How to deal with this moral/ethical question...

gwenith, BSN, RN · Mar 16, 2005

I think this question will do better in the dialysis forum. To be honest - where I work we have to get an electrician to OK EVERY freaking electrical appliance brought into the place!!! Can you suggest a nice big Doona for the man??

The other alternative is to take your concerns about the patient's health and well being back to your supervisor.

steelcityrn, RN · Mar 16, 2005

Maybe you should have mentioned at the meeting how you had to remind her to draw a pt/inr! That could have caused him much more damage then a gosh darn electric blanket...keep up the good work, your a true patient advocate!

Okay, the gist is this:
Patient (on dialysis) is dying. Has a liver disease as well and will be lucky to make it through the summer. He is freezing cold all the time, and his tympanic temp runs 92-94 degrees all the time. He uses an electric blanket at home to stay warm. We turn the temp up on the machine as much as we can, but that wasn't enough. SO I allowed him to bring in a NEW, SMALL electric blanket. Everyone at work was ok with it, but I did NOT get my immediate supervisors okay (although she has okayed things like this in the past)...
Fast forward 1 month later (yes, patient used blanket for a month). The OTHER RN I work with got mad at me for pointing out to her (in private I might add) that she neglected to draw a stat PT/INR that was ordered. So, during a meeting that day, she told the boss that pt. so and so was using an electric blanket and I okay'd it. Fine. I said YES I DID...he is dying and the short amount of time here he has left should be made as comfortable as possible.
So, in short, the other nurse is HURTING a patient (he had stated he just couldn't dialyze any longer due to being so very uncomfortable due to the cold)...which is when I told him to bring in his electric blanket to see if that helped. It did. So he has continued to dialyze.
THE OTHER NURSE KNOWS THIS...and has pretty much just given him a death sentence by her actions! He will quit!
HOW DO I HANDLE THIS? I would literally like to take out her own body's thermostat and let her freeze for the rest of her life!

jaimealmostRN · Mar 16, 2005

Can you present this to the Ethics committee? I'd document this man's exact words, ie. "I'm not coming back b/c I'm so cold and cannot use my blanket anymore," oral temp 94F, dialysate warmed to x degrees F. Pt. shivering and pale, covered with 10 blankets, skin pale....etc." Also, can you get one of those "bear-hugger" blankets? Like the ones used in the OR (they blow hot air (like your co-worker) into this bubble blanket). Good luck :) .

jnette, ASN, EMT-I · Mar 17, 2005

I can certainly understand the concern of using an electric blanket in an area which is exposed to so much potential for water spills... acid, bicarb, dialysate, blood, bleach solution for cleaning the machines, etc., etc., etc.

There are fluids EVERYWHERE in a dialysate unit and I would think this could present a major hazard.

However, that said..several of our patients make up their own little "heat packs".. cloth bags filled with corn which are heated in the microwave, or we heat up outdated saline bags to place on them.. there are many ways to add warmth. The simple act of wearing something on their head helps retain a LOT of their own body heat as well.

Hope you get this resolved for this patient... surely there is something that can be done to help keep him warm.