My 1st Mistake

dinkymouse · Aug 25, 2005

Mistakes are made by even experienced nurses. Just learn from this and move forward. Many pts. with dementia make statements like this and while you must question their accusations check and see if this aide has had other pts or family complain about him. Observe him yourself if the report comes back unfounded. It is possible the bruising came from his blood thinner but it is always better to check out all possible reasons.

One question though is why you didn't know he couldn't speak English? Did you ask him questions or talk to him during his treatment. Did you read his chart before you did the drsng change? It is important to find this stuff out before you go into a pts. room. I know though that sometimes it is hard to find out this kind of info from their chart sometimes.

Why didn't the daughter tell staff about his previous accusations? That is another question to ask.

Hang in there. The fact that you are upset about this mistake is a good sign. You feel responsibility for you actions and that makes a good nurse. :nurse:

SueNYC · Aug 25, 2005

Ive never heard him speak at all but I knew he didnt understand english. Ive only been in to see this same patient on 3 occasions. Every time I go in, I always say hello, ask how they are, explain what I will be doing and never got anything more than a grunt, or faint mumble of some kind.I and my instructor thought it strange that during all our treatments, which had to be especially painful because the wounds were so deep, that he didnt move at all but his hand once, nor made any noise at all.

The niece says she never reported anything before this incident because she never saw physical signs and thought he was lying until she saw his eye.

Tweety, BSN, RN · Aug 25, 2005

You live and you learn in life.

Usually sidelying positioning doesn't cause redness and swelling like you describe.

Patients with dementia who claim abuse is indeed a sticky situation.

essbee · Sep 2, 2005

I feel terrible...
Now on my third week of orientation and I got tested on treatments today. I had a patient with 3 stage 4's. I walked into the room with my instructor and the patient was side lying and I thought great, because two of his wounds were now nicely accessible, one on his hip and the next on his sacrum. They took a while especially since we stopped in between the first two because patient was to eat breakfast. So we came back to work on the second and third wound. For the third, it was on his stump, so I had to reposition him , more towards his back to get to it properly. Thats when I noticed his eye, the one he had been lying on was slightly swollen and red. I pointed it out to the instructor, but she didnt acknowledge, I just assumed it was because we were in the middle of doing a million things. I think now, she may have simply not heard me. Either way, we were done, and the mistake I made, was forgetting about this patients newly found condition. It wasnt until change of shift, did the next cna ask what happened to his eye. Thats when I remembered and then i told my charge nurse I had seen it earlier, almost 2 1/2 hours earlier. I felt so stupid.Dozens of people were called in, the cna who was caring for this patient was questioned as to when he saw it and why didnt he report it. At the same time this patients niece comes in to visit him and starts asking what happened. Now saying that her uncle is saying that a tall gentleman was feeding him the day before and when he didnt want to eat the gentleman hit him. She(the niece) says her uncle has mentioned incidents like this before to him but she didnt believe it much because there was no proof and the man is slightly demented. I guess the reaosn why the patient himself never said anything because he doest speak english, and only told his niece. I didnt even know the patient could speak up til this point. Either way, the cna was immediately suspended until further investigation. The pt is on heparin, and had been lying on the side of the affected eye for hours because thats the only way for him to lay without lying on his sores. So it could very well be r/t his positioning. None the less I felt terrible.
Outside of this incident, how can any patient who is demented claim someone abused them, and it be proved? Ive had patients already who would scream that Im hurting them when I only walked near their bed.

At least you told at some point what you saw. Imagine how many persons went in and saw the eye but either said, it's been like this(someone must know) or simply did not notice due to the invisibility of true problems with the elderly. Your instructor should encourage a quick assessment of patients prior to treating them, and as you nurse you will learn to due mini assessments quickly. No nurse is perfect and even an experienced nurse forgets or dosen't notice everything. Use this opportunity to remind yourself to stop and write things down because due to the volume of information you receive it is easy to forget. The government heavily regulates how possible/actual abuse is handled which is why there were so many people involved once the incident was reported to the charge nurse. Those who are demented or confused have often been underserved and there is great emphasis in making sure they are not cast aside simply because they are not alert and oriented x3. You did the right thing and obviously are a very ethical person, it is better to report than to avoid it and a resident is harmed.

Nat_gagui · Sep 2, 2005

The first step to become an expert in every area of your life is a trial. you will become an expert in your life and your loved profession one day at a time, believe me. this is my old saying in life: Failure's is the price to pay for SUCCESS

Nat

leopold · Sep 2, 2005

why was the cna suspended? It seems like he/she reported it on coming on shift.

SueNYC · Sep 2, 2005

Update:

First, thank you all for the words of encouragement. I went through so much BS regarding that incident. For several days, all the cnas would talk about what happened from the beginning of shift until the end. I was ignored by once smiling faces and any time there was a cna with another, you can hear the echo through the hallways about whom they really thought were to blame.(ME) I didnt take it personal, I understood this was a fellow employee whom they cared for. But, during one shift, while i was in a patients room, I could overhear them talking about me at the nursing station. It started with the incident that happened, since i was in a room about 20 ft away, parts of the convo were a bit faded. I then started hearing them say things like she signs for meds she hasnt given, shes signing forms she has no authority to sign on. I couldnt believe it. These grown woman were turning into children making up stories and putting my job on the line.When my instructor came to check on me half way during the day, she asked me how I was. She knew something was wrong and after a little prodding I just burst into tears.I told her what happened, told her to keep it between us, and when she said she was moving me immediately I told her no. I have no reason to move because I havent done anything wrong and if i do go onto another floor then theyll assume i felt guilty. I knew Id be moving within a week to the floor id be assigned to. But it still bothers me...

Anyway, the cna was suspended until further investigation cleared him and it did.He came back to work in about a weeks time was written up for not reporting the incident(he never did, he said he assumed the instructor and I saw it and reported it so he didnt mention it until the change of shift asked the head nurse about it. Thats when i said what I saw and then he was asked if he saw it)) He was also written up for using the hoyer lift alone. And to address what was mentioned by another person, there was another nurse who gave him meds in between all of what happened and she says she didnt see a thing. I dont think she even looked. Because we went in just 5 minutes after her and I saw it. I dont think its even possible for the reddness and swelling to form so quickly.I didnt even remember she had just been in to see him until after i gave my report of what happened. I didnt want to look like I was passing blame when I was already being looked upon as the devil in a pair of scrubs.