Today I had a bariatric-size patient on med-surg floor. CA pt comes in for BSO. Large vertical abd incision dehisces and resists healing. Her health is not improving after a month in hospital and a short stay in ICU. She is very high maintenance. She needs to be toileted every 20-30 minutes (diarrhea) but she's unable to get to commode or bedpan without help. It's a 2 person assist (200+ lbs unsteady weight) but she doesn't want us using the lift. She's in constant pain "all over". She's got IV, central line, 2 nephrostomy drains, ilieal conduit drain, O2, and woundvac lines that she keeps tripping over and being upset about. She wouldn't ambulate so she ended up with DVT. Contact precautions because she's now got an infection. Also has a skin yeast infection in her folds because she can't shower or keep clean enough. Bedsore risk due to immobility. Edema isn't improving. Having trouble regulating body temp and needs a fan or a blanket brought to her on and off all morning. In short, she just needs alot of nursing care.
Today, as a student nurse, she was my patient. For the first time in this facility, I felt like I could not find my primary nurse or my aide. For my entire shift, I saw my aide once and then I swear she hid from me because I could NOT find her anywhere. After talking to my classmates who had her over the past few weeks, turns out they commented the same thing: nurses HIDE from this one patient. At one point my primary refused to get me pt's pain meds because nurse was "too busy", and she sent me to go beg help getting the med out of the Pyxis from another section's nurse. What was my pt's nurse doing that was so important? She wandered off to watch a new product demo at the other end of the unit when a vendor wandered through.
So, to use this as a learning opportunity, I had some questions:
Is there a good way of addressing it so that this pt gets the level of attention she needs? Was it a hospital policy issue (# pts per nurse) or something else? Is this common in some hospitals to treat a high-needs pt the same way as everyone else, not allowing for the extra attention she needs?
Any tips on dealing with pt when you can't get a helper but she's a 2 person assist -- but she throws a fit about the lift sling. She's also having explosive diarrhea, so even if I used the lift to get a commode or bedpan under her, I have no way by myself to lift this large woman off the sling enough that she can access the commode. She refuses to stay on the commode more than 5 minutes because commode is not bariatric-sized and pt states "it's too uncomfortable", so we'll get her back in bed, and 10 minutes later she starts asking for the commode again.
Any words of wisdom for me? Right now I feel disturbed to see a patient who needed care so much being avoided as the 'problem' patient. Was the staff at fault? Or where they good people just overwhelmed by the situation, and it's management's fault for not staffing things better?
If you were her primary nurse, is there anything you could do to improve her overall situation? Could you call a case worker or your supervisor to share concerns?
