Have I made the correct decision?

[Newnurse1994]

Hi to all the lovely nurses out there.

I am a District Nurse and I want some advice. I am 18months out of Nursing school so I often doubt my clinical decisions.

I have a 91year old patient with an IDC, blocked 2/7 ago and was changed at home. Blocked again 10pm last night then the patient called at 1400 to let us know.

I visited at 1430 changed the catheter no issues on insertion but only 50mls of concentrated urine drained.

Called patient at 1530 to check if any more urine had drained. No urine drained even with 4 glasses of water.

I visited again at 1545, attempted bladder washout as per protocol fully blocked. So I removed thee catheter (large mucous plug on end of catheter) and reinserted another catheter. Small drainage of urine, patient still feeling pressure in bladder. Bladder washout performed but soon blocked again.

I sent him to hospital for a bladder scan and to be assessed by urology.

Just to add, yes I inserted the catheter to the bifocation so I know that I was not the urethra. Also he does not have a prostate.

Very uncomfortable family dynamics, I was verbally abused the whole visit by another family member, which then made me begin to question myself.

What could have I done better? I'm really doubting myself.

Kind regards

New and under confident nurse.

[Here.I.Stand, BSN, RN]

(((Hugs))) I would have wanted him assessed by urology as well.

As far as the verbal harassment, that's tough being in someone's house (in the hospital I could immediately summon the charge nurse/house supervisor/security). You could have requested they step out for privacy, and if they refuse you and client could go to another room for privacy.

It likely had nothing to do with you. Here's a personal anecdote from my family. I have an aunt who is, to use the technical term... a nut. I'll call her Hazel My grandma was a home hospice pt following release from her umpteenth hospital stay. Hazel first of all got very angry at my mom for "giving up." My grandma had had some wounds which the RN was treating; Hazel decided she knew better and "treated" them her way after the RN left. She blamed my mom when Grandma died...apparently her endstage CHF and COPD and propensity to clots (4-5 hospital stays for DVTs and PEs) were all treatable, if only my mom hadn't poisoned her with meds. Years ago, Hazel went nuclear on my grandma when she decided to make my then-102-yr-old grandpa DNR/DNI.

So just to give you an idea. She was frequently verbally abusive with the staff and with her family. Having met most of the people involved, I know they took VERY professional and compassionate care. Her behavior had nothing to do with them. It sounds like this might be the case here to...I mean when helping their loved one, a normal person's reaction is "thank you." If it wasn't you, it would be someone else.

[Newnurse1994]

Oh gosh thank you so much. I feel much better just with some reassurance! I called the hospital tonight to check up on how he is and he's awaiting a urology bed.

I actually had to leave the house when trying to call the non-urgent ambulance for transfer as the family member was following me around yelling at me calling me all the names under the sun because "who was going to make their dinner tonight". Very difficult situation which sounds similar to the one you have mentioned! Thanks again

[Been there,done that, ASN, RN]

Your assessment and intervention were correct.

Family members do not get to question or abuse you. Refer their concerns to the physician. Just because you are alone with them in the house, it does not mean you have to answer to physician questions. There is a doc making big bucks , when you do your visit.. make them earn it.

[Newnurse1994]

Thank you for your advice, much appreciated