PCloudy

Hello to everyone. Just 2 weeks ago, our "in touch" administration mandated open visiting hours. We have tried to be positive but our experience so far has been unbelievably negative. Families are largely inconsiderate and we find ourselves trying to instill some common sense and guidelines for appropriate behavior in the critical care settings. We have had everything from rubbernecking during procedures in other patient's rooms to significant other's climbing in the bed and exploring under the covers when the pt is on contact isolation. I am firmly convinced that our society shows pathetic signs of exponential rise in the numbers of really stupid people. We have small rooms that not only have to accommodate the pt (frequently bariatric in nature), vents, IABP's, CVVHD machines, cooling blankets and any number of other pieces of equip.....but 9-10 (or more) family members that insist on waking the pt from a propofol siesta to agitate them to the point that interventions are necessary. We have found that the family members expect flawless care and attendance by the nurse and doctors but they can't pry themselves away from the side of the bed long enough for the staff to get within arm's reach of the pt. It's only a matter of time before a back injury occurs because these single digit IQ's can't see the need in giving us some room. It's hard enough to drag a limp (or stiff - equally as difficult) body around in bed when there is very little room to begin with. In the last 2 weeks, we have had 3 people give their notice and are moving on to other areas that have reasonable visitation. They are tired of wiping butt only to have 3 people barge through the closed door while the pt is uncovered. Somehow, I doubt that these visitors make the pt more "comfortable." I could go on forever. I, too, have applied for a job closer to home and with appropriate visiting time so that we can get our work done and the pts can have time to rest between the parades of well-meaning family and friends. Our hospitalists and cardiologists (among other groups of MD's) have serious complaints that have been voiced to our administration (in vain). Naturally, the ones making the rules don't have to contend with the fallout.

Hello to everyone. Just 2 weeks ago, our "in touch" administration mandated open visiting hours. We have tried to be positive but our experience so far has been unbelievably negative. Families are largely inconsiderate and we find ourselves trying to instill some common sense and guidelines for appropriate behavior in the critical care settings. We have had everything from rubbernecking during procedures in other patient's rooms to significant other's climbing in the bed and exploring under the covers when the pt is on contact isolation. I am firmly convinced that our society shows pathetic signs of exponential rise in the numbers of really stupid people. We have small rooms that not only have to accommodate the pt (frequently bariatric in nature), vents, IABP's, CVVHD machines, cooling blankets and any number of other pieces of equip.....but 9-10 (or more) family members that insist on waking the pt from a propofol siesta to agitate them to the point that interventions are necessary. We have found that the family members expect flawless care and attendance by the nurse and doctors but they can't pry themselves away from the side of the bed long enough for the staff to get within arm's reach of the pt. It's only a matter of time before a back injury occurs because these single digit IQ's can't see the need in giving us some room. It's hard enough to drag a limp (or stiff - equally as difficult) body around in bed when there is very little room to begin with. In the last 2 weeks, we have had 3 people give their notice and are moving on to other areas that have reasonable visitation. They are tired of wiping butt only to have 3 people barge through the closed door while the pt is uncovered. Somehow, I doubt that these visitors make the pt more "comfortable." I could go on forever. I, too, have applied for a job closer to home and with appropriate visiting time so that we can get our work done and the pts can have time to rest between the parades of well-meaning family and friends. Our hospitalists and cardiologists (among other groups of MD's) have serious complaints that have been voiced to our administration (in vain). Naturally, the ones making the rules don't have to contend with the fallout.

2/12. Amazingly enough, I was working ER and noticed that the 8 month old brother of the ER patient looked way more ill (white as paper) than the sister that didn't even belong in the ER. Convinced the parents to check in the baby and found him to have the HH 2/12. He was starflighted to the nearest pedi ICU with a scalp vein (that I started) and blood infusing. Turns out that he was extremely malnourished. Parents had been diluting formula and so on. The ER doctor later said it was a good call as she hadn't even noticed the baby since she was focusing on the sister. Sometimes it pays to be aware of your surroundings. Needless to say CPS was involved on that one.

tencat - Thanks. It was well worth the uphill battle I had with administration to make it happen. I hope someone does the same for me someday (not anytime soon though!). I actually had a number of fellow nurses (and people from other depts) come up to me in the few weeks after that saying that they were glad that I was the nurse....saying that if they'd have had the pt, it wouldn't have been that way. I'd like to think that anyone would make it happen but I had the luxury of only having that pt that day and I can be a bit on the assertive side when I put my mind to it. Plenty of people (ahem - our caring administration) said no but I wasn't willing to make his last wish only a dream. You only have one chance to get it right. Those last few hours will be forever in the memory of his family. Thanks again for the kind words....PC

Perhaps "pro-death" is a bit strong. I think you got the idea though. Maybe "pro-last wish" or something of that nature is more suitable. I was just reading all the arguments and so forth thinking that I might could add a slightly different twist on the topic. I have witnessed family members throwing themselves on the floor, collapsing in the pt's room or the middle of the unit and so on. My concern with that is that we have lost one member of that family and we need to keep the others safe - grieving or not. I am ever aware that grieving and the sometimes total shock of losing a loved one - especially unexpected (even expected deaths bring a variety of reactions) - may cause brief moments of what would otherwise be classified as insane behavior in the survivors. I just try to keep them safe - to avoid syncopal episodes and causing themselves injury - or other such reactions in the particularly thesbianistic family. Some of the variances - as pointed out by many - are cultural in origin. Whatever the case may be, it's an isolated incident that is likely not to occur on a daily basis so chalk it up to experience and move on. ~~PC~~

I almost think this hostile thread needs to be deleted. It seems most are trying to out do the others. I am very pro-death and try very hard in my job to allow family members and the patients the decency of having death as conducive to their wishes as humanly possible. For those of you that need an example, the first one that comes to mind is a man that I took care of for weeks in the ICU last year. He was septic, MSOF, ESRD on CVVHD and was on everything that would fit in the room short of a vent (at that time he died - he had been on one earlier that admission). There was no hope of his recovery and he was well aware of that. His family wanted him to be a full code but the pt disagreed. To make a long story short, I had to (over several days) get his team of doctors together, involve pastoral care, get his family in (some from out of town) and make plans to allow him the best possible death in the hospital setting. His wishes were to die outside under the trees while he heard the birds singing. That had never before been done at our hospital and I met up with incredible resistance. I planned with him (as close to down to the moment as possible) for two days. The morning that he decided that he wanted to die, it took several hours to get his family in at that time, turn off the CVVHD and get cardiopulmonary and pastoral care that I would need their help. He would need several O2 tanks as he was on a NRB needing >10L flow. Well, after two dry runs with two different stretchers (had to find one that would fit through the courtyard door), coordination with the OR (since we had to go down that hall) and L&D (they were the other side of the courtyard), he was ready to make his final journey. We planned to leave the pressors on outside until he decided that it was time to turn them off (knowing that he'd last only a few minutes after that) so we had to take several triple pumps outside as well. We got him out there, placed him under the large tree that he had selected from the ICU room, watched the birds, went through several O2 tanks, visited with his family, looked at family pictures, ate ice cream (that his son went to get at a local Baskin-Robbins which was closed but they opened the doors just for this occasion) and prayed. I stayed with him the entire time and was on phone contact with the unit, RT, etc so that he could have his needs met. After nearly two hours in the blazing heat (Central Texas), he decided that he was ready and asked me to turn off the IV's. In less than 30 minutes, he took his last breath with his family all there praying over him. A remarkable event after they sat and told me repeatedly that they just don't understand why he wanted everything to end that way. I had lengthy discussions with them after which they thanked me endlessly for making their loved one's last wishes happen. He was a 1:1 pt because of the CVVHD but it should be noted that my manager ran up to me as soon as I returned the blood and turned off the CVVHD stating that "Good he's not a 1:1 anymore." All she was concerned with was staffing issues. Nevermind what was best for him. I told her that he'd continue being a 1:1 until he died which could be in 1 hr, 5, or 10.... I am VERY sensitive to the dying issues and the fighting that appears to be going on here on this thread is getting old. Before I close, yes, I have personally experienced death far too many times as have my children. I held the hands of two grandparents and a best friend as they died. My kids father committed suicide when they were 8 & 7. My oldest daughter lost her 2nd grade science teacher to an accidental drowning as well as a close friend from suicide when she was in the 7th grade. My daughter's beloved kindergarten teacher that we had remained friends with, died of breast cancer that had mets to the brain less than one week before she graduated from high school. Her former teacher wanted to live to see her graduate. My brother's best friend lost his 5 year old sister when they were in high school - she drowned in their backyard swimming pool. I can go on here - there are several others but you get the idea. Try not to judge and to take comments so personally. Everyone has a different level of experience and exposure. I'm not proud to say that I have experienced way more than my share of death nor am I condemning of those that haven't. The death rate on Earth is 100% - always has been, always will be. Those that have not experience death as yet, will eventually. Lets move on to something else, shall we?

Yes, there are lots of means of tuition assistance out there (you just have to look for it). I went to a two year college for my nursing degree. I was denied entry at first based on a speech impediment. It was bad at that time but the Texas Rehabilitation Committee went to bat for me and, not only gained my admittance, but paid for my school as well. I never imagined that having a handicap of sorts would be to my benefit. I have since gone back for a BS in Biology that I decided to do after my divorce when the girls were 2 yr and 3 mo. My family (expecially my parents) was a big help, I worked and went to school full time. My job was 60 miles from where I lived and I worked evenings (in an ICU) to be able to go to school all day. My youngest didn't sleep through the night until she was 18 months old. Both girls had some serious asthma problems when they were young. I had to charge much of their medical care. They are now 18 and 16 and I am still paying off the bills that I acquired when they were young and I was in school. What's worth having is worth working for. I you're dedicated to the cause, you'll find a way to make it happen. I, too, was in a nasty (abusive) marriage which is why I was divorced when the youngest was only a few months old. I would have been divorced a year sooner but once I filed, I found out that I was pregnant and the court wouldn't allow my divorce until the baby was born. My ex died when the girls were 8 & 7. I have been in a great relationship the last 5+ years that has resulted in a third child (now 4). My partner is very emotionally supportive and has been wonderful with all 3 kids. There is more to the story but I won't bore you all with it here. I am thankful every day that I am alive and have the ability to make choices no matter how bad things seem at the time. Best wishes to all.....PC

:melody: that's one of the best terms i have heard lately. definitely could be used in numerous situations.

Sometimes guilt accentuates grief. Various cultures display grief in various ways. We just had an experience last week where we had to pick family members up off the floor and call for help with managing the crowds.

That is so true. You can't make excuses - you just have to want to survive the bootcamp called nursing school. I started with 56 in my class and we graduated 12. If I had it to do all over again, I'm not sure that I would. That's difficult to say since I started at age 17 and am now 45. I did take a short break from full time nursing to teach high school. I prefer bedpans over that without a doubt. I am trying to decide right now if I should continue in nursing - risking another spinal fusion or worse - or retraining to do something else. Nursing is an interesting profession but there is no glamour in it. I suppose, as a CNA, you are well aware of that. There is some truth in the saying "where there's a will, there's a way" but you have to decide if the battle is worth the fight for you. There are some posts here that give you some ideas on financial aid and so on. Some facilities provide tuition reimbursement to further your education. Depending on where you work, they may pay for your school if you commit to a certain number of years after graduation. I wish you well.

That is so true. We have to walk through a hard hat construction zone to get to and from our cars. I wonder what OSHA would think about that? Anyway, we have only the one ICU but we're going to move into the next tower when it's finished - supposedly in April 2006. They have been telling us it will be in 18 months for about 10 years now. At least they poured the foundation today. We have to float out to almost every department but rarely does anyone float in. We want to be a closed unit but the stepdown management is so bad that they can't keep staff. It's easier to use us. I am one of 2 people that also works ER so I freq float there. I'd much rather do that than to go to the floor and have 6-8 crazy patients to deal with plus eMar. At least ER is eMar free right now. I'm trying to get PICC certified so that I can venture out some and, hopefully, get into something a bit less hazardous than bedside nursing. My manager is soooo helpful. She came in at 1030 today and left at 1215. She worked hard for her $. We should all be so lucky.

This guy must have another income as well...most trench nurses I know are not weathy by any means.

We used to have typanic thermometers in our ICU but it was noted that there was a huge amount of user variance. If the thermometer is not positioned just right, the reading was off. I notice that many people are not that concerned about temp. They take an axillary temp and get, say a 96 F, and chart that. I have come along right behind them and got a very different reading. You just have to use your good sense. When in doubt, check it out - try a different hole.

Hi - thanks for the reply. I will start over as I accidentally lost the last explanation before it was "posted." In this country - I am guessing that close to half the population would be deemed as overweight. It's my understanding that the percentage of "morbidly obese" people is about 2.2% of the entire population which means that roughly 5 million people could be classified as morbidly obese in the United States - something that we are definitely not proud of. Morbid obesity is defined as having a BMI of 40kg/m2. In the average person that would be approximately 45kg overweight. That's highly variable. Bariatric refers to the care of morbidly obese patients. This requires special equipment and large beds, etc. Hill-Rom (a major manufacturer of medical equipment) is now developing a bed to accommodate a 1000 lb (455kg) person. It's truly unbelievable. When I visited the Hill-Rom factory in Indiana last Oct, we fit 3 people comfortably in one of the larger wheelchairs. I took a picture that I can email to you if you'd like. Can't put it here. In the US, obesity is a national epidemic. There is exponential growth in diabetes (especially Type II - even in young kids). I doubt that you have seen someone THAT large in the UK. I visited a friend in Manchester a few years ago. I was about 53 kg at the time and I was generally the largest person anywhere I went with few exceptions. Here, that is relatively small by comparison. We went many places between the Lake District and London. I could go forever about this topic especially since it directly affects me - and will continue to affect me. Although I have no problems to speak of from the cervical fusion last year, there is the ever-present risk of having the same thing happen again. The patients are only getting bigger all the time. Did I answer your question or am I simply rambling? Sorry.

When I got out of nursing school. Someone that weighed 300 was enormous. They were an oddity. Now the norm is around 600 it seems. Try a 5'1'' woman that weighs 850. You can easily get lost in there. Doing pericare generally takes about 6-8 people. That many spare hands is hard to find. Nevermind the spelunking equipment required to place a foley. There's no easy solution but our bodies we not made to carry that much weight nor to care for that much weight. Routine exam gloves are useless...they only get filled with yuck. Can't buy calving cloves in this country unless you're a licensed DVM. Where are the UFO's when you really need them (just joking)??