she has dementia or just doesn't understand.

It could be any number of things.

Koyaanisqatsi-RN · Apr 22, 2009

A) Someone may have already tried a chemical restraint and it was ineffective.

I forgot to mention, I went back later at the end of the day and she was sleeping. Apparently someone gave her Ambien. That seemed to me to be a much better solution. It isn't really a chemical restraint, but she was sleeping peacefully.

And I don't mean for a nurse as a sitter, I mean one of the volunteers around, or someone from a nursing home. That's a job that some people do. It could have been looked into.

And yeah I suppose people were burned out. But how hard is it to at least pretend like you care about someone else suffering like this? Does it really take that much out of people?

Atheos · Apr 22, 2009

I'm just saying it could have been any number of things.

They could have dropped the ball. Of course, if you get a sitter for everyone that is scared and confused you'd have a HUGE bill.

I don't think they are ever going to solve the problem.

The main thing is to try and look at it through a new students eyes AND and seasoned veterans eyes and come to a good middle ground I guess.

The first question I'd ask is where is the family?

How come families have some how managed to get out of caring for their family members? The usual answers don't apply because this seems to be a big issue mainly in America. Shrug.

DeepFriedRN · Apr 22, 2009

could be they tried sedatives and they didn't work.. maybe they don't have the manpower for a sitter(or the budget for it, at least that's what our management tells us..it's gross)..it's also possible that that re-orientation had been attempted, but had failed because pt is too altered. Or someone could just be being lazy, which is terrible, but it happens. Sorry you had a rough day.

hawkfdc · Apr 22, 2009

Soon enough it will all become clearer to you.....

Chemically restraining someone is not necessarily the best course of treatment, physical therapy, respiratory therapy could have been coming during the day to work with this patient and she needed to be somewhat alert. She was probably restrained because a) she kept pulling out her IV and/or b) she had dememtia and would wander the halls not knowing where she was or what she was doing if unrestrained. Its just a day in the life of a med/surg nurse, sorry to say. And on night shift you get the sundowners. All is well with the world then they show up at the desk naked and bleeding (from the IV).

Koyaanisqatsi-RN · Apr 22, 2009

I'm just saying it could have been any number of things.
They could have dropped the ball. Of course, if you get a sitter for everyone that is scared and confused you'd have a HUGE bill.

I agree, but I have never seen anything like this before. I'd never before really thought of getting a sitter for anyone, but this seemed literally the very definition of when you would want to have one.

The first question I'd ask is where is the family?

Since she isn't my patient I couldn't look at the chart, but I heard she had a son. Lord only knows where he is though. Sure wasn't at the hospital with his mother.

How come families have some how managed to get out of caring for their family members?

I think it's because someone convinced them that dumping them in a home or hospital means they're being 'cared for'. If they saw what we see it would be different, at least I hope.

Chemically restraining someone is not necessarily the best course of treatment, physical therapy, respiratory therapy could have been coming during the day to work with this patient and she needed to be somewhat alert. She was probably restrained because a) she kept pulling out her IV and/or b) she had dememtia and would wander the halls not knowing where she was or what she was doing if unrestrained. Its just a day in the life of a med/surg nurse, sorry to say. And on night shift you get the sundowners. All is well with the world then they show up at the desk naked and bleeding (from the IV).

I hear what you are saying. I do understand that you simply can't have patients yanking out IVs and catheters and wandering about. I guess I'm just confused as to why no one could at least pretend to care. Maybe it wouldn't have made a difference either way, but the patient did seem to be comforted somewhat by my limited interaction with her. I realize I have more time as a student than do the nurses, but again, just pretending to care doesn't seem like it would "cost" that much.

newohiorn, BSN, RN, EMT-P · Apr 22, 2009

Just my 2 cents:

Chemical restraints aren't necessarily better. Why would it be better to knock someone out? If someone's knocked out we can't tell if they are having any pain--like chest pain--which is something we need to know. We can't tell if they have any neurological change that could indicate a stroke, etc.

Why do you assume no one has explained to this patient why she is NPO? It is entirely possible that it has been explained to her many, many times.

It is possible that this patient has pulled out 5 IVs. Leaving her unrestrained and having to repeatedly start new IVs is not very kind either--not to mention that every stick is another risk for infection.

Sitters are great but--as someone already said--most budgets can't afford a sitter for every confused patient.

I know what you saw seems cruel and heartless--and maybe it was--but there may be a lot more to the story than you saw. No good nurse wants to restrain a patient that doesn't need to be restrained. However, once someone has pulled out several IVs, a Foley and an NG, you start to change your mind because repeatedly subjecting them to re-insertion of these items is not nice either.

locolorenzo22, BSN, RN · Apr 22, 2009

I admit that when you have 7-8 patients and a lot of things to do....the sitting and talking aspect goes way down....I always CARE. But I can't always take the time to sit down and talk and reassure ALL that would be needed. If the situation warrents, when things calm down, I would take my computer in there, charts and chart while reassuring her.