Lessons from the Eyes of a Patient Companion

cd365c · Sep 22, 2014

I arrive on the floor at 1858 and quickly head to my sitter case(I am a patient companion this night) after meeting the charge to find what room to head to. Whenever I go into a shift knowing that I will be a sitter I anticipate one of two things happening: the patient is either going to sleep the entire time or have an altered mental status and make the night very difficult. Unfortunately, it was not the former.

The patient had recently attempted a suicide. So, I start getting report: q4 vitals, diabetic, came from ccu, not combative, fall risk, ambulation with one person. I had it all in my head: I got this; the patient will be okay to work with. I was in for a surprise.

The patient, though, was already asleep. They had some form of antianxiolytic, and I was not just about to wake them. So, an hour ticks by gradually. I am startled as the patient wakes up abruptly and claws over two rails out of the bed. The catheter is now on the floor following them as they ambulate to the bathroom without me standing behind them. As I assess their gate, I find them unsteady. The patient sways from one side to the other, looking like they were going to fall imminently. I rush to their side, and say, "Hi I am ...., do you know you have a catheter in?" "Yes, I want to sit on the toilet". "Okay, I am going to need to assist you up out of bed so that you won't fall; do not get up on your own." "No, I am fine!" The patient is having a bowel movement, and I thought I would be a nice companion and get them some wash rags so they can wipe.

The patient is already up walking around by themself by the time I am back by their side. They are yelling, "I need a pair of pants". I calmly inform them, "You need to sit down, and I will get someone to grab you a pair since I can't leave your side" (they were out in the hall). The patient, ignoring my words, while I walk right behind them falls to their right side. I am on the left, but am nowhere close enough to help them fall to the floor in an easy manner.

By the time the nurse arrives, I have already got the patient back in bed. We get a fresh set of vitals, with nothing too bad. Sometimes you realize with mentally unstable people, you must be over them like a hawk. There is a likely chance the person won't comply with much you say. Therapeutic communication and patience are the two best things to always remember. In the year that I have been a CNA and student nurse, I have yet for one person to fall when I am by their side. No nurse, tech, or doctor can ever think they have enough "experience" that something won't go wrong; it will happen when you least expect it.

So, the patient is back in bed, and I am back in business being extra careful and on my toes. Even with another dose of antianxylotic medication at 001, the patient remains restless in bed. Here is the 15 minute routine, patient would turn on his left side, right side, sit up to go to the bathroom (forget about the catheter), me tell him we just went 15 minutes ago/ already has a catheter, and he would get up anyway. So after we had been between the bathroom 5 times in an hour, 3 pairs of pants (all soaked from incontinent stool), I am peeved. What is going on?

So, the patient continues to tell the nurse when she does two hour rounds, "I am not in pain". It was far from true: the patient keep repeating "Oh God, f this, f that". No sir, you definitely are in pain, and not sleeping through the night. Finally, 500 rolls around, the patient finally admits to the nurse, "I have been in pain all night". So, with some Tylenol, the patient is sleeping soundly by 600 (the time I am about to leave of course!).

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If there are signs that the patient is hiding the pain, it is pertinent to let the nurse know. I wish I would have connected the dots much earlier to why the patient was so restless. It surely wasn't just because "he has altered mental status". Watching those patient signs is key!

Another piece of the puzzle was the patient constantly taking off his oxygen. Me, being the companion, repeatedly kept putting it back on. This back and forth cycle I fought with all night! But, the patient's oxygen dropped into low 80's. I had no choice! The patient had much congestion, and I tried to figure out how I could help with all those secretions going on. The nurse ended up ordering a respiratory therapist to come up and do a nebulizer treatment. Soon, I was to find out though, it does not do any good to give someone that type of treatment unless the patient has a narrowed airway. The RT told me that nurses often just order the treatment "because they think it helps anyways without understanding that this treatment does nothing to help this certain problem". She told me, all the patient needs to do is use their cough reflex to get those secretions out. Then came my aahaa moment! Why wasn't I trying to use that incentive spirometer with the patient all night? We could of worked on expanding the lungs and getting rid of those secretions! I began to see the bigger picture of care. Despite what the patient didn't want to do, the healthcare's role is to push someone to do thing that will "make them better" regardless of how they feel. We need to get them out of the hospital stat!

Regardless of all the good and bad of the night, every healthcare provider plays a vital role in the patient's well-being. To all my patient companions, mad props to all the hard work you must do 75 percent of the time. Dealing with mentally unstable people is a very taxing task. It involves repeated therapeutic communication, dealing with combative behavior, sitting in one area hours on end, and dealing with people who will not listen to a lick of what you say. CNA's, your role may feel hopeless at times because of everything you must do, but you play one of THE most vital roles to each patient. You will spend at least equivalent of what the nurse must spend with each resident each day. Your role keeps skin from breaking down, makes walking to and from the bathroom a safe thing, and keeps nurses on their toes about that blood pressure of 200/90. The patient's very well-being lies partially in your hands each shift.

Of course all my murses and nurses are definitely the biggest importance to the team, but you got to give a shout out to the whole team. Often the CNA's and Companions are overlooked, but there roles are the rock to a solid facility foundation. Their level of care, what to report, safety, and overall critical thinking will make or break each day.

*names have been changed/removed