Bending and Breaking the Rules in Nursing - page 4

I believe rules can be bent at times. Heck, I feel that some rules can even be outright broken as long as doing so has brightened someone's day. Billie is a pseudonym for the septuagenarian... Read More

  1. by   NotFlo
    Quote from CapeCodMermaid
    We are in the middle of getting rid of diet restrictions at my facility. Read the studies....restrictive diets do little to nothing for an elder except upsetting them and diminishing their appetites. Really does a 90 year old need a low cholesterol diet? Of course not. The medical director is all for it so pretty soon the residents will be able to eat what they want.
    That is great! I wish all nursing homes would go for this model of care for 99 percent of elderly LTC patients. There really isn't any rationale for keeping them on these restrictive diets. At least where I work the food is bad enough, the more restrictions that get added to the diet the worse it gets.
  2. by   KristeyK
    I was blessed to be able to do a hospice rotation during school. It was WONDERFUL! Better yet, no restrictions. If they wanted a burger, they got a burger. If they wanted to smoke, we took them out to smoke. If they wanted a beer, we kept it in the fridge for them I want to go in a place like THAT if I cannot be at home.
  3. by   matgirlBSN
    Working on an Oncology floor, on nightshift, we had a lady who was actively dying. She raised german shepards and her only regret was that she would not be able to see her dogs again. My charge nurse also raised german shepards. She went home on her dinner break and got 4 of her pups and then called the floor to help carry these "puppies" up 5 flight of stairs. We were a sight!! The patient was delighted when the puppies came in her room. She cried and played with them for about 2 hrs when she got tired. At that point my charge nurse took the puppies home. The patient died a few hrs later but not before telling all of us how happy she was and that she could now die in peace. Yes, we broke the rules and I have no doubt we all would have lost our jobs but the look on that patient's face was one I will never forget and would do it all over in a heartbeat. <3
  4. by   RJmanuone
    thank you bro for sharing such a beautiful experience... you have a loving heart... and i guess that must be the ground rule for every nurse - to have a warm loving heart...
  5. by   ERnightsRN
    Love all the stories here! I, too, have broken or bended the rules at times. I refuse to become a nurse who is more concerned about the rules than the well-being of my patients. Denying a dying patient the food they crave is just inhuman if there is not a real reason to do so. A cancer patient who finds the food unpalatable isn't going to be hurt by being given a food they want. Several nurses and I went to some great lengths to smuggle a cancer patient's poodle in one night; if I had been fired, the tears of joy she cried would have made it worth it. She died the next day. I believe that we are not just providing physical care, but holistic care - the whole person: mind, body, spirit, emotions - and rules that make that impossible are meant to be bent or broken from time to time! As a side note - one of the docs I work with routinely writes for regular diets for elderly or terminally ill patients. It makes me sad when I give report and hear something like, ""Wait, why isn't he on a restricted diet? He's a heart patient!" (I heard this one regarding a 98 year old patient with terminal cancer who had come into our ER for chest pains and was going to the cardiac unit for observation.) We are nurses, but we are human beings first!
  6. by   pfongk
    I regularly bring in food for residents from home and management know I do it. So long as I do the appropriate paperwork for food from home and if they're not 'meant' to eat it I give it to them myself on my own time, they're pretty much ok with it. One of the resident's loves it as she's got celiacs disease and I make all sorts of goodies for her that the facility won't supply, I have no issues doing this as it's like a slice of cake here, or a couple of biscuits there that I've already made for my son.
  7. by   Yankeeborn
    Good for you! I think we, as nurses, have gotten so caught up in the "rules and regulations" due to it being shoved down our throats, that we have forgotten that our patients are human beings living their lives. When I see one of my patients with a DNR on their chart, or simply an age past 90, I figure, "what the heck" give them what they want! Some of them are soldiers who have risked their lives to protect us. And some have spent all their lives working hard to make a living. Why should their last days be so restricted. Thank you so much for reminding me of that. AMEN!
  8. by   nykkinels
    This post brought tears to my eyes. I too have broken rules! Its a beautiful thing to see that nurses do care. Ive only been a nurse for a year and Ive learned that many of us are in it for the wrong reasons. Here I am believing that there is no compassion any more. Not even with doctors or cnas...and definitely not with administration. Kudos to you guys for truly making a difference
  9. by   Nascar nurse
    Quote from CapeCodMermaid
    We are in the middle of getting rid of diet restrictions at my facility. Read the studies....restrictive diets do little to nothing for an elder except upsetting them and diminishing their appetites. Really does a 90 year old need a low cholesterol diet? Of course not. The medical director is all for it so pretty soon the residents will be able to eat what they want.
    This region was moving that way as well and then all this fuss about the 30 day rehospitalizations came along and suddenly everyone has jumped back on the bandwagon with all these restrictive diets, the worst being these 2gm Na diets. The most frustrating part is the residents generally refuse to follow the restriction to begin with (and who could blame them). I could go on and on with my frustrations with the whole rehospitalization problems/procedures but that's for another thread.
  10. by   ktwlpn
    Quote from Sadala
    Just a student question here. Why does LTC have a rule about food items for patients whose care is being managed by hospice? I don't get it? What's the rational
    In my LTC even though the resident is on hospice they are still under the care of the physician in the nursing home and he can concur or not with any hospice recomendations. As far as dietary restrictions we,too have gotten much more liberal however we have (and continue to admit) more and more younger residents with multiple co-morbidities and diet continues to be a focus for their docs.These residents are all full codes and as non-compliant as they can be. I don't get it-all we can do is educate,provide the appropriate diet and walk away.I get a kick out of seeing what some of the folks fill their plates with in the independent dining room.And then I always see them later at the snack machine for the salt licks and sugar highs.
  11. by   misted
    I have done this several times. It is a totally awesome feeling to see those residents eyes light up over an egg sandwich, cheesburger, chocolate cake ect.
  12. by   dah doh
    Yea for you! I do it too...there's a time to bend the rules a bit! What's the point of putting the patient on an 1800 ada low cholesterol diet if they won't eat for 3 days? It's usually an ethnic thing...they don't like our American food, so I will tell families bring in food from home for the patient so they'll eat something! Gotta get a doctor's order upon transfer to CYA.
  13. by   auntiedebe
    Oops I have been known to break a few...lets see there was once that pair of really furry slippers being worn by my CCU DNR/DNI patient who wanted to see his dog one last time--of course, dogs are not allowed, thank goodness the slippers didn't bark during their visit. Or the trip to the 24 hour store so my intubated (yes I knew he couldn't taste) CCU patient could have his last hours of oral cares include a local brewery concoction--nursing involves caring for the family as well as the patient. And of course, the trip to the morgue for my patient who at 79 had needed knee surgery because she slid into third playing softball with her family: if the trip to the morgue includes a incline, the patient should get to have a last gurney ride down the incline...Wheee! She would have loved it.

    These rules were broken because nursing is relationship based and treats the whole person, not just their medical needs!!