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.

Specializes in Geriatrics, Home Health.

CPS needs to be notified yesterday.

However, once that happens, Dad will probably want to get back at whoever reported him. Your agency won't stand behind you, so you need to make sure you're safe before you report him. Find a new agency, change your phone number, get a pistol permit, do whatever it takes to make sure you are protected if he decied to track you down.

CPS needs to be notified yesterday.

get a pistol permit,

Ay yi yi. :eek: What is this world coming to?

I believe anyone can change? Wasn't that a nurse question on one of my pretests? :) At what age do people stop being able to change?

Vera

Specializes in Hospice.
Ay yi yi. :eek: What is this world coming to?

I believe anyone can change? Wasn't that a nurse question on one of my pretests? :) At what age do people stop being able to change?

Vera

Vera, I hear what you're saying. Of course, anyone can change. But the issue here is whose needs come first?

From the info given by the OP, that child is in a potentially very dangerous situation ... at least one angry, substance-using parent with access to firearms ... and plenty of reason to wonder how the child is monitored and cared for at night. If mom is the only one working, she needs to sleep sometime ... if she's the only one caring for the child, how alert can she be? If the father is supposed, you gotta wonder how sober he is at night if he's willing to smoke weed during the day with a stranger in the house. I would report based just on the acting out that the OP says she witnessed.

I agree that we have little information and no proof of neglect/abuse from the information given ... but it's enough to wonder and that's what is needed to mandate a report.

Yes, folks can change ... after the child is removed they will have plenty of time to do so. Grown-ups have a choice about where they live, with whom and how they behave. That kid has no choice at all.

Specializes in Hospice.

And, yes ... the OP needs to do what she can to protect herself. If, in her judgement, she needs to be able to shoot back if the guy threatens her, she has that right. He has a temper, has made threats in her presence and probably has substance issues.

If it was me, I'd get a restraining order at the first hint that either parent was trying to locate me. I'd have to think long and hard about carrying a weapon, but that's just me. She has a right to defend herself.

Specializes in Emergency & Trauma/Adult ICU.
I honestly don't know what other language to say this in. :) I am not disagreeing with the course of action at this point. I am merely stating how parents respond when the child they dreamed of is gone and the fact that they go through the grieving process. When a person is in that anger stage, they can be quite irrational.

I haven't read the new stuff on SIDS....yet... but at least from my last encounter with it, they were not really sure what causes it. There are new theories and now all moms are told to keep their children on their backs after feedings instead of placing them in a prone position. But it is a horrible feeling to think that this could have been avoided if only.......

Anyway, in another post, I made the point of how much I disagree with how we might deal with a person that exhibits that anger such as telling them "it's ok to be angry with everyone for a while." It isn't ok and this is the very reason it isn't ok. It is so important to help people to get past this point as soon as possible.

From what she shared here, I had gathered that this was not a new situation but something that had been going on for quite some time but has now escalated to a critical point. It is the very fact that most people are taught today to concentrate on the client as opposed to the whole situation that lends to this situation getting so out of control. I personally would have been addressing the situation way back, when the man started yelling at me the first time. I don't have to put up with that kind of nonsense and be assured, I would have addressed it to him and possibly to the supervisor. I would have also talked to him about what he was going through. But at the same time, when you are caring for a pediatric patient, you are also in close contact with parents. They are a very real part of the whole of that child. To suggest that they are separate is almost out of touch with reality. Those people, for better or for worse, are that child's parents not the nurse. No matter how this happened whether it was congenital or an accident, parents grieve over the loss of the child that "could have been' just like folks go through when someone died. I have experienced that phenomenon many times.

I am in full agreement with you that he has no excuse for venting on the nurses, smoking pot and do whatever because he's angry. Anger is a very destructive harsh human attribute that, imvho, should be nipped in the bud not only for the sake of all those around but for the sake of the person. It eats you from the inside out. I was just shedding some light on possibly why he is angry. I hope he gets some help and counseling.

Vera

OK, I'll try some different language.

Within this thread, the psychosocial dynamics of the father, the mother, and the family unit in the OP have been speculated on at length. And it is all just that - speculation.

You've devoted multiple paragraphs to painting a picture of parents ineffectively coping and grieving over the loss of a normal child. That is one possibility. Another equally valid possibility is this picture: one or both parents used one or more drugs on an ongoing basis before the child was born, and continues to do so. The child may have been unplanned - not all couples spend 9 months joyfully anticipating the new arrival and dreaming of what will be in soft pastel colors. To not acknowledge this possibility, and all the various gray shades in between those 2 scenarios, is out of touch with reality.

OP's post laid out her difficult decision and asked for input. In my post, I offered my opinion that the whys and hows of drug use were not particularly relevant to the decision she must make: whether or not suspected drug use in the home mandates her to report the situation to CPS. My ethics dictate that I would make a report, based on the reasonable suspicion of drug use and my legal standing as a mandated reporter. You may come to a different conclusion.

Specializes in Staff nurse.

While we are all upset about this situation, those who feel moved to...please pray for this little boy's safety and for his parents...and for the nurses caring for them...that it would be resolved in the child's best interests. AND the safety of the OP as well.

I feel very sorry for everyone involved, particularly the OP. I wish I had some advice. I will definitely pray.

Thanks, To All Who Responded,

I would call CPS and anyone else I could in a minute if I had some solid proof. So far- smelling something, and verbal threats toward the pt./fighting is not things CPS would be able to get involved over and maybe pull a child out of the home for, I don't think. The Dad told my supervisor they had been smoking expensive cigars. They would deny not caring for him at times, like at night, and say they didn't say the things they said.

The problem is, too, where would a ventilator child go?

But I may call CPS at some point.

Right now, only two teachers who come to the house and me realize (and encourage) that he moves his thumb for "yes" to answer questions. If some other people, like his Drs. could be made to realize this, he would have more of a voice and it may change the whole senario for him.

Nurse4years

"Guy sounds like he knows the inside of a jail cell quite well. People like this could care less about his grieving process- he's probably happy to be getting a check and having very little responsibility.

I have to disagree with Verandoug- who obviously has a heart of gold and possibly never worked a prison (I'm assuming).(?)

Daddy is a controlling, abusive, lazy, free loading druggie. Not a parent-almost not human. Lots of these in prison- many more in society jush pushing the envelope. That is what this guy is doing. Knows who he can push and what he can get away with.

Soul-less"

Yeah, I think you're right, the more I see.

Thanks for your response.

Specializes in OB/GYN,L&D,FP office,LTC.

Peggy,you are a mandated reporter...so report it!

The dad putting the kids vent tube around his neck while arguing with the mother?

I call that a threat and emotional abuse.

The last time you saw the child you were concerned about his well being..yet his parents did nothing until the next day.

I would not spend another shift in that house. The man yells at you,tells you IF they have drugs it's none of your concern. Your agency has done nothing...they are also mandated reporters. I would find another job. If you are worried this guy will come after you then you need to do what ever it takes to keep you safe.

There are facilities that this child can go to with a vent. I am praying that he get what he needs.

And I'm praying that you do what you know needs to be done!

Report that evil father now, stat, without delay, to CPS. He is an addict/alcoholic/whatever, he doesn't care about that helpless little

boy, he belongs in jail. Can I be any clearer?

You: do not set foot in that house ever again. You are in danger. Can I be clearer on that? I know you don't want to "abandon" the child but your own safety is at stake.

You are a mandated reporter. Follow the law if you don't want to lose your own license. You have gone public now on this board, perhaps CPS monitors boards like this. You could be in trouble for not reporting. You don't need that. Call them today.

Thanks, To All Who Responded,

I would call CPS and anyone else I could in a minute if I had some solid proof. So far- smelling something, and verbal threats toward the pt./fighting is not things CPS would be able to get involved over and maybe pull a child out of the home for, I don't think. The Dad told my supervisor they had been smoking expensive cigars. They would deny not caring for him at times, like at night, and say they didn't say the things they said.

The problem is, too, where would a ventilator child go?

But I may call CPS at some point.

Right now, only two teachers who come to the house and me realize (and encourage) that he moves his thumb for "yes" to answer questions. If some other people, like his Drs. could be made to realize this, he would have more of a voice and it may change the whole senario for him.

You do not need proof to report, only suspicion and concern for the welfare of that helpless child. You are, IMHO, remiss, maybe breaking the law, to not report now. Let those whose job it is to do so figure it out. Never mind where the child will go if removed from the home. That is not your worry, that's on CPS. There are foster parents, there are hospitals. I am very worried about your safety, too. I'm telling you again, report and get out and stay out, for your own welfare.

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