Proper way of assessing pts on nights

[LisaSh]

:) Hello again all, ok this is for night nurses, mostly, but I'd love to know what other shifts think as well. I work nights in LTC, on a short stay unit, short term/rehab. In order to chart my assessments I have to assess, and in order to assess, one must listen to lungs, check surgical sites, listen to bowel sounds, and assess LOC, mood, etc. The issue is, how do we arouse the sleeping recovering patient with finesse', without startling them:uhoh3: and making them upset and/or angry?:angryfire

After counting narcs, and getting report its almost midnight and them I'm off to first rounds to do my assessments, medicate for pain, etc.

I'd like to know of the different ways that my co-nurses use to awaken patients.

Thanks so much, Lisa :)

[allele, LPN]

I'm no longer a night nurse, but I was for quite a while. I work on a surgical unit where we do full assessments q four hours for the first couple of days after surgery, by about the third night I would assess stable patients at the beginning of the night only and leave them alone the rest of the night, just look at them every couple of hours and make sure breathing is regular, rhythm is okay, etc. I apologized to the patient and let them know I was doing it for their safety and welfare. What I do now, as a day nurse, is tell my transfers out of the ICU what the routine is on our floor. I let them know that the night nurses really need to assess them often, not to mention weigh them at night (this is the protocol on our unit, unfortunately). I let them know that night nurses TRY to give them at LEAST two hours uninterrupted sleep. I also tell them that when they are woken up by the nurse, it's a good opportunity for fresh sheets if needed, a little moving around so they're not stiff in the AM (especially when they have to stand up to get weighed, also gives an opportunity for chest tubes to dump), etc. At least they're not surprised by the necessary inconvenience!! Hope this helps a bit. :) Good luck!

[Talino]

CFR 483.15 Quality of Life

(e) Accomodation of Needs

A resident has the right to -

(1) Reside and receive services in the facility with reasonable accomodations of individual needs and preferences, except when health or safety of the individual or other residents would be endangered.

One must ask - is it so inherent that these assessments be performed to protect resident from an "impending doom"? Or is it simply a facility's norm or SOP?

The assessments mentioned can be performed before bedtime and during waking hours. If a more frequent clinical observation and phy'l exam are critical, the short-term rehab may be an inappropriate placement.

[nursemary9, BSN, RN]

Hi

Been a night nurse for almost 30 yrs.

There is no way to completely assess a patient without waking him/her up.You just need to be gentle about it. For instance, when I initially go into the room, I do not automatically flip on all of the lights. I go in with my flash lite, gently waken them and warn them to watch there eyes, that I'm going to be putting the lights on. As you said, I then explain what I am doing and why. As you said, The patients who are up and about, I put them off until a bit later if they are asleep, b/c you can always get them when they waken as they are sure to do. As the nite goes on, people awaken for this and that and during those times you can do your assessment.

I work on a busy med/surg/onc floor, so it is really important to assess these patients & do a good assessment. We have a rapid turn over of patients with sometimes very rapid condition changes, so it is important to have a baseline.

Also, on my floor, we have lots of meds to be given during the night. So, sometimes the assessment can be done at that time, depending on condition or how stable they might be.

Mary Ann