Nightmare at a major hospital in Jamaica

[clay07]

As a self-regulated profession, nurses are expected to provide safe, effective and ethical care; are obliged to refrain from abandoning, abusing or neglecting clients, and to provide an empathetic and knowledgeable care; to act as advocates, promote clients' well being and to prevent or remove harm. The commitment to clients also includes a commitment to respect family members and/or significant other(s).(College of Nurses of Ontario - Practice Standard, 2008).

As a nurse, it is within my rights to use sound nursing/clinical judgment and to act in accordance with the professional code of conduct as stipulated by the regulatory body of nurses within the country in which I practice. The standard of nursing practice is the same throughout the world; the culture only defines/influences how such care is delivered. The nurses at a major hospital in Jamaica, have proven to be functioning without the governance of a regulatory body for a while. On several occasions my family has experienced the negligence and incompetence of the nurses and have yet to see the regulatory body (NCOJ) intervene. This is a synopsis of our most recent experience, included are testimonies of other patients who have experienced death and/or malpractice due to negligence and abandonment.

Rewind

...On the evening of November 29, 2002, my father was pronounced dead at the alleged hospital, after suffering injuries to his C4-C5 vertebrae (his neck was broken). My mother, a nurse practitioner, upon hearing the news of his accident, rushed to his side before they wheeled his naked body off to the morgue where she found evidence that he was still alive! He stayed the night and between 7 p.m. to 7 a.m. no nurse had gone in to do a neurological or general assessment on him. My mother made the decision to move him to a private hospital after realizing that he was NOT receiving the quality care necessary for a patient in his condition.... This was not going to be the last time we would experience negligence and malpractice there.

Fast FWD>>>

...April 6, 2009. It was almost five in the morning when the sound of a slightly alarming ring at my head woke me from my sleep. It was a message being left on my blackberry "I'm going by "K" (my sis), Kiki (not her real name) had vomited twice and had diarrhea. She is crying and not taking anything or keeping anything down-Mom." Drowsily, I put my jeans on and a T-shirt and hurried up the stairs to get further info, there was no way I was going to sleep now. Kiki is only five months, a baby this age having eaten only since 4 p.m. the day before and had not kept anything down and was having diarrhea was at risk for Fluid Volume Deficit related to dehydration 2nd to vomiting, diarrhea and inability to keep things down! Risks: Hypernatremia, altered mental status, seizure, shock or death if not quickly treated and the problem not quickly corrected! Those were the first things that popped in my mind as I went up the stairs. It was serious enough that she was having diarrhea, but to not be able to retain fluids orally was another matter at hand! We must get her to the hospital!

We arrived at my sister's after a few minutes pass 5 a.m.. The baby was sleeping and it was hard to tell how well she was doing. Usually by 6 a.m. she would have been bubbly and very alert and ready to discover the world through play. Not so on the morning of April 6, 2009. Her small frame was limp from exhaustion from the retching and projectile vomiting after her mother's attempt in trying to get her to drink some Pedialyte throughout the night. At 6 a.m., we tried to wake her, her head fell helplessly to the side as she tried her best to stay awake. She was drowsy, lethargic and weak. My mom encouraged my sister to call her pediatrician, and he encouraged her to take her directly to the children's ward, where he would meet her at around 0830.

When we got there, the doctor was bombarded by other patients, but directed us to his office to objectively assess Kiki's condition. It was then he told my sister that the baby would be admitted because she needed parental fluids. He started the IV and gave orders to start the drip (term used in Jamaica).

Simple and basic nursing assessment was what I anticipated...

First let's look at the nursing priority: replace fluid lost, monitor neurological checks and watch for signs of Altered Mental Status-AMS (this is basic nursing judgment). Assess baby's condition for improvement, listen to cry, watch movement as a baby's leg movement may indicate types of problem (nonverbal communication in babies is very important), baby's type of cry indicates intensity of the pain, leg movement indicates possible location of pain. The nurse should use the opportunity to assess mucous membrane when the baby cries for further signs of dehydration and to effectively document progress notes. Assess breathing, check for perfusion, initial assessment would have included parents or guardian (redundant statement, but you'll see why I am saying all of this) i.e., baby's colour/color, activity level and or people interaction. Kiki is a "chubby" and playful baby, she is not "light skinned", however skin is not the only thing to use when assessing for signs of dehydration (a nurse should know this right?), so the only alternative to effectively check for good perfusion is her capillary refill on nail beds or on the soles of her feet, mucous membrane.... After the doctor started the IV around something past 9 a.m., it was going on 10 o'clock-ish or something past the hour and the nurse still hadn't started the fluids yet!!!!!! Her priorities, to interview the parent first! Are you kidding me?!! This was the first bell to go off in my head. The interview could have been done at bedside after initiating the first bag of fluids (drip)! By the way, I can only assume that this was a nurse as she did not define her role, no i.d.'s , no badge/pins to indicate formal training : Registered Nurse (RN) or Registered sop'm (something)! She was however in white (and so are Jamaican cosmetologists in training), but that was as far as her identification went. My sister had to ask her her name before providing this stranger other personal information. When the "nurse" was through with her interview, she managed to successfully hang the drip after several attempts in getting the air out of the tube. Kiki was becoming more and more drowsy and was by this falling in and out of sleep for several minutes (not her usual behaviour/behavior)-I don't think the nurse noticed this-or cared (last statement you'll later understand why).

It was almost 11 a.m., she (the lady in white) had done what she needed to do or was ordered to do and had left the room. There were four other patients in the room. A small boy was standing in his, what I will now refer to as a cage, and was crying uncontrollably. His hands hung over the rail of the cage, one of them still hooked up to an empty bag of fluids. Another baby by the wall was screaming as he tried to get up out of bed he tried to raise himself up as he held on to the bars of the cage. There was a two month old baby by the far window (I learned of his age after his mother came in that morning). That's another thing. Why aren't mothers allowed to stay with their babies in this already scary environment, and the rate of abduction rising in Jamaica? There was another baby, adjacent to Kiki's cage who was also sleeping, her mother was also just coming in. I sat there for a good hour, and it was only once that I saw another lady in white come in and give the baby by the wall his medicine through his cage, no comfort; no touching; just feeding him through the cage (I guess that it was his scheduled medication so it had to be done). Kiki's lady in white still had not come back to check on her or her IV site. Is the site infiltrated is it compromised? She wouldn't know because she had not come back since she hung the bag, it was now approaching 12! :angryfire

Kiki had another bout of diarrhea and the lady in white managed to peel herself from the desk to come and have a look. She directed me, an extension of the patient, to pull the baby's diaper and let her have a look, after which, I was then left to clean her myself. It was close to 1 o'clock, she still had not checked the IV site, nor had she assessed her for signs of improvement or deterioration. Kiki was still lethargic, the drip was slow and she was occasionally restless, pulling in her legs as she apparently responded to the jerk of pain in her abdomen. The nurse didn't know any of this, yet she spent most of the morning into afternoon writing in the charts. What was she writing? None of the other nurses had come in to see the other patients; no one had come in to remove the IV tube from around the neck of the baby who was standing with his hands hanging over the cage, who had now fallen asleep from crying so hard. I had already quickly shifted the tubing and made sure he was ok. By that time his grandmother had come in and prayed for him and the others (common practice at home in Jamaica). The baby by the window, his mother had come in earlier on as well, she had changed his diaper and found blood in his stool, she pointed it out to a doctor, no one checked on this baby throughout the rest of the day.

At the time of his initial assessment, the doctor had ordered an X-ray on Kiki to rule out intussuscepton-which to the medical profession is a life threatening emergency! So, let's say, the doctor saw her around after 9-ish and it was close to 1-ish...still no X-ray to rule out a life threatening emergency?!!!!!!!!!! Finally, someone is here to take us to radiology, the lady in white clamps off the fluid on the dehydrated baby whose mental status had turned for the worst! Where did this woman get her training?! I was helpless, I had no jurisdiction in this country, I am not registered here therefore I have no voice, still I could do no nothing! My mother, the nurse practitioner had met me by the lab, she asked why was the fluid not going....When we got back to the floor, we told the lady in white that we were back and if she could turn the drip back on, we waited and waited until finally after ~5 mins or so she once again peeled herself away from the desk. She still has not assessed Kiki, no neuro checks, no IV checks, no follow-up assessments. I asked the other families if they had come in to see them yet, they said no. One of the mothers said that she once asked the nurse to pick up her baby, should he start crying and he'd go right back to sleep, she said the nurse's response was that "if shi show special treatment to one den shi haffi show to di res!" (Inerpretation: "if she shows special treatment to one, then she'd have to show the same to the rest!" By the way, the special treatment would be for the nurse to occasional hold the babies. Still, the mothers aren't allowed to stay and the nurses do not tend to the babies when they cry?! Yet, in all of this all of the nurses were at the desk and were writing away/charting, what were they writing?!!!!!!!!!!!!

The X-ray did not satisfy the doctor so he ordered an ultra sound, poor Kiki was traumatized, the X-ray was horrible (this is another story all together), she hadn't anything to eat, the doctor had made her NPO for six hours since time of admission. She was only to be NPO (nothing by mouth) for six hours, which would have ended at 1500. None of the nurses had come in to offer oral rehydration. She was now apparently not getting any IV fluids because there was something wrong with the line or the site. Of course, the lady in white wouldn't know this....So we were supposed to be off to get the ultra sound, no ambulance available, still thinking that this could be a medical emergency, and the nurses were still at the desk writing up a storm!!!!!!!!!! My mother and I went to the desk to find out what the alternatives were, a doctor gave us the go-ahead to take the baby off the ward/floor as my mother was on duty and in uniform-FNP. The lady in white detached the fluid from the baby who was still NPO and had not shown any signs of improvement! The baby was still retching but because she was now so "dry" there was nothing coming up. My mother then proceeded to ask the lady in white if she wasn't going to send the baby with the IV fluids (drip) and she told her no it had to be disconnected. My mother didn't bother to debate the rationale, she simply asked the pediatrician on the floor at the time, who, being aware of this blatant medical error quickly put the baby back on the fluids and sent us on our way. And so we took our daughter/niece/grand-daughter to get her ultrasound done across May Pen town, with only the supervision of her grandmother RN, RM, FNP (Jamaica) and me, her aunt RN, BSN (Oklahoma, USA).

We're back from the ultrasound, and again we inform the nurses at the desk that we are back, none had motioned to follow us in the room to ensure the baby's IV site was not compromised or to assess her. After a good five to ten minutes, the lady in white comes to the room, passes all of us (Kiki's mother, me and her other aunt, her grandfather, her sitter, and her grandmother) without a greeting or an acknowledgement. She goes straight for the baby's IV bag to hang it and proceeded to maneuver the tube so as to get the drip flowing. As I stood there I notice something that would be considered another no-no in practice, she proceeded to "milk" the tubing as she attempted to dislodge the clot back into the baby's veins! My mother quickly stopped her and asked her what she was doing and told her that the tubing is lined with blood, the "nurse" proceeded to argue with my mother and was adamant that she knew what she was doing. Let's for the sake of reasoning say there was no evidence of blood in the tubing, even then, no one milks the tubing back into a patient especially a baby! Can someone say pulmonary embolism?! She then explained to my mother that it's the site that was compromised, I am still in awe of her skill to assess the site and identify the problem while the site was still covered with tape and bandage. Even if that were the most plausible assumption, a nurse knows that we cannot document assumptions unless these assumptions have been validated by actual assessments. By this, this lady in white had become perturbed by the fact that not only did she not know what she was doing but the fact that she was called out on it. She left the baby with the drip still connected to her hand, hung the bag on the pole of the bedside, and abandoned the baby who still had not improved since she got there earlier that day. I watched the nurse as she walked over to her desk and told her colleagues, "shi (my mother) a gwaan like sey mi frighten fi seniority, oonu can gwan een deh to har cause a dun mi dun!" (Interpretation: she (my mother) is behaving as though I am scared of seniority, you guys can go back in there because I'm not, I'm done!" This act made us question leaving Kiki, because not only like the others had she not received any care, but now would be at further risk because of the interaction with the concerned and anxious parents/guardians.

I went to the desk to voice my concerns, I had had enough. I asked one of the nurses how it was that everyone was feverishly writing away and yet I had not seen anyone come into the room where Kiki was, to make any assessment on any of the babies. I also mentioned that as a nurse, I took nothing personally when patients' families are disgruntled or aggressive it is recognized as anxiety and concern for their loved ones. Therefore it is imperative to recognize that the patient is a member of a family and a community and to be treated accordingly. By this, our frustration had reached its high, it was pass 5 p.m. and nothing was done, other ladies in white had come out of hiding and suddenly the nursing station was over flowing with curious onlookers. What was amazing, regardless of the shift change, was the fact that there were so many people at work. Then I remembered that someone had told me that during the night some of these nurses brought their nightgowns to work, or would go to the movie theater by the nurses' station. That's another question, why is there a television at the nurses station?

We called the doctor and asked for immediate discharge and follow up on Kiki's condition. It was at his office we learned that her Sodium level was 158mg/dl!!!!!!!!!!!!!!!!!!! This is a detrimentally high level for an adult not to mention a baby; the nurses should have known this and should have been performing in accordance with the standard of practice.

We took the baby home and followed the direct orders of the doctor. You might ask why not take her to another hospital, it would have been the same difference. With the guidance of prayer and faith along with use of professional knowledge/evidenced based practice by Kiki's grandmother and aunt, including the overwhelming attention given to her by both her parents and relatives, she showed marked improvement by the time she went in for a follow-up assessment at her pediatrician the next day. Babies who went in with the same condition were there from the week before and were still there the next day.

There have been a lot of mortalities at this hospital, why isn't anything done...see crime rate in Jamaica.

Thanks for allowing me to vent here!

[clauds001]

Very enlightening piece of writing. Amazing and terribly sickening state of affairs. Guess they have never been sued, eh? Seems like they rest assured that they will never be held accountable for these acts of negligence, incorrect procedures and unprofessionalism. Where is Jamaica's governing or regulatory body in all of this? Has this been brought to their attention? What about the government? The Minister of Health? The local media? The Gleaner and the Observer and TV stations such as CVM TV and TVJ?

That 'woman in white', along with her movie-watching colleagues should be removed from duty. Where in the world do you hear of things like this happening without suffering the consequences to the fullest extent? The helpless babies are there to be cared for and these so-called care givers are not even in physical contact with them? In addition, writing whatever their minds tell them?! What???

I'm sure this doesn't go for all nurses in Jamaica, but this set (and similar ones) MUST be held accountable for these atrocities!

Imagine having to run FROM the hospital to ensure better care!!! Absolutely disgusting behaviour on their part.

Thank God you all took the decision to get baby KiKi out of there! I'm positive she was saved from the worst. Glad to hear she is doing well.