I'm afraid for my pt. and afraid to go to work.

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I'm a private-duty home care nurse working for a small agency. My patient is a six y.o. boy on a ventilator, an adverted SIDS pt. who is quadraplegic and gets tube-feedings. He is unable to move at all, except his fingers a little and stretching.

At first, the family (Dad and Mom), seemed nice. They do live in a poor, dangerous part of town. She works, he is around the house, mostly drinking and playing poker on-line. They were somewhat critical of me, "we don't put the blanket on like that", or the window, door, or "leave him alone, let him rest!" when I would do even what I needed to, (pulse ox readings, assessments).

After a few months, I found I was getting yelled at almost everytime I was there, by the Dad. I also smelled pot occas. I saw arguments between the parents. And I came to realize when the evening nurse left at night, the parents didn't do anything and the pt. didn't get care 'til the nurse in morning arrived, (other than, hopefully, they were listening for alarms from the ventilator).

I talked to my supervisor about the Dad being angry with me, and especially smelling pot. She callled him to address the pot issue, he denied all. She was subsequently not supportive with me. Next day, I got yelled at, "this is our house, maybe we have pot, heroin, coke, it's none of your business."

I was there 4days/wk, went down to 2/wk. (for other reasons, but thought things might improve,too.)

Not so, still anger toward me and in general. I witnessed Dad and Mom at pt.'s bedside having a argument. Dad said, "mama better behave or I'll wrap this around..." & he wrapped the pt's ventilator tubing around his neck. She said, "stop it!". I was still smelling pot each time I was there. Mom was sometimes passed-out sleeping.

Last week, the pt. didn't void the whole shift, (usually has no problem voiding). The room had been very cold. He started to vocalize as if crying. I called the office for advice (should I get an cath. order), to report no void/crying and was referred to calling another nurse who works with him more. She is kinda an enabler with the family, but sadly, though, provides more care for the pt. than his parents. She said he's done this a few times before, (but hasn't for 6 mo.). When leaving, I gave report to Dad, told him pt. hadn't voided/was crying. I was trying to be reasuring and said I had called the other nurse and agency, if they need anything during the night, they could call them. Well, I got my daily verbal lashing- "Don't call them, Don't tell on us.. you think you know my son better than me... he's fine.." Shaken, I left the house with echos of the pt.'s crys/whimpers in my head, regretfully. I worried all wk. Today, the agency called me off. My pt. has been in the hospital since the morning after that eve I left last wk. He has pancreatitus. Who knows if he suffered all night, (he had finally voided, though), but when the other nurse came on, he was getting unresponsive. She told the parents, something's wrong, and said he had to go to the hospital. They nearly lost him and have had him on Dilaudid for pain, with other tx, too.

I think the pt. is fully alert, which makes all this worse. He reliably answers questions with thumb movements.

I afraid for my pt. that his parents don't really care if he suffers. He is a pay-check to them (Fed SS money). They don't seem to want him to get better, very resistant to any therapies, like they just want him to lie there. Due to drug usage or up-bringing, they seem unable or unwilling to care if he's in pain. And they should have taken him to the hospital that night, based on that they nearly lost him.

He is scheduled to go home tomorrow. I feel like calling the hospital and telling them about his parent's drug usage and lack of giving care. Is he safe there with them high? My supervisor has already dismissed this, so she is no help.

These people are the kind that would probably come after me, (there are guns in the house).

If I quit all together, I will feel like I'm abandoning my pt.

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Specializes in Trauma/Burn ICU, Neuro ICU.

Wow. I think that this warrants a call to Child Protective Services.

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Specializes in Home Health/PD.

I agree with the Child Protective Services. If your agency is not wanting to deal with it, you should go to the next step, which most likely would be social services. Hope everything is ok with this kid! I deal with vent and g-tube children constantly and it hurts me even when the parents are distant while we are there. i cannot believe what you feel for this child!

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Specializes in ICU/Critical Care.

Yeah, this needs to be reported STAT to CPS. I don't know if you can do so anonymously or what but that child should not be placed in that home after his hospitalization.

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CPS is the best way to go about this

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I feel really bad about this situation. However, call me selfish but I would not go back to that home if I felt unsafe. I could just kick your supervisor in the pants. You report drug use in the home and the supervisors calls and ask the person the person using the drugs if they are using drugs?? How stupid is that. I got bad news for the supervisors. Once you told her about the fact that the child is in danger she was legally bond to report to CYS just like you. Can the supervisor be trusted not to give the people you address if you call CYS. She sounds like such an idiot I wouldn't put it past her.

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Specializes in ICU/Critical Care.

Find a new job after reporting the parents to CPS.

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I was going to concur with some of this advice but make one other observation. I also did some home health many years ago. I took care of a child with Trisomy 22. She had multiple issues. One thing I recall vividly from that incident was the way these two young parents acted out. The mom regressed (sucked her thumb). The parents had many heated arguments. Talk about letting your psych nursing come into play.

Remember the loss of something doesn't have to be through death. These folks have never resolved the loss of the child that "would have been." That child is gone and in place is the one they have. When we get pregnant, we envision a little boy out in the field with a baseball glove throwing balls back and forth to daddy or a little girl playing with her dollies. We don't envision a sick child who will never be able to do those things. When we are blessed with a child such as this, who btw, can be a tremendous blessing to the family once these feelings are resolved, we have to work through the grieving process because the child that we envisioned is gone.

How can they admit that without feeling burdened beyond comprehension with guilt? Who would understand such a feeling? IOW, aren't we supposed to love this child just as he is? They are perfectly well aware of the fact that it is nobody's fault and that the child is certainly not at fault. They are angry with God sometimes. They are angry with themselves no matter how many times you tell them it isn't their fault. The drugs (pot) are to ease these symptoms. They are probably self-medicating. I don't know if any of you are aware of that kind of drug usage with illegal drugs. When they lash out in anger at you, it is probably because they are stuck in that state of grieving. Few people even recognize this because they are only trained to recognize these symptoms once the person has passed away.

It may seem at this point that the trust connection is non-existent. However... I wouldn't be surprised if these people do trust you because they feel comfortable enough that they can vent that anger on you. Unfortunately, it is like a viscous cycle right now. They probably feel even more guilt once they've lashed out of you and then rush off to smoke some pot to relieve the pain.

There are folks that have worked through these things and have been able to help others work through theirs. I have many friends who have.

Vera

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is quadraplegia, with intact mentition a likely sequelae of SIDS?

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Specializes in school nursing, ortho, trauma.

I agree - a call to the local child protective services is well in order. In my state the complaintant is kept anonymous - granted, due to the limited number of people coming in and interacting with the child it may be easy for the parents to figure out who called. Buit given the fact that you've reported to your agency a few times, i am a little surprised that there hasn't been a call sooner.

I understand the points being made by Verandoug, but if there are illegal narcotics in the house and they are not addressing the child's pain (the non verbal child's verbalizing / crying pain) then a call really needs to be made and an investigation done.

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I agree - a call to the local child protective services is well in order. In my state the complaintant is kept anonymous - granted, due to the limited number of people coming in and interacting with the child it may be easy for the parents to figure out who called. Buit given the fact that you've reported to your agency a few times, i am a little surprised that there hasn't been a call sooner.

I understand the points being made by Verandoug, but if there are illegal narcotics in the house and they are not addressing the child's pain (the non verbal child's verbalizing / crying pain) then a call really needs to be made and an investigation done.

Unfortunately, that is probably true.

Vera

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What an awful situation to be in but that little boy needs you. What a heartbreaker. He'll be in my thoughts and prayers. Be strong for him.

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