Is it just me or............?

[eriksoln]

I've been noticing something lately, noticing it going on a lot recently. Maybe its just the pool of pt's coming to my specific hospital or something, IDK.

We all know pt's over react to certain (usually the wrong) things. "OMG, my mashed potatoes are cold" meanwhile their saturating is like 72% and they don't want to hear about putting their oxygen back on until you've heated up those potatoes.

On my unit, the "thing" to over react to seems to be sleep. Now, I understand having an upset sleeping schedule is disturbing beyond belief.........heck, I work nights. But lately, I've had a slew of patients who act like a bad night's sleep is going to land them in the ICU or something. Literally, they are panicked and crying as though a limb was just amputated. They want double and triple dose sleep aids until they are sleeping, regardless of the risks.

I try to tell them "Maybe its not really a medical problem at all, might just be U R not tired". I bite my tongue and thing to myself "Yeah, you lay in bed all day telling the staff to get this and do that..........so why would you be tired? I wasn't aware being waited on was such hard work that it should provide you a good nights sleep."

Last night I literally had a woman go into a full blown panic attack that almost lead to me calling the rapid response team. What stressed her so? Her blood was not done and she wanted to go to sleep........it was going to keep her up and she'd never sleep and then the world tilts on it's axis causing great shifts in the climate (or so she acted/though) and killing millions............................(tongue in cheek).

What gives with the...............poor cooping mechanisms? Seems to be a bad nights sleep just meant you didn't sleep well.

[Meriwhen, ASN, BSN, MSN, RN]

Even if someone does have good sleep habits, being in the hospital can disrupt them.

I don't think this always requires medical intervention, but I can see how that might be the best course of action at times.

It's definitely the best course of action when dealing with an entitled borderline who's been grating your nerves for the last three hours whining about everything. Its definitely no problem for me to give these patients the Ambien/Ativan nightcap at the stroke of HS :)

[canoehead, BSN, RN]

My pet peeve for instant gratification is the warm blanket brigade. Families that need their loved one snuggled in tight before we can get a johnny on. Forget about the various tests and assessments.

I recently had a man come in that put a new definition on SOB. He was shirtless and tripoding, and declined a blanket no less than 5 times while I was there giving NTG Q3min. He was HOT! So the sixth time his wife asked him if he needed a blanket he gave in. She immediately looks at me-I haven't left the room since he arrived- and says "could you go get him a blanket, he's cold." YES I know she's just worried! But I was actually waiting for/preventing his impending arrest. It was gobstopping to realize she had no idea how ill he was, or how hard he was working. Sheesh.

[scoochy]

As someone who suffers from insomnia over long periods of time, I only wish I could get instant gratification once every six months. I could not believe how rested I felt, although in pain, when I regained consciousness after being under general anesthesia for surgery. I made a point of telling my surgeon, although I am sure he could care less that I can't sleep.

Caliotter,

You are not alone..........

[nursel56]

it's definitely the best course of action when dealing with an entitled borderline who's been grating your nerves for the last three hours whining about everything. its definitely no problem for me to give these patients the ambien/ativan nightcap at the stroke of hs :)

yep - the frequent interruptions, noises, and strange environment of a hospital at night are pretty much what ambien and ativan are made for imo. for most hospital stays, anyway.

then again, i've always been the princess and the pea type. i wake up because of little noises, wrinkly sheets and jammies, etc. i'm not entirely sure people who say they sleep for eight hours straight are telling the truth.

yes, it is a pun. don't you get it?

<_>

>_>

it was a bad spelling day.

it happens. and some people have hypoactive humor, sarcasm and pun detectors.

[efda3]

Oh, BTW............"she"......................is a HE.......................

Haha, I had a lapse..was looking at the "juli" screen name. Forgive me

[flashpoint]

I think a lot of people lose their ability to cope when they are sick. I had mono a few years ago and when I finally felt well enough to eat, the restaurant we got food from messed up my order...I bawled like a baby because of it.

Often, I find that taking the time to do the little things that I really don't have time to do takes less time than explaining why I can't...and sometimes helps relax the patient more than anything. Sometimes what the patient says is the problem, really isn't the problem, but taking care of it helps fix the problem.

[PostOpPrincess, BSN, RN]

I sooo hear ya on that one ...

Life, death, ethical/moral dilemmas, shift work, lack of family understanding of what I do ... these things about nursing are not wearing on me nearly as much as the lack of coping skills among so much of the population.

I will be blunt.

Our society is NUTS NUTS NUTS NUTS NUTS....

Enough said.....

J

P.S. Nobody is able to deal with life's pressures anymore without being medicated.

Some people really need the meds for the most valid of reasons. Others just want to be numbed for whatever reason they can think of--i.e., just NOT to deal with regular life.

[efda3]

I will be blunt.

Our society is NUTS NUTS NUTS NUTS NUTS....

Enough said.....

J

P.S. Nobody is able to deal with life's pressures anymore without being medicated.

Some people really need the meds for the most valid of reasons. Others just want to be numbed for whatever reason they can think of--i.e., just NOT to deal with regular life.

Yes, true! And it just gives them an excuse to abuse nurses...who, in turn, accept the abuse.

[nyteshade, BSN]

I don't understand what that's supposed to mean. Why wouldn't she be?

Juli--sounds typical. I have seen this as well.

You mean why wouldn't he be?

[BluegrassRN]

Well, I've just had a rash of pts from the OTHER end of the spectrum. Two patients have now complained about me that I didn't check on them all night.

"She was only in here twice all night, I could have been dead for hours". Apparently on hourly rounds I'm supposed to wake my a/o x 3 patients and ask if they are sleeping okay and if they need anything. I even told these people during my evening assessment that I make hourly rounds but I don't wake them if they are sleeping unless I need give a med or grab some vitals.

Jeez. We can't win, people. Seriously.

[SharonH, RN]

I know this is unpopular Erik, but I'm sorry.....I may be vein but I too suffer from insomnia and I understand the panic. This is a problem that has developed for me over the past year and although I am completely healthy otherwise I now find myself depending on a sleep aid to rest. The alternative is an entire day of a complete lack of energy, inability to focus or think clearly, muscle aches and headaches. I know this because I've tried several times to stop and practice good sleep hygiene, etc. I can understand how people might become panicked.

Yes, there are people who lack coping skills but we often don't know what stressors people are dealing with in addition to their hospitalization. In fact, I find that there is a large segment of the population dealing with incredible challenges financially, emotionally and socially and an illness and a hospitalization is usually the last straw. If you knew what so many of people are going through out there, your jaw might drop. I wish you and more of my colleagues could understand that.

[nursemike, ASN, RN]

It's not just you, Eric, but I'm afraid it's at least partly us. Sleep deprivation can be a pretty effective form of torture. And by torture, I don't mean discomfort or inconvenience; I mean torture. Most patients on my floor have Q4H vital signs and neuro checks. I've tried to do my neuro checks right behind the aides' vitals, but it rarely works out. My pts are usually scattered, and if I have 0400 meds on one or two, it just isn't feasible. It wouldn't be so bad, but in most cases we really aren't waking people for any medically necessary reason. Just CYA. Now, my 0400 neuros are pretty gentle: do you need anything? are you in pain? do you still know who you are and stuff? And I'll time-shift a bit. Pt calls out for something at 0300, I'll do their neuro while I'm there. Do for d/c tomorrow, might get check with their 0600 Nexium. From 2300-0700, our rounds are Q2, so a lot of times you can kill two birds. Still, between vitals, neuros, am labs, etc, most people get awakened 3-4 times a night.

Our stepdown is worse. Standard of care is full head-to-toe Q4H, vitals and neuros are often Q2H. Well, I can see that. It's stepdown. But with all the checks, often frequent labs, trips to CT at 0100, and all the bells and whistles, you begin to understand what ICU psychosis is all about. And it's hard to persuade a resident that a TIA with all symptoms resolved may not really need to be in stepdown. If they weren't pretty sick, they wouldn't be having TIAs, but we do have remote tele if they need it.

I've lately come to feel strongly that sleep and pain management are our biggest failures. We seriously under-medicate for pain. The logic is not to mask neuro changes. It's hard to fault that logic, except I don't recall ever seeing any significant neuro changes in an L-spine fusion. At least strokes aren't usually painful, and how many stroke pts have osteoarthritis or fall injuries? Oh, yeah, quite a few...

I've told patients' families that if sleep is what the patient needs most, they shouldn't have come to the hospital. But I recognize that sleep is important, even when it isn't a top priority, or even in the top three. I've told a doctor that my patient is getting a little suicidal because her neighbor in a semi-private stepdown bed is throwing a lot of PVCs and has a lot of visitors. I try to group tasks and even cheat when I think it's safe, but I'm understandably hesitant to put my license at risk. When I work our seizure monitoring unit, I often have pts with orders for Q4 V&N, "while awake" and sometimes peds neuro with strict do not awaken orders, period. I sometimes get med pts with Qshift vitals. Still, I see an awful lot of unecessary sleep deprivation, often in conjuction with under-medicating pain. And then, on the rare occassions when I feel like I've been an effective pt advocate, I get what Bluegrass described in the previous post.

Ah, the call of the open road, pushing big rigs on our nation's highways...