Hello my follow nurses! I am wondering how you would handle this situation:
Patient in its 20s. Has severe type 1 diabetes with resistance to sc insulin. Taket 250 E doses with not much effect. Has lost 2 pumps due to infection. Is now since 1 month stuck at my ward with continious glucose/insulin drip, can go from 12 to 30 in p-glucose in 2 hours without. Is very private and does not say much.
Has however warmed up to me and we have talked quite much. Has evident suicide ideation, wont verbally say it but nods when asked. Also has suicidal plans. Self-harmed by banging head against bed post. Did not want me to tell anyone due to being afraid of psych, has not had a good experience with them. I told the day nurse about it yesterday. Tonight pt actually called for me when the anxiety got too much which is huge for being this patient, did not self-harm since our last conversation. Patient obviously needs help.
Agreed to me telling day time nurse who in turn could speak to the doctor but did not want to talk to them personally which i said would be difficult cause they need to assess. Patient wished I would work more, feels no contact with the other nurses but yeah I am off now for 10 days. Well I am slightly groggy now but how would you handle a patient who confides in you like this? I am concerned and wish I could do more. I did strongly encourage the pt to be honest if it gets too much and that the only way to avoid psych at this point is to accept treatment.
I completely agree with KelRN215, this patient needs at least constant observation, if not 1:1 sitter. SI with a plan is not something to dilly dally about. I would get an order immediately.
I was really scared, thinking "does this nurse not understand the LAW?" Then I read you are in Sweden. Im sorry this is a very frustrating situation. Here in the US we are required by law to document and report it. The patient would immediately have a psych consult and be placed on continuous observation. The physicians are also required by law to intervene. The rule here is if the patient is at risk to harm themselves OR OTHERS we must document, report, and intervene.
It is a really uncomfortable situation to be in. We as nurses develop very close relationships with our patients and they confide in us. It feels like a violation of their trust: but we have to think of their safety first. I always say; it's not ABC, it's SABC. That includes YOURS, too, btw.
@kelrn & sarahmaria Where would you get the order from if the on-call w/e physician was not willing to come in, assess the patient and sign the legal form to hold the patient as an involuntary patient?
@kelrn & sarahmaria Where would you get the order from if the on-call w/e physician was not willing to come in, assess the patient and sign the legal form to hold the patient as an involuntary patient?
This so much, I have nothing to say about it when the on-call doctor won't do anything. I reported it (and I'm also obliged to) saying this worried me and that she was not in a good mental state. But I got nothing in return, now my back is "free" but the patient still hasn't gotten help. It gets quite lonely as a nurse in the night (I got 18 patients with 1 on-call manning ER plus 3 medical acute wards). I strongly advocate for my patients but can't do much of anything besides giving the best possible care if the doctor decides it. So I sat with the patient half the night because luckily I had a really calm night and most were sleeping soundly, no critical patients, and barely any IV meds to give. So I do not dilly-dally and I thought I was clear that I found this very worrying and serious. Else I wouldn't have two mornings in a row really pressed the issue with the day-time crew.
@kelrn & sarahmaria Where would you get the order from if the on-call w/e physician was not willing to come in, assess the patient and sign the legal form to hold the patient as an involuntary patient?
I know what you are saying, and I agree on a semantics level, but this situation needs to be escalated in some way. I'm not sure how, either.
I would also let night nursing sup. know and document, try to follow up on days, document.
The confiding. I have kids confide to me all the time, that there is sexual abuse, drug use, suicidal ideation, etc. I escalate it every time. If I didn't, I should be fired. It's not about me being their confidante, it's about the kid (patient) getting help.
You did the right thing hybr1d, the patient is a voluntary patient, admitted for a chronic medical condition, who is also dealing with undiagnosed mental health problems but is willing to see a psychiatrist outside of the hospital. PS did you see my PM to you.
I'm it at the night, no sup or anything. I have a ward by myself and there's no other nurse on the entire floor (used to be one on the other ward but they closed it due to lack of nurses). I know it's very differently organized in my little corner of the world than in US. Had that discussion sometime ago :-) I really hope she will get help tomorrow when the new week starts and the doctors man the same ward for rest of the week since it seems the doctor today didn't do crap
I know what you are saying, and I agree on a semantics level, but this situation needs to be escalated in some way. I'm not sure how, either.
I would also let night nursing sup. know and document, try to follow up on days, document.
The confiding. I have kids confide to me all the time, that there is sexual abuse, drug use, suicidal ideation, etc. I escalate it every time. If I didn't, I should be fired. It's not about me being their confidante, it's about the kid (patient) getting help.
When you escalate do you mean you notify the kid's family? GP? or send them to emergency department for an involuntary admission? I always share mental health concerns with the attending physician and team. The physician determines whether or not the patient is in imminent danger to themselves.
When you escalate do you mean you notify the kid's family? GP? or send them to emergency department for an involuntary admission? I always share mental health concerns with the attending physician and team. The physician determines whether or not the patient is in iminent danger to themselves.
I'm in a school setting so the first thing I do is call psych
Unless they are actually high, deep cuts, etc. Then we call 911. Only had to do that once.
Psych takes it from there. Usually parents, ambulance, psych hospital, etc.
@Farawyn, Thanks for the information, we don't have school nurses where I am, so I wasn't sure what the school nurse's protocol is in these situations.
@Farawyn, Thanks for the information, we don't have school nurses where I am, so I wasn't sure what the school nurse's protocol is in these situations.
No. If a kid is in danger, we escalate.
Mind you, there are high kids that are just high and then we call the AP.
SarahMaria, MSN, RN
301 Posts
I completely agree with KelRN215, this patient needs at least constant observation, if not 1:1 sitter. SI with a plan is not something to dilly dally about. I would get an order immediately.