Questionable practice

lpnadmin · May 23, 2005

To me, it would be demeaning (not to mention detrimental) to the patient. The risk of skin breakdown and pressure ulcers related to skin irritation and impaired mobility is WAAAAY too great. Not to mention the psychological aspects of the whole deal (the patient may think "if I'm not worth their time, I'm not worth anyone else's either"). And what if a family member or the fine, friendly folks at JCAHO came in? :uhoh21:

If I were in your shoes, I'd talk to the DON or higher if need be. Something about this just doesn't jell.

student4ever · May 23, 2005

I had a situation this past week that really upset me. Since I am a brand new nurse working on a neuro step-down unit, I have no clue if this is something "normal" or if it is as horrible as I thought it was.
One of my patients was an ex-heroin addict and dealer. He isn't the nicest person in the world, but he is a patient right now and needs care. He is an incomplete quad so he needs a lot of help with most everything.
The RN I am working with, the night shift nurse giving report, and the CNA all had negative, nasty comments about this patient. It was quite obvious that none of them wanted to take care of him.
During the shift, he called me in the room and said he needed to have a bowel movement. I told him I would get someone to help me put him on the bedpan. He told me that the nurses had been telling him to just go in the bed. He is laying on a pad...no chux...just a cotton pad over his sheet.
So, I went out and found the CNA and asked her if this was true. She said it was because it was "easier" that way. I walked away and asked the same question of the RN I am with. She said "With him, yeah..we just let him go in the bed." I must have made a face because she said "You look like that bothers you." Of course it bothered me!! I can't imagine having no control over my body and then being told to just go in the bed. :angryfire :angryfire
The RN then told me that I could go ahead and give him a bedpan but that I would be in there every five minutes if I did. I responded that this was okay because I wasn't really doing anything else at the time. I went in and gave him a bedpan.
Is this standard practice, or is it pure laziness and disrespect for the patient??? I was really shocked and upset, but I didn't know if maybe it's how things work on a neuro floor with this type of injury.
Jaimee

:angryfire To me, this is just awful nursing on the parts of those who refused to treat this patient with dignity and compassion. No matter what life choices this patient has made that have resulted in his debilitating condition, he still deserves respect and compassion. HE IS STILL A HUMAN BEING, NOT A D**MN DOG!!! Everyone deserves to be treated with care and compassion, be it the President of the hospital, the President of the US, the frequent flyer who is always on your floor as a result of failure to comply with their treatment, the druggie, the ax murderer, Mother Teresa, the 15 yo pregnant prostitue with every STD under the sun.... etc. etc. this list could go on and on. Who cares who the patient is or what they have done in the past. It is YOUR job to take care of them, make them feel comfortable, and to be a point of good in their lives, even (and usually ESPECIALLY) if there's not that much else good in their lives. Congratulations on your committment to treating people with respect and caring for your patients comfort. It's difficult to stand up to the lazy, irresponsible co-workers who may have more seniority than you. But you were a good advocate for your patient, and deserve commendation for that. Good luck with the rest of your career - may you be blessed for your committment to good nursing, and may you be rewarded for your hard work! :balloons:

Aneroo, LPN · May 23, 2005

:angryfire To me, this is just awful nursing on the parts of those who refused to treat this patient with dignity and compassion. No matter what life choices this patient has made that have resulted in his debilitating condition, he still deserves respect and compassion. HE IS STILL A HUMAN BEING, NOT A D**MN DOG!!! Everyone deserves to be treated with care and compassion, be it the President of the hospital, the President of the US, the frequent flyer who is always on your floor as a result of failure to comply with their treatment, the druggie, the ax murderer, Mother Teresa, the 15 yo pregnant prostitue with every STD under the sun.... etc. etc. this list could go on and on. Who cares who the patient is or what they have done in the past. It is YOUR job to take care of them, make them feel comfortable, and to be a point of good in their lives, even (and usually ESPECIALLY) if there's not that much else good in their lives. Congratulations on your committment to treating people with respect and caring for your patients comfort. It's difficult to stand up to the lazy, irresponsible co-workers who may have more seniority than you. But you were a good advocate for your patient, and deserve commendation for that. Good luck with the rest of your career - may you be blessed for your committment to good nursing, and may you be rewarded for your hard work! :balloons:

I couldn't have put it better!!! -Andrea

Kandee Roses · May 23, 2005

Omg! I can't believe there are people, especially nurses, out there that would treat another human being like that! Who cares what a person has done outside of the hospital in the world? A patient is a patient no matter what he/she has done. Nursing is showing love, compassion, and caring to those people that are under our care. I couldn't care less about his background! He is there because he needed the care at the time. It's a shame to disgrade anyone!

NurseFirst · May 23, 2005

I had a situation this past week that really upset me. Since I am a brand new nurse working on a neuro step-down unit, I have no clue if this is something "normal" or if it is as horrible as I thought it was.
One of my patients was an ex-heroin addict and dealer. He isn't the nicest person in the world, but he is a patient right now and needs care. He is an incomplete quad so he needs a lot of help with most everything.
The RN I am working with, the night shift nurse giving report, and the CNA all had negative, nasty comments about this patient. It was quite obvious that none of them wanted to take care of him.
During the shift, he called me in the room and said he needed to have a bowel movement. I told him I would get someone to help me put him on the bedpan. He told me that the nurses had been telling him to just go in the bed. He is laying on a pad...no chux...just a cotton pad over his sheet.
So, I went out and found the CNA and asked her if this was true. She said it was because it was "easier" that way. I walked away and asked the same question of the RN I am with. She said "With him, yeah..we just let him go in the bed." I must have made a face because she said "You look like that bothers you." Of course it bothered me!! I can't imagine having no control over my body and then being told to just go in the bed. :angryfire :angryfire
The RN then told me that I could go ahead and give him a bedpan but that I would be in there every five minutes if I did. I responded that this was okay because I wasn't really doing anything else at the time. I went in and gave him a bedpan.
Is this standard practice, or is it pure laziness and disrespect for the patient??? I was really shocked and upset, but I didn't know if maybe it's how things work on a neuro floor with this type of injury.
Jaimee

I guess the question I have is, how do you know that they were treating him that way because of his past? Make sure you know WHY they think it is "just easier"...Was it more because he "is not the nicest person in the world." ?

Not defending the practice; just trying to point out that there may be more than one way to look at the situation.

Personally, I think one of the best ways of dealing with unpleasant patients is to treat them with dignity; if you see them as a person, they will see you as a person and things will work better.

It also helps if you treat your co-workers the same way. Yes, there are ideals in how we should behave, but most of us fall short. A lot of times if you don't go along, others may re-consider their actions.

NurseFirst

kadokin, ASN, RN · May 23, 2005

I had a situation this past week that really upset me. Since I am a brand new nurse working on a neuro step-down unit, I have no clue if this is something "normal" or if it is as horrible as I thought it was.
One of my patients was an ex-heroin addict and dealer. He isn't the nicest person in the world, but he is a patient right now and needs care. He is an incomplete quad so he needs a lot of help with most everything.
The RN I am working with, the night shift nurse giving report, and the CNA all had negative, nasty comments about this patient. It was quite obvious that none of them wanted to take care of him.
During the shift, he called me in the room and said he needed to have a bowel movement. I told him I would get someone to help me put him on the bedpan. He told me that the nurses had been telling him to just go in the bed. He is laying on a pad...no chux...just a cotton pad over his sheet.
So, I went out and found the CNA and asked her if this was true. She said it was because it was "easier" that way. I walked away and asked the same question of the RN I am with. She said "With him, yeah..we just let him go in the bed." I must have made a face because she said "You look like that bothers you." Of course it bothered me!! I can't imagine having no control over my body and then being told to just go in the bed. :angryfire :angryfire
The RN then told me that I could go ahead and give him a bedpan but that I would be in there every five minutes if I did. I responded that this was okay because I wasn't really doing anything else at the time. I went in and gave him a bedpan.
Is this standard practice, or is it pure laziness and disrespect for the patient??? I was really shocked and upset, but I didn't know if maybe it's how things work on a neuro floor with this type of injury.
Jaimee

As other posters have written, good for you. No this is not good nursing practice. Although, the fact that the RN you were with said "you'll be in there every 5 minutes" makes me think this pt may have a difficult time knowing when his bowels need to move. Maybe a good compromise for this pt would be to put him on a toileting schedule. I know, this is more difficult w/bm than w/urination. Maybe some of the staff who have been working w/him for a while have an idea of when he usually has a movement. Or, maybe you could try putting him on the bedpan 1/2 hour after his meals and see if this works. This situation reminds me of some lessons I've learned post nursing school-1)Get to know your patient 2)Listen to your colleagues and WORK TOGETHER for the good of your patient.

apaisRN, RN, CRNA · May 24, 2005

Sometimes we tell patients who are somewhat incontinent to "just let it go, don't worry about it" but they always have chux under them and I always change them ASAP. It's more telling them that it's okay that they're incontinent and we won't be mad or horrified that they lost control. If a patient has the control to ask for a bedpan, the only reason I wouldn't get them on one is if there wasn't enough help to turn them without risk of hurting myself.

Telling a continent patient to go on a plain sheet is just gross, in my mind, and in this case the general attitude of the staff sounds very inappropriate.

SharonH, RN · May 24, 2005

I had a situation this past week that really upset me. Since I am a brand new nurse working on a neuro step-down unit, I have no clue if this is something "normal" or if it is as horrible as I thought it was.
One of my patients was an ex-heroin addict and dealer. He isn't the nicest person in the world, but he is a patient right now and needs care. He is an incomplete quad so he needs a lot of help with most everything.
The RN I am working with, the night shift nurse giving report, and the CNA all had negative, nasty comments about this patient. It was quite obvious that none of them wanted to take care of him.
During the shift, he called me in the room and said he needed to have a bowel movement. I told him I would get someone to help me put him on the bedpan. He told me that the nurses had been telling him to just go in the bed. He is laying on a pad...no chux...just a cotton pad over his sheet.
So, I went out and found the CNA and asked her if this was true. She said it was because it was "easier" that way. I walked away and asked the same question of the RN I am with. She said "With him, yeah..we just let him go in the bed." I must have made a face because she said "You look like that bothers you." Of course it bothered me!! I can't imagine having no control over my body and then being told to just go in the bed. :angryfire :angryfire
The RN then told me that I could go ahead and give him a bedpan but that I would be in there every five minutes if I did. I responded that this was okay because I wasn't really doing anything else at the time. I went in and gave him a bedpan.
Is this standard practice, or is it pure laziness and disrespect for the patient??? I was really shocked and upset, but I didn't know if maybe it's how things work on a neuro floor with this type of injury.
Jaimee

How can it be easier to allow somebody to poop in the bed? Then you have to clean not only the patient, but change the sheets and etc.

I have known CNAs to tell someone to go ahead and poop in their diapers especially if that person was having frequent BM's or required an enormous amount of assistance for the bedpan.

leslieanne · May 24, 2005

:angryfire To me, this is just awful nursing on the parts of those who refused to treat this patient with dignity and compassion. No matter what life choices this patient has made that have resulted in his debilitating condition, he still deserves respect and compassion. HE IS STILL A HUMAN BEING, NOT A D**MN DOG!!!
Actually, I think that if a dog were treated this way, alot of people would get pretty hot under the collar....:uhoh21:
les

JaimeeG · May 25, 2005

Thanks for all the replies. I have discussed this with lots of my friends, and everyone is of the same opinion. This was just wrong.

I went in and said hi to this same patient when I worked yesterday. He got a big ol' smile when I walked in and said "Oh..you came back to see me!" I felt really good that I could make him happy, if just for a few minutes. Poor guy.

He is now starting to feed himself, which is a big improvement, and they are talking about transfering him over to a big spinal cord injury rehab center in the Bay Area. I am hoping he can make a nice recovery and then make good choices in his life!!

Jaimee

zenman · May 25, 2005

Considering only the chances of skin breakdown, is it safer for him to lie on a hard bedpan or go in a chux and be cleaned immediately thereafter?