What does it mean when we wake up a sleeping, elderly, demented woman at 0300 in order to place a catheter in her bladder for a UA? When the woman is yelling and can't possibly understand what is going on or why? When in reality she is dying anyway? What is the point of waking people up at 0600 in order to give them a medication such as Prilosec or Synthroid (Tylenol?) - then telling them to "go back to sleep"? (This is done because pharmacy recommends med given at least one hour prior to eating - eating is done at 0700 for the convenience of the kitchen staff.) Where is the sense in placing a frail, 90 year old in an uncomfortable twin sized bed with a plastic covered mattress, in a room with three other people in the same condition? How enjoyable is life when you are hooked up to a feeding tube and cannot taste food or lie flat to sleep because it will kill you? Why must we send a person who is peacefully dying to the ER to undergo some more torture before they finally pass? Why, why why? Where is the gentleness?
The families are not present to see these things - they want "everything done" for their residents - everything except for comfort and dignity and peace. The "corporation" and management only care about what is done on paper, how it will look to the "state", and how many dollars are coming in and also how they can cut staff to the bone to decrease costs and increase their own bonuses. The doctors and nurses must go along with the program in order to not be sued.
I've worked in long term care a long, long time and there is nothing that is right about it and it is all so wrong! I am obviously going crazy at this point and it is obviously time to retire from this madness. Tell me, geriatric nurses, how do you endure?
Wow! I am exactly at that point! We have a new DON who is just bringing in young, inexperienced nurses, and has been busy "cleaning out the deadwood", as the expression goes. One of her new nurses, under my supervision on night shift, made a major, life-threatening med error, then called me to fix things. This nurse had no repercussions whatsoever; but another nurse, loyal for 15 years, was fired because she failed to complete an incident report. I am so ready to just call it quits, and of course, due to my mental status, I should. The young ones just come in late and leave early, and as you said, much of their time is spent texting, etc. I will say the CNA's in my facility are mostly excellent, caring people, young or old.
I have been in LTC for years and your "rant" is so spot on! I am surprised at how many residents are very fine with waking up early for 1 or 2 pills. For the most part the residents have way fewer problems with this I do. For the few residents that do have a problem with this we adjust the med times to their preference.
There will always be families that just don't or can't wrap their heads around the concept of quality of life, some can be educated and get it, but some just don't and never will. For those residents I just truly pray that they don't decide to code on my shift. It would completely stink pounding on some poor old souls chest knowing how futile it is. Even if by some miracle compressions convinced the heart to work a little longer the complications post CPR are most likely going to decrease even further any objectively measurable quality of life. I say objectively measurable because of course quality of life is completely subjective. Just because an educated and experienced health care worker can see that there is very little quality of life left doesn't mean that residents family agrees and unfortunately for all involved it is not our call to make. If the POA wants to maintain a full code status despite all the education we provide there is not a darn thing we can do about it.
Specializes in L&D, CCU, ICU, PCU, RICU, PCICU, & LTC..
" Much easier for them-try undressing and fighting to put a LOL back in bed "
a LOL???? please don't be demeaning...she's not a LOL...she's a grandmom or a mom or a sister or a friend
What is so wrong with calling someone a "Little Old Lady"? Why do you feel it is demeaning to call a woman a "lady"? Guess I am missing something here.
A lot better than geezers, vegetable, or idiots and some of the other things people are called by staff.
It's really strange that your lab insists on this practice. Literature does not support this. The only differences I found so far in recommendations are how soon to test 'fresh' specimen (non refrigerated ones.) The range has been to test anywhere between a 30 minutes to within 4 hours of collection of a fresh specimen. All the articles warn of growth in bacteria the longer a specimen remains unrefrigerated and state that refrigeration retards the growth of bacteria for up to 24 hours.
This is an exerpt from a study on urine storage and how it affects the lab results:
Urine specimens should be tested as soon as possible after collection in order to obtain accurate osmolality results in clinical laboratories. Standard practice indicates that specimens should be tested as soon as possible, or refrigerated within
4 hours and tested within 24 hours of collection to obtain accurate osmolality measurements. When immediate processing of urine specimens is not possible, this study suggests that both neat and supernatant human urine samples, either refrigerated or stored at room temperature up to 24 hours, can be accurately tested for osmolality without significant bias. No appreciable difference between neat and supernatant samples was observed.
There is a huge push for 'culture change' in LTC that is discouraging both procedures and medications that aren't medically necessary to be done on the 11-7 shift. Culture change recognizes that Residents of LTC deserve to have their quality of life needs met just as their medical needs. There has also been rising support for this movement in our Government as well, (surprisingly) to get away from the old 'medical model.' (Though, often it's governments own regulations that make it challenging in itself, but that's off topic.)
I can see no justifiable reason to wake up anyone at 3 in the morning to put a cath in for a specimen, especially when studies and general accepted practice doesn't support it. My recommendation is to do your research and approach administration with it in a respectful manner. It's hard but I have gotten facilities at times over the years to change and update their policies with persuasion and research myself on best practice. Good luck.
My MIL had been in an LTC facility for 9 years. She had Pick's dementia. When we placed her initially we decided then on 'no feeding tube' or other extraordinary actions. Recently she developed a UTI, and her fever wouldn't break. She simply stopped eating, and became dehydrated. She was hospitalized, put on IV fluids, etc. They called us about a feeding tube, and we elected to stay our course, so no tube was inserted. We agreed that she should return to the LTC, get hospice involved, and hope for the best. She died quietly in just a few days, probably from the pneumonia that developed from aspiration.
But this decision was one that was not made during the crisis. It was still not easy to keep to the plan; my husband needed a lot of support. We were relieved that it was over so quickly.
About waking up people for meds needed to be taken on an empty stomach - - ask what they do at home. I was recently in a rehab facility and was aroused for an early morning med - twice was enough. I then told them that since it was not an 'empty stomach' med they were not to wake me up again. And they didn't. But the patient needs to express their needs/wants. Some things should be about common sense.
I am so glad that you opted against a feeding tube for your MIL, for sure you spared her a very rough time. Just last night, I suctioned a lady several times throughout the night, as she was gurgling, etc. Her family recently placed her on feeding tube and she has developed pneumonia. Poor lady has not been able to speak or do anything for herself for years due to dementia. On the flip side, my neighbor, a youngish man, had a feeding tube for short term as he recovered from throat surgery. So there are appropriate cases for a tube.
Our residents are advanced dementia, so do not have the capacity to ask for med time changes. If they refuse their med, I always respect that. There are some A & O x 3 residents in our rehab, maybe they do not understand their right to ask for changes, and they may feel they are following "doctor's orders". I hope that someday the whole long term care philosophy will be based on resident's needs and comfort.
Specializes in LTC,Hospice/palliative care,acute care.
I've been a nurse for many years and have spent a great deal of time working in memory units.. I am NOT restraining anyone,when I say "holding in my arms and soothing, singing to them" that is EXACTLY what I am doing .I have always been known for being able to encourage the most resistant LOL to accept her meds.It's an art and I have worked hard at it.
Specializes in LTC,Hospice/palliative care,acute care.
I have laid my cheek against that of a sweet LOL and sang "you are my sunshine" and "amazing Grace" right into her ear while she sang with me and was so still in that bed,so relaxed and still-she never moved an inch while another nurse cathed her due to urinary retention.
I would not want my mother straight cathed in the middle of the night, I am not defending that at all. I think HS is appropriate and preferable to trying to do it during the day when they should be at the coffee shop or getting their hair done.I am not debating the recommended storage times for the specimens,either. We have policy and procedure,it's a dead horse.
Everyone thinks they work the hardest-every shift has that LONG list of reasons why THEY have it so rough....another dead horse.
You are entitled to your opinion and you can continue to try to prove me "wrong" in some way but if you are not at the bedside observing me you have nothing to base your opinion on. And it's pointless for me to belabor the point because your opinion of my technique is of no consequence. I know I have not assaulted, battered, unlawfully restrained or otherwise done anything I would NOT have done for my own mother. As I said, I have always had a knack for communicating, cajoling-whatever you want to call it-with this population....I have loved working with them and have been passionate about it for years. I am in a different specialty now but am still willing and able to share the knowledge I have gathered. Over and out.
Specializes in Emergency/Trauma/Critical Care Nursing.
I have laid my cheek against that of a sweet LOL and sang "you are my sunshine" and "amazing Grace" right into her ear while she sang with me and was so still in that bed,so relaxed and still-she never moved an inch while another nurse cathed her due to urinary retention.
I would not want my mother straight cathed in the middle of the night, I am not defending that at all. I think HS is appropriate and preferable to trying to do it during the day when they should be at the coffee shop or getting their hair done.I am not debating the recommended storage times for the specimens,either. We have policy and procedure,it's a dead horse.
Everyone thinks they work the hardest-every shift has that LONG list of reasons why THEY have it so rough....another dead horse.
You are entitled to your opinion and you can continue to try to prove me "wrong" in some way but if you are not at the bedside observing me you have nothing to base your opinion on. And it's pointless for me to belabor the point because your opinion of my technique is of no consequence. I know I have not assaulted, battered, unlawfully restrained or otherwise done anything I would NOT have done for my own mother. As I said, I have always had a knack for communicating, cajoling-whatever you want to call it-with this population....I have loved working with them and have been passionate about it for years. I am in a different specialty now but am still willing and able to share the knowledge I have gathered. Over and out.
Regardless of what others have said, I would hope to find someone as caring as you to take care of my family if I was unable to. I totally understand the picture you are painting, and respect what you do for your patients.
You may well have a different resident population than I have. At my facility, there is no coffee shop, and most of the residents would not be capable of enjoying one - they are advanced dementia. Our shift is not by far the busiest - nights definitely are a slower pace. That does not enter into the situation. The problem is waking up a poor, demented soul in the middle of the night for an unpleasant experience. HS may be a better time. I don't have an opinion about your technique. I'm glad it works for you. Nonetheless, waking up a sleeping peaceful person like that is not a good thing.
Sixtyseven
47 Posts
Wow! I am exactly at that point! We have a new DON who is just bringing in young, inexperienced nurses, and has been busy "cleaning out the deadwood", as the expression goes. One of her new nurses, under my supervision on night shift, made a major, life-threatening med error, then called me to fix things. This nurse had no repercussions whatsoever; but another nurse, loyal for 15 years, was fired because she failed to complete an incident report. I am so ready to just call it quits, and of course, due to my mental status, I should. The young ones just come in late and leave early, and as you said, much of their time is spent texting, etc. I will say the CNA's in my facility are mostly excellent, caring people, young or old.