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.
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.
She will get help, keep encouraging her to talk and ask the charge nurse to press the regular attending physician to send a referral to the psychiatrist that the patient is willing to see when they are back on duty.
Thank you dishes (and thank you for the pm!), I needed that. It's sometimes difficult wanting to help but not being able to, or allowed to, make the decisions needed. When I'm back on thursday for my single night I hope something will have changed!
@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?
A patient on an insulin drip, I would assume is in the hospital. I admit that, with hospitals, I have only ever worked in academic medical centers with physicians in house 24/7 but there must be some chain of command to climb.
Sorry but your patient is staff splitting. She is manipulating you for attention. You need to set firm limits because it sounds like she has cluster B traits. You can still validate a person's feelings without crossing boundaries. :)
@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?
Why would the patient have to be held involuntarily? Are you indicating a PEC or other such means? A c/o or 1:1 in my state and facility does not require a LIP to asses the patient face to face or place them on an involuntary hold. A RN would call the on-call LIP, explain that the patient has S/I with a plan and the LIP would more than likely give a telephone order for the special observation and then re-evaluate in the morning. Thankfully, I work in a psych hospital with a psychiatrist on site at all times.
Just an update. Nothing had happened since I was at work 5 days ago with regards to a psych-consult. Patient said she had confided in two other nurses but I saw no notes from doctors or them. Heard some banging from patients room and found her banging her head against the door, sitting on the floor. Called the on-call who said he would write a note and so did (finally someone) but didnt come to see pt. I wrote another extensive note about it. My work really frustrates me sometimes. I'm not a psychiatrist so I won't presume pt has some personality disorder or whatever like that, that's up to the psychiatrist to judge. Even if a pt would be manipulating and is self-harming I have to take it seriously until she has been assessed in my opinion.
At least the other doctors will see the on-calls notes and it will be less easy for them to ignore it. I'm doing my best to handle my first case of a pt who is like this so give me a break and serious suggestions and examples of HOW to actually handle it better instead of remarks like "You can still validate a person's feelings without crossing boundaries." Thanks. :-) I'm sure you too can remember how it was before you knew it all!
dishes, BSN, RN
3,950 Posts
She will get help, keep encouraging her to talk and ask the charge nurse to press the regular attending physician to send a referral to the psychiatrist that the patient is willing to see when they are back on duty.