Published
Sometimes I just don't think doctors take the time to think about the patient at all. Without specific details I just want to mention a recent situation that just breaks my heart.
A patient was debrided at the bedside. Very large abdominal wounds, with wound vacs. Initially he offered to let the RN bolus her off the PCA, but I heard afterwards he even changed his mind about that. (All the nurse could do was stand there at the bedside and help the patient hit the button as often as she could.)
The screams coming from the room were wrenching and sad, though she only cried out loud enough for us to hear twice in the THIRTY minutes he was physically debriding her.
It absolutely broke and enraged my heart. She deserved a fat dose of dilaudid and a shot of versed...at least.
Tait
PS. As always, please feel free to share your stories on the subject.
That is horrible. He should have been reported. Unacceptable.
This is a good thread because it serves as a reminder to all of us to act in the moment. Sometimes we are so overcome with emotion it is hard to think and we need to be able to get beyond that and act immediately. The more nurses come together in situtations like this the less doctors will be able to continue in this vein.
When I read things like this it helps me to compose my thoughts in regards to what I would do if faced with the situation. I would now speak out, call my CN, and go up the ladder as needed. Form a plan of action so when taken so off guard by someone so callous that you know what to do and how you will do it.
I saw something along these lines while in nsg school, and I know how horrible it makes you feel for your pt. Not only do we need to be an advocate for our pts...we need to educate them as well. I make sure they understand this is their body, their decision.....they have the right to say no. This kind of stuff makes me furious!
I saw something along these lines while in nsg school, and I know how horrible it makes you feel for your pt. Not only do we need to be an advocate for our pts...we need to educate them as well. I make sure they understand this is their body, their decision.....they have the right to say no. This kind of stuff makes me furious!
I had a similar experience. The patient was writhing in pain during a femoral cath insertion by a PA. The pt even asked him to please stop and the PA said, "I just gave you some numbing medicine so you shouldn't be hurting this bad. I think you are overreacting." I was so upset for my patient I almost passed out. When I had to sit down the PA just rolled his eyes.
Looking back, I really should have said something. The pt even looked at me with pleading eyes and I said nothing out of fear of being out of line as a student. Never again will I allow a pt to be in pain like that. It was just so unnecessary.
m
Nurses are patient advocates. If you don't take a stand on your patient, no one else will. Go up the chain of command. Involve the charge nurse (which was done). Call the DON. Let the MD know you will activate the rapid response team. Refuse to get him supplies or help him. Call the family.
If only a nurse would have intervened when an MD ignored my husband's symptoms, my husband would still be alive today. But instead she testified that she was afraid to raise a ruckus...
My fiancee's mother was in and out of the hospital for pretty much all of 2009, and repeatedly had to deal with procedures without appropriate anesthesia/pain relief. She had complications from an achilles' tendon reconstructive surgery as well as a very deeply infected cyst/boil thingy on the buttock/hip area. They took a football-sized chunk of muscle/tissue out of her buttock, and was put on wound vacs, IV antibiotics, etc for both the ankle wound and the buttock cyst/boil.
They did PICC lines in the arm and the neck without painkillers (not sure if this is standard procedure or not but she said it was painful and they said they couldn't give her anything), dressing and woundvac changes without any kind of anesthesia, and in one circumstance when she had a bowel impaction, the doctor came in, put on a glove, didn't even use lube, shoved his finger into her rectum, and left--all without saying a word or any kind of courtesy/explanation/etc.
Also there were continuous issues with getting her pain medication as it was supposed to be given, she had to "remind" them to give it, and if she refused it at 3pm because she didn't need it just then, then she asked for it at 4pm, she couldn't get it. But then at a later stay, none of the nurses noticed when she was having hallucinations and drowsiness and paranoia from being on high doses of dilauded from an extended period of time...
On the other hand she has also had a wonderful doctor at one point, and some wonderful nurses... so I guess it's the luck of the draw.
The doctor who refuses to write an order for pain medication because he doesn't have time won't respond to "better" advocacy. The nurse could have called a superior, but by the time things played out, the procedure would have been done.Exactly how would YOU have made this situation better?
Well, J.silverstein, I would have raised all kinds of hell and probably gotten disciplined for it. And then I would have started writing letters until an investigation occurred. In short, I would do everything in my power to prevent that scenario from happening to one of my patients. And even if I failed to prevent it from happening, that poor woman would know I went ass-over-teakettle to advocate for her and that I shared in her horror and humiliation at what was happening. I dunno, if that were your wife (husband), mother, or daughter lying in bed screaming like that during an unanesthesized debridement, how would you respond?
Well, J.silverstein, I would have raised all kinds of hell and probably gotten disciplined for it. And then I would have started writing letters until an investigation occurred. In short, I would do everything in my power to prevent that scenario from happening to one of my patients. And even if I failed to prevent it from happening, that poor woman would know I went ass-over-teakettle to advocate for her and that I shared in her horror and humiliation at what was happening. I dunno, if that were your wife (husband), mother, or daughter lying in bed screaming like that during an unanesthesized debridement, how would you respond?
And how does this prevent the pt from undergoing the procedure?
I find it interesting that you failed to mention educating the pt to be their own advocate. If the patient refuses the procedure, the MD cannot preform it. (Under most circumstances) Funny. That would have been my first course of action as it's the only one that would have actually stopped the procedure from happening.
But I guess you can write all the letters you want while your patient is undergoing a painful procedure without medication.
But since you asked, if it were my family member, I would react the same as I would with my patient. I wouldn't start a letter writing campaign, or raise hell in an unprofessional manner that would get me disciplined. I would explain to the pt (or family member) that, while the procedure is necessary and will likely be painful, it does not require that it be done without proper anesthesia. If the MD is not willing to write an order for pain medicine and allow reasonable time for that pain medicine to work, I would consider refusing the treatment. As their nurse I would be happy to then call the MD's attending or whoever is next up on the chain of command, fill out an incident report and ensure the procedure is preformed under more humane conditions.
This way, my pt is allowed to participate and is empowered. I've given them the tools to make their own decision all while remaining professional. And then, after the crisis is averted, I may start filing out an incident report an writing letters and whatnot.
But I suppose it's easy to get all enraged when one is still a student. Learning how to actually advocate for your patient comes with experience.
Well, as a student I reached out and actually grabbed the arm of a PA to prevent something from continuing. This after I voiced my problem with his efforts and suggested he take another course of action. Before he could rip me apart, I actually kind of went off on him and said, "what part of STOP don't you understand!!" and slid between him and the patient's bed. He was mad/flustered and left the room. I stayed to calm the patient and wonder how much trouble I was in. The intensivist came in as I had started to leave the room to get help. He looked at me and I said, "there is a problem here", and he said, "I know". He came in and (without me giving any detail) solved the problem. I did not get in trouble, nothing more was said and I did not se the PA again while I was there.
I saw something along these lines while in nsg school, and I know how horrible it makes you feel for your pt. Not only do we need to be an advocate for our pts...we need to educate them as well. I make sure they understand this is their body, their decision.....they have the right to say no. This kind of stuff makes me furious!
A group of us in nursing school were sent to watch a tracheostomy being done on a supposedly comatose patient-- it was horrible- he kicked, writhed and shook his head back and forth throughout the procedure. He was naked with just a wash cloth tossed over his genitalia and a glass thermometer (still used then) in his rectum, held by no one. The nurses told us he couldn't feel the pain when we reacted with shock to what this poor man was going through.
And how does this prevent the pt from undergoing the procedure?I find it interesting that you failed to mention educating the pt to be their own advocate. If the patient refuses the procedure, the MD cannot preform it. (Under most circumstances) Funny. That would have been my first course of action as it's the only one that would have actually stopped the procedure from happening.
But I guess you can write all the letters you want while your patient is undergoing a painful procedure without medication.
But since you asked, if it were my family member, I would react the same as I would with my patient. I wouldn't start a letter writing campaign, or raise hell in an unprofessional manner that would get me disciplined. I would explain to the pt (or family member) that, while the procedure is necessary and will likely be painful, it does not require that it be done without proper anesthesia. If the MD is not willing to write an order for pain medicine and allow reasonable time for that pain medicine to work, I would consider refusing the treatment. As their nurse I would be happy to then call the MD's attending or whoever is next up on the chain of command, fill out an incident report and ensure the procedure is preformed under more humane conditions.
This way, my pt is allowed to participate and is empowered. I've given them the tools to make their own decision all while remaining professional. And then, after the crisis is averted, I may start filing out an incident report an writing letters and whatnot.
But I suppose it's easy to get all enraged when one is still a student. Learning how to actually advocate for your patient comes with experience.
J.silverstein,
I was under the impression that the patient in question was unable to advocate for herself. I imagine most oriented patients would decline an invasive procedue without proper medication. I was under the impression that the patient wasn't completely oriented. I don't know, I could be wrong.
As far as a letter writing campaign: obviously, I wouldn't be writing letters while I was standing in the room with the doctor obviously. I guess I should have indicated that in my previous post but it's one of those things I expected people to clue into. So let me explicate it more clearly: I would only write letters after the event happened.
So, back to the original scenario: You are this woman's nurse. And, for argument's sake, let's say she isn't oriented: elderly, turner, feeder, bed-ridden with dementia. This is all hypothetical by the way. The doc comes in at shift change in the morning and orders you to prepare the patient for debridement, time is short, and he's not going to write orders for IV Diluadid or anything else. "She can have what's already in her PCA," he barks, and you know her PCA drugs aren't going to shield her from the pain of the procedure. All sarcasm aside, what would you honestly do in a situation like this? One of the nurses in this thread mentioned she stood between the PA and the patient...
belgarion
697 Posts
In 1978 my wife was in the hospital because she was having lady partsl bleeding. They suspected she was pregnant but the tests, including what passed for ultra-sound then, had been inconclusive.
Well, at 0300 all doubts were erased when she had a miscarriage. The ob on call came in and proceded to do a D&C right there in the bed with no anesthesia or pain meds. My wife said the two nurses in the room were both crying and were about to get sick. This was a two bed room and the other patient had to just lay there while this was going on six feet away. When he was finished, the ob turned around and walked out without saying a word. He didn't order anything for post procedure pain, just wrote discharge orders.
My wife was 19 at the time. I was not called and informed as to what was going on so she had to lay there and deal with this until I showed up around 0900. Both of us were young and dumb so we didn't even think of filing any kind of complaint or lawsuit. Back then we were raised to believe doctors were gods and always right. I just wish I had known then what I know now.