I may get a lot of flack for this from the more experienced nurses, but I would like some help in understanding this situation.
Today, I walked by a patient's room in the hallway. Keep in mind she is not my particular patient today. She calls out to me in a frail voice for help, and sounds like she is in very bad shape. I go in to see her and she is crying, and very frail. She must have been in her 80s or even higher. She stated that she could not move her arms, and that she was desperate for some water. My first thought was that she might have been having acute MI or something similar because she couldn't move her arms, I really didn't know. I held her hands quickly and asked if she could feel my hands in hers. She said she could, but that she can't move her arms, and continued to cry and beg for water. She kept saying that she did not know where she was or why, and to please help her.
At this point, I noticed the restraints. She was strapped into her bed, this is why she couldn't move her arms. I was horrified. This is a med/surg floor, not a pysch ward. I asked one of the tele people what was going on and they stated 'it's just some crazy old woman, she's weird don't worry about her'. I asked her nurse and this was the same answer I got from her, again. She stated this woman had previously tried to pull out her IV and so they restrained her.
So...
Help me understand. They clearly had to get an order for these restraints. Why did they not choose a chemical restraint or sedative instead of strapping her into the bed? Why does no one care about this woman, writing her off as a crazy old lady; when she is, in reality, a frightened human being who was strapped into her bed in a strange place and scared to death. Not to mention thirsty, as she was apparently NPO and no one would explain to her why.
I went into the stairwell and cried for about 5 minutes. This is not why I wanted to go into nursing. I see things like this every day, but never this bad before. Restraints! They strapped this poor woman down and wouldn't explain anything to her. I spent some of the rest of the day talking to her and trying to help her relax even though all she wanted was to get out of bed and get some water.
It broke my heart. And if this is what nursing means, that eventually you become so burned out that a fellow human being suffering in one of the worst possible ways becomes just some 'crazy old lady', then I want no part of it.
If it is done with the patients best interest, and you tried but can't get a faimly memeber to come in and sit with the patient, and nothing has worked. then with proper placement and policy followed, offering beverage, food, checking for circulation, getting that order from the doctor, making sure the restraint doesn't cause more harm, explaining to the patient every time you go in there to check why they are in place, everytime...as even though you think they don't get it...somewhere somehow they need that reinforcement....and document everything in a timely manner...if you have tried every single thing, and you follow policy...then and only then would I agree with restraining.
I had a patient come to the floor with restraints on, the nurse from vascular say...she has restraints on but there isn't an order! an odacity of a professional! If I wasn't so totally short staffed I would have reported that nurse and she needed to be reported or had a talking to to make her understand, that is against the policy. Never ever do that. If you have to stay with a patient until someone can get an order, better to do that than to break policy. How many patients have hung themselves, how many patients have done harm with the restraints. Always think, why are we nurses (hopefully because we want to provide care to everyone) and why is the policy in place. What would we want if that was our loved one in front of us. That's all....all common sense and morality.
We aren't nurses to throw our authority around, we are nurses to provide care and to do no harm first of all.
So you have never done anything in a patients best interest without an order?? I find that hard to believe. Getting an order before making a independent and/or urgent decision and rigidly following policy, yes, covers you legally but in my opinion does not make you a more caring nurse. What if other patients are put in harms way while you sit by this patients side waiting for the doctor to phone and give you an order to let you know that your decision is okay?
What about the patient with a high temp whose doctor forgot to write a tylenol order and it is 3 in the morning, or the patient who can't void who you scanned for 900mLs and doesn't have a straight cath order. Where I work these are nursing decisions that we would get a new one ripped for if we didn't do without an order.......... and on our unit this would include the use of restraints.
I don't know....... in a perfect world patients wouldn't need restraints and doctors would be standing by at our beck and call to write all the orders that we need when we need them....... but, we all know the rest.....
In my state and at my facility, I can legally initiate restraints, but a doc needs to see the patient and evaluate the need within an hour. Of course, what really happens is I call the doc and they sign off on it. So far, I've never had a doc veto my restraints, but a few have ordered restraints when I might not have. I say might not have, because leaving them off can be as much a gamble as putting them on.
I had a real dilemma, one shift, when I picked up a patient in 4 point "leathers," (actually, hard vinyl) with no doctor's orders, but in the custody of a deputy sheriff. Most of the time I had him, the patient was too unconcious to care, and the described behavior that led to the restraints seemed to justify them. But I'd have been a whole lot more comfortable if the officer had been using his own restraints, rather than ours.
It's funny, because I'm a real bleeding heart liberal, but I really, really didn't want to interfere with a law enforcement officer. I wasn't mad at the patient, didn't hate the patient or even particularly care whether he deserved to be under arrest, although it sounded like he probably did. All I know is that he was treated humanely, and I feel pretty sure I'd have raised a fuss if he hadn't been, but him running loose would not have been safe for the staff, the deputy, other patients, or even the patient/prisoner himself.
There are many things you do not need an order for in my unit but restraints? no...that is a state reportable violation...and you can't just get an order over the phone....you need to have that doctor come up and visually see the patient before he signs the order within 60 min or you need to take off the restraints....and yes the order needs to be signed. We follow that rule in my facility to the T. When in Rome...you know.
I have parameters that I can work within according to policy...restraints aren't one of them where I work. Everything is a judgement call of course. I did what I thought was best...I got her two daughters in the unit by her side holding her hands and distracting her. We don't allow visitors, I wouldn't lose my license for that, just get scolded. I thought it was a win win...the pt. got to be with her daughter, I didn't break a medical policy and the patient didn't get intimidated from the restraints. The love of her daughters was much kinder. I had an easier nightr because they were there.
If I didn't I would have called a supervisor to come up with a remedy or the director of our unit who is awesome.
If I threw those restraints on and any injury came to her it would be my RN license threatened. If I lost my Rn I would then truly not be able to help anyone. That would be a shame for sure. So I have one eye on the patient, one on the policy, one on the short term and one on the long term effects and goals.
We do have leeway but hardly ever have to worry because it is a teaching hospital and Drs and NPs are in and out all day long, several times. Also, I could have had a nurse or an aide come until I got help. I was able to actually remove the restraints which was the best case scenario. I did get the order in case anything changed.
There is no perfectly right or perfectly wrong decision or call. Each and every nurse has a patient before them and makes a call...your call may have been to get the restraints on and get to the other patients. I knew where I was with my scheduling. My patients are all visible practically which is different than rooms off a hallway. I became a nurse especially to be loving and kind and give good care. That isn't a crime, If you became a nurse to get the most efficiency out of your day...then that is okay also and I have to respect that. I would support you with that if that is your style and the patients were cared for.
When I first started this job I was always putting one patient on, setting the next up at the same time. My boss said not to be in such a hurry with patients and the most important thing to her was recording meds we took out of the system right away because that is where we are losing large amounts of money. If that is there concern, I am happy because I never forget, or try never to forget recording a med. Some of our little vials are over a thousand and the stronger doses even more. If the amount not recorded is as stated, I see where she is coming from and I would be more than happy to "take my time" for the patients benefit.
I think your scenario could work, but mind did also. So there doesn't have to be a right, there doesn't have to be a wrong. Nurse need to stick together in a respectful sisterhood and with a positive attitude. I don't have to even think if one is right or wrong. But one thing I won't let another nurse dictate how I will treat my patients. I use kindness and understanding, a little goes a long way. I feel that a few min. of that can save you so much time later and saves legal action later.
Every facility is different, budgets, and acutity. I chose this place because they have the best of everything for the patients and the pay is also great at the same time....another win win.
I will not compromise my morals for anyone or anything, I am true to what I stand for every minute of everyday. I know there are a lot of situations where I coudn't work because of that.
I had an 18 yr old daughter die because of short staffed overworked medical staff. so you know exactly where I am coming from.
Of course, laws vary a bit from state to state, and policies at various facilities can vary considerably under the law--that is, a given hospital or nursing home may have more stringent rules than required by law.
That still leaves some room for variation from nurse to nurse, as well. I've felt, at times, that some of my peers were a bit quick with them, but in at least some cases it may be because they are more experienced, and not necessarily more burnt out.
One thing I've always had a problem with is hearing people say, "If you don't stop doing that, I'm going to have to tie your hands..." or whatever. It's appropriate to keep a patient--even a confused one--informed of what's going on with his care, but too often it sounds like a threat to use restraints as a form of punishment. Our law and our policy permit the use of behavioral restraints, but on our unit we only use med-surg restraints--i.e., to protect the patient and facilitate treatment. Mostly for pulling at lines and drains, and usually more "serious" lines than peripheral IVs. Some use restraints to prevent falls, and I have, at times, but we're told evidence-based practice says restraints don't reduce falls, and my own experience suggests they can make falls worse than if the patient fell unrestrained. I believe restraints can prevent a fall, if you apply them correctly and continue to perform the measures you would if the patient weren't restrained, like frequent checks and reorientation. Leave a restrained patient unobserved for an hour, and he has nothing better to do with his time than to figure a way to get out, or partly out, of them. But a patient with a GCS in single digits can still pull a trach or a PEG tube in a heartbeat.
I don't like restraints. They look midieval, and the time required to do the paperwork and perform CMS checks/mobility is a burden I prefer to avoid, but in some cases, not using them would be patient neglect. Like a lot we do, it's a question of nursing judgement, and like everything we do, if anything goes wrong, it's the nurse's fault.
I worked as a student on a med-surg floor for a year before becoming a med-surg nurse. I've officially been an RN for about a year. My experience as a student was invaluable to me in this area because it gave me a perspective as a cna, a sitter, and now a nurse.
As cruel as restraints may seem, they are sometimes the safest method to prevent someone from hurting themselves in a much worse way. Every medication that is considered a chemical restraint can have paradoxical effects that actually increase the confusion of an already confused patient. Sometimes the amount of a medication that is required to "sedate" someone is exactly that - sedation. Sedation requires the assessment of patients on a 1 to 1 basis on surgical units. Something that is impossible to safely monitor on a med surg unit with an elderly patient. The second problem is that on any given day on a med surg unit there can be 10 confused patients. There is never enough sitters, volunteers, or money in a budget to provide that for everyone. Family members are usually to never present or unable to dedicate the 24/7 care that these patients require and their medical illness, unfortunately, requires their admission on a med surg floor.
The most unfortunate part of your day for me was that no one took the time to explain these things to you. Elderly confused patients that have dementia are unable to understand many of the instructions that are given to them. Many "burn outs" probably allow this to prevent them from still providing the compassionate care required of a nurse and a mentor to students such as yourself. Restraints sometimes are not only the only option, but they may be the best.
The positive is that even if med-surg doesn't look like where you would like to work, there are so many options for people of all types. Nursing is a profession of many fields.
Quit with the "nurses don't seem to care" generalization of all of us. We all have our days where we do not meet the "Florence Nightengale Seal of Approval" as you will also have at times once you get out in the "real world".
As for sitters, many hospitals are cutting back the use of sitters due to budget constraints.
It broke my heart. And if this is what nursing means, that eventually you become so burned out that a fellow human being suffering in one of the worst possible ways becomes just some 'crazy old lady', then I want no part of it.
Why can't you be part of the change??? Who says that you have to be like that nurse??? Who says that you have to be burnt out???? Sounds like you are giving up before you even start.
Suck it up to experience, learn from it and let these experiences model your care in the future.
i wrote on this one already, and i realize we are probably beating it to death...but...i cannot believe what i just read in one of the most recent posts. going in to check on this patient would be construed as an invasion of privacy? uh, i think that is taking the whole hipaa thing way too far. what state/institution do you live/work in? i am finally back in bsn school to finish my degree i started over 25 years ago. i worked at that time and for the next 9 years as a cna in a large hospital. we are more short staffed now nationally than we were then, albeit for different reasons this time around. we are nurses for hospitalized patients (read "all" hospitalized patients) not just the ones we are assigned to. my former head nurse would have chewed my rear for walking down the hall past a call light going off without at least poking my head in to ask what the person needed or if they wanted their assigned nurse to come and assist them. if you cannot provide what they needed, which often times is a two second task; "can you move my bedside table/glass of water/call light/etc. closer so i can reach it?", then let their assigned nurse know. as we are all currently understaffed/overworked, i would help another nurse's patient not only for the patient but to assist my fellow staff member as well. i would hope that they would feel compelled to do the same for me and/or my patients. ya, i worked with some lazy people who took advantage of this part of my nature, we have all worked with a few here and there. however, when i went home and looked in the mirror it was myself i had to answer to. we are not volunteering when we are paid staff on the clock, we are employed to do a job, and we take an oath to assist and care for the infirmed, not just those within our shift assignment. just my
My understanding is that the OP is not a nurse nor an employee of the facility. As a student, she is a guest there with certain restricted privileges. If the patient and/or family did not approve the student taking care of the patient, then that would be a violation of privacy in the facility I work in.
I mentioned it because I had a student in my facility once, who decided that a unassigned patient down the hall was suffering too much, and removed the patient's sling to readjust it. She was kicked out of school and some other nasty things happened with the family. I was not trying to scold the student but protect her from unintended consequences.
uh, i think that is taking the whole hipaa thing way too far. what state/institution do you live/work in? i am finally back in bsn school to finish my degree i started over 25 years ago. i worked at that time and for the next 9 years as a cna in a large hospital. we are more short staffed now nationally than we were then, albeit for different reasons this time around. we are nurses for hospitalized patients (read "all" hospitalized patients) not just the ones we are assigned to. my former head nurse would have chewed my rear for walking down the hall past a call light going off without at least poking my head in to ask what the person needed or if they wanted their assigned nurse to come and assist them. if you cannot provide what they needed, which often times is a two second task; "can you move my bedside table/glass of water/call light/etc. closer so i can reach it?", then let their assigned nurse know. as we are all currently understaffed/overworked, i would help another nurse's patient not only for the patient but to assist my fellow staff member as well. i would hope that they would feel compelled to do the same for me and/or my patients. ya, i worked with some lazy people who took advantage of this part of my nature, we have all worked with a few here and there. however, when i went home and looked in the mirror it was myself i had to answer to. we are not volunteering when we are paid staff on the clock, we are employed to do a job, and we take an oath to assist and care for the infirmed, not just those within our shift assignment. just my 
Aquamarine
213 Posts
If it is done with the patients best interest, and you tried but can't get a faimly memeber to come in and sit with the patient, and nothing has worked. then with proper placement and policy followed, offering beverage, food, checking for circulation, getting that order from the doctor, making sure the restraint doesn't cause more harm, explaining to the patient every time you go in there to check why they are in place, everytime...as even though you think they don't get it...somewhere somehow they need that reinforcement....and document everything in a timely manner...if you have tried every single thing, and you follow policy...then and only then would I agree with restraining.
I had a patient come to the floor with restraints on, the nurse from vascular say...she has restraints on but there isn't an order! an odacity of a professional! If I wasn't so totally short staffed I would have reported that nurse and she needed to be reported or had a talking to to make her understand, that is against the policy. Never ever do that. If you have to stay with a patient until someone can get an order, better to do that than to break policy. How many patients have hung themselves, how many patients have done harm with the restraints. Always think, why are we nurses (hopefully because we want to provide care to everyone) and why is the policy in place. What would we want if that was our loved one in front of us. That's all....all common sense and morality.
We aren't nurses to throw our authority around, we are nurses to provide care and to do no harm first of all.