patient advocacy

missmollie, ADN, BSN, RN · Nov 23, 2014

One example: I asked a patient her pain on a scale of 1-10. She said a "7", showed signs of distress with grimacing and guarding when she moved, BP was elevated, and her respirations were elevated. She had a chronic disease that had landed her in the hospital quite a few times in the last several years. I asked her when she had last had pain medication, and she told me she didn't want to ask for it because she didn't want to be compared to those people who would just come to the hospital to ask for pain pills. This lady was legitimately in pain, had no record of pain pill abuse, and she was worried what the nurses and doctors would think of her.

I taught her about pain, about the methods we could use to relieve the pain, and then I went to the nurse and reported what the patient had said to me. I don't know if it was easier to talk to me because I was a student nurse, but she confided in me and I had to do something for her. I asked the nurse to call the doctor and request pain medication. The nurse did not question my request, and called the physician. My patient had pain medication administered via IV, and later that day she thanked me profusely. Her BP, subjective pain assessment, respirations, and physical manifestations of pain decreased.

I had to advocate for my patient to herself, my nurse, and the nurse to the doctor. Advocating is doing what is right for the patient, and sometimes overcoming barriers (like the knowledge deficit my patient had) to get the care or treatment needed.

rob4546, BSN, MSN · Nov 23, 2014

Had a patient that was over 300 lbs., confined to a wheel chair due to bilateral below the knee amputations, and in for removal of tumors in the left arm. CRNA, Surgeon, and patient decided on a block for pain control during and after surgery. After thinking about the situation during charting I went and stopped the procedure for reevaluation due to the fact that the patient would loose control and strength of the dominant arm resulting in the inability to care or transfer himself from the wheelchair to the bed (outpatient). The result was switching to a local block in the arm so that the patient would not have to be admitted until the block wore off and he could continue to care for himself at home.

Funny how the little things are missed. No one thought, not even the patient and mother, about how he would get into bed once they got home if he didn't have any strength in his arm. What if he needed to transfer to the toilet?

KelRN215, BSN, RN · Nov 23, 2014

Patient less than 24 hours post VP shunt replacement (not revision, full on removal of an old calcified shunt and placement of an entirely new system)- had required a TON of IV pain meds overnight. Resident decided that she was ready to be discharged and could go home with nothing but Tylenol for pain. I refused to discharge her until she was given a prescription for PRN Oxycodone. Had to go above his head to get the prescription and emailed the patient's primary Attending telling him he needed to follow-up with his Resident about appropriate post-op pain control. *Side note, this Resident never gave me this problem again after this day.

Different patient, same resident, same day- child s/p untethering of tethered spinal cord. Had required morphine, valium, tylenol and oxycodone overnight. Our hospital had a policy that children could not receive toradol until 24 hrs post-op. The night nurse and I discussed during report that we should get her on it as soon as she could have it as toradol usually made a big difference for these patients. For reasons known only to him, the Resident flat out refused to write for it. Spent all day arguing with him about it, finally went over his head and got the order and then, whaddya know, the patient's pain was controlled overnight that night with toradol alone and she went home as soon as her activity was advanced to ad lib.

The strangest advocacy/victory you can do/have for a pediatric patient is advocating for her to be removed from her home. I have personally been the one who filed the report with CPS that led to a child being removed from her mother's custody once (in the hospital we had social workers and a child protection team for that)- 3 days after Mother's Day this year- and it was by far the strangest victory of my career when they took her, but it WAS a victory.

NurseGirl525, ASN, RN · Nov 23, 2014

I have advocated for patients who have had differing problems ranging from impaired skin integrity to pain. At the facility I am doing clinicals at, it seems like the only the nurses get to do are med passes. They just have so many patients assigned to them that when the one comes on duty at 2 all she does is pass meds on the hall I am assigned to. I had a patient who was so nauseous and sick the other morning and wanted to talk to a doctor. I went and found her nurse and she said the doctor wasn't assigned to her that day. I informed her that she was very sick and that she could not even get out of her chair without feeling like she was going to vomit. She had the doc see her that day. Another one had terrible skin issues on her feet. I again went to the nurse to get her to do a skin assessment so the feet would not get any worse. As students, I sometimes think we get to interact with the patients more because we have so many things to practice and maybe pick up on stuff that these overworked nurses can not. They honestly could use just one more nurse at this facility to just perform assessments and collaborated with the other nurses on treatments that should be done on these people. Unfortunately, money comes before anything else.

nicky12 · Nov 23, 2014

Thank you guys soooo much for these detailed examples!!! :-) They are all very helpful! Thank you so much again!