getting past a horrible clinical experience?

[alicia_rae122]

I've always thought I had a stomach of steel, so I really surprised myself today.

My clinical group and I were asked to administer a bed bath to a patient on a ventilator, and I've given bed baths before so I thought it was going to be no big deal.

As it turns out, I was completely unprepared for what I saw. This patient had an ulcer on his sacrum all the way down to the bone. This person also doesnt use a bedpan or wear protection, so you can imagine what was all over this patient's body. I don't know how normal that is, but it doesn't seem right at all!!

he was also in so much pain and had zero control over his situation. the sight of unbearable human suffering and the smell of the mess that this person was laying in caused my body to act in such an undesirable way that I almost passed out and became the patient.

I had to remove myself from the room to empty the contents of my stomach no matter how hard i tried, i couldn't seem to perform the task at hand. i knew that this patient needed my help, but i had to leave or else i would have thrown up everywhere...

my question to y'all is how do you keep your body from reacting in such a situation??

A classmate asked me why I was so upset and after I told her what happened, she rolled her eyes and said "you just have to be positive with those patients."

to say the least, that wasn't helpful!

also, is it practice to let bedridden patients defecate everywhere without use of a bedpan or an adult incontinence pad?!

[jrsmrs]

Was there some reason given why this person wasn't at least using Attends? And am I understanding you right that the ulcer was left open? A full-thickness wound without a dressing?? I really hope I'm misunderstanding that one!

I would have been disturbed, too. No one should be left to lay in their own waste. Nevermind if there's a wound in the area.

As to the smell, I think it's something you just get used to for the most part. But I think your reaction was probably from the whole combination of wrongness.... and totally understandable.

[TigerGalLE, BSN, RN]

It is not uncommon for patients who are intubated and bedbound to be incontinent of stool. Usually briefs/diapers just make things worse for these patients. Briefs are for patients who are incontinent and ambulatory. Briefs put patients at risk for UTIs when the patient is bedridden.

I do hope there was a dressing on the wound and you were assisting in changing the dressing. Sacral ulcers are very slow to heal because of the close proximity to the rectum and the frequent exposure to stool. Very often there isn't much that can be done to prevent this. Wound vacs are an option and occasionally a surgeon will give the patient a colostomy to let the wound heal and then reverse it later. That is usually only done if there is a great chance the patient will survive their current disease state.

You will get used to seeing/smelling these things the more you are exposed to them.

[alicia_rae122]

there was a dressing on the wound, but it was definitely drenched in feces. it just seems so wrong that he had to lay there in it.

even while we were trying to clean him up, it just kept coming out. is there really no solution to that other than colostomy? wow...

the whole situation was just wrong

[TigerGalLE, BSN, RN]

If the stool is very loose then they could get a rectal tube/flexi seal. We do this often in the ICU. The colostomy would only be performed if the sacral wound was not able to heal after many other methods have been tried. It would not be done because he is incontinent.

[WeirdNurseKelly, BSN, RN]

The patient would not need a colostomy because they are incontinent of stool. That puts the patient through anunnecessary major procedure. We don't put foley catheters in patients because of urine incontince for our convenience so we wouldn't have to change their briefs all the time.

Also, I would hope that this patient was sedated, and/or paralyzed and medicated for pain.

It is awful to hear about this, but sometimes patients just can't help it when they don't have control over their bodily functions. Get used to it though. You will see a lot of pretty gross stuff through your nursing career. Remeber too that the patient probably feels worse off than you do and embarrassed of their inability to control their urine or stool. Put yourself in their position.

I know there are some tricks out there to help avoid the smell. One was to use vicks under your nose. I don't know if I would do that but just a suggestion. Good luck.

[MattiesMama]

The smells and the sights are just something you get used to over time-I never did the Vicks thing. If I walk into a room that smells horrible, I take a few giant whiffs-after the initial shock, I don't notice the smell anymore.

As for the sight of human suffering though, thats not something you ever just "get used to"-and if you do, it's probably time to leave the profession.

The fact that it affected you on such a visceral level is actually a good thing-it means you care. You just need to learn how to channel that feeling into action-next time you have that patient, hold his hand, stroke his head, talk to him-focus on HIM as a human being, not his wounds and the contents of his bowels.

[alicia_rae122]

yeah i didnt think a colostomy would be a realistic solution! i thought that the staff was being lazy for just not dealing with it.

and no one i talk to about this seems to understand that this person was barely functioning, besides the fact that a ventilator was maintaining his breathing. he was concious but the look on his face was just this frozen look of absolute misery.

thats what affected me the most.

[TigerGalLE, BSN, RN]

yeah i didnt think a colostomy would be a realistic solution! i thought that the staff was being lazy for just not dealing with it.

and no one i talk to about this seems to understand that this person was barely functioning, besides the fact that a ventilator was maintaining his breathing. he was concious but the look on his face was just this frozen look of absolute misery.

thats what affected me the most.

The colostomy would only be performed if the sacral wound was not able to heal after many other methods had been tried. And it would only be done if there was a chance that the wound could heal and if the patient had a good chance of survival. It would not be done just because he is incontinent. It would be done so the wound could heal. I didn't mean to confuse you with all this colostomy talk. I apologize.

It sounds like your patient needed some sedation. Being on a ventilator and being awake is no fun. And, I can't imagine the pain he was in with that huge sacral wound. Sometimes it is a good idea to premedicate patients before turning, cleaning them, and redressing the wound.

[alicia_rae122]

The colostomy would only be performed if the sacral wound was not able to heal after many other methods had been tried. And it would only be done if there was a chance that the wound could heal and if the patient had a good chance of survival. It would not be done just because he is incontinent. It would be done so the wound could heal. I didn't mean to confuse you with all this colostomy talk. I apologize.

lol no all this i understood! another post said that a colostomy is not a procedure that is performed just for the convenience of the staff. that would be unreasonable. i knew what you were saying, i found your post helpful :) thank you

[alicia_rae122]

no medication was given to him immediately before he was cleaned, but as a first semester student i can't give medication or even suggest that a supervising nurse do so. at least, that's what i'm told. during the whole bathing process a CNA was present, and she gave little regard as to whether or not the patient was comfortable. i'm starting to doubt this facility that i'm working in...

[TigerGalLE, BSN, RN]

no medication was given to him immediately before he was cleaned, but as a first semester student i can't give medication or even suggest that a supervising nurse do so. at least, that's what i'm told. during the whole bathing process a CNA was present, and she gave little regard as to whether or not the patient was comfortable. i'm starting to doubt this facility that i'm working in...

She probably cared. She is just used to doing this everyday. So it doesn't "phase" her anymore. She had a job to get done. Get the patient clean as quickly as possible so he can be comfortable again. She probably had good intentions. There is nothing pretty and sweet about cleaning up poop. Of course you always keep the patient's dignity intact and be a gentle as possible. Buts sometimes in order to even move a patient you have to put some ummph into it.