and I want to teach them the importance of waking your patient when you come on shift, especially if they are a high risk patient. I can't find any literature which I find is odd because when I went to nursing school, my instructors always said you can't assess your patient's loc if they are sleeping so you must arouse them when coming on shift. Does anyone have any supporting literature?
Specializes in CCU, SICU, CVSICU, Precepting & Teaching.
I think the OP is looking for some sort of standard to teach her orientee, and using your critical thinking is indeed appropriate; but it would be nice to be able to teach the orientee a defensible standard. I haven't been through the literature looking for that particular standard in a VERY long time.
It's going to depend a lot on your patient population. I'm in ICU, and I always wake my patient for an assessment at the start of my shift. My assessment is due at 8, but if they're sleeping soundly, I may check the other patient first. If they're both sleeping (or if I have only one), I'll wait as long as I reasonably can to wake them for an assessment. ICU patients usually need something, so I make sure I have everything I need to do my assessment, flush any lines that need flushing, give them their meds, etc. so I only have to wake them once. Assessments are every four hours, so I won't do them more than an hour late or an hour early. On the floor, things may vary.
I don't have a lot to add to the above comments, all good points. I just wanted to share what I see as a hospice nurse. I work in palliative care units, which often receives patients fresh out of the hospital. When I explain what to expect on our unit, one of the first questions I get is "You mean you will let me sleep and not keep waking me up in the middle of the night? That's wonderful!"
Being in a hospital is stressful and draining. Yes it's necessary to wake certain patients such as those requiring frequent neuro exams. No, it's not necessary to wake patients just because. I let mine sleep in until 10 before I make small attempts to wake them gently. If they have once a day meds due at 0800, I give them at 1000 and just mark down the time and the reason they were late as "sleeping." I don't, however, skip important meds such as ones for pain or ones that need to be taken exactly a certain amount of time apart.
If you do a neuro check in the middle of the night and they are lethargic (most people would be in the middle of the night) how do you interpret the results? Their LOC would be different than during the day but appropriate for 4am. If they were having a brain bleed at 4am, how would you know?
If you do a neuro check in the middle of the night and they are lethargic (most people would be in the middle of the night) how do you interpret the results? Their LOC would be different than during the day but appropriate for 4am. If they were having a brain bleed at 4am, how would you know?
True story: Years ago I worked with a doc who made his morning rounds at 0430. EVERY SINGLE PROGRESS NOTE started "Lethargic..." No duh!
This is a fantastic topic for reminding us all of the value of getting back to basics. It has always bothered me (especially in med-surg, rehab, and long-term care environments) how easily the healthcare infrastructure forgets what nursing and patient-centered care is supposed to be all about-- helping the patient heal with the goal of helping the patient enjoy the highest quality of life possible. The operative term here is "the patient." It's not about us, as nurses, ya'll.
Having said that, we all need to use our clinical judgment and realize that every patient is different. Of course, if we're truly practicing in a way that's patient-centered, which means we are actually providing care in a way that supports the patients' best interests (ie, in most cases, letting them sleep!), we're already doing that.
As a patient and a family member, I have been and have witnessed patients aroused and made to wake up for actually no medical reason. If they are asleep and resting why wake them only to check their blood pressure and lift their gown to listen to their breathing?
That having been said I understand when a patient has had a traumatic accident or there is a chance of internal bleeding or recent surgery that the surgical site or injury site needs to be checked or roused to be sure they are breathing deep enough to prevent lung complications. But to wake a patient who was just admitted for observation or simple surgery if their vitals all appear normal on the monitors and the telemetry monitors why wake them? Then once you have roused them up have a doctor prescribe something to help them relax because they can't sleep or are irritable. It is hard enough in a hospital to be able to sleep with the change in bed, the machines, the sounds you may be hearing from other rooms and just having someone enter your room to make sure you are okay and do the visual check that needs to be done on the patient.
The thing is common sense says if you can rest and relax things are going to heal faster and the patient will be more likely to participate in therapy, getting up and moving around and it will be a more healing experience for both the patient and the nursing staff if the can just rest and let the body begin the healing process.
If I am not mistaken, there was a thread here on AN a few years ago about whether or not a pt should be woken up to do a pain reassessment. After a long discussion, there was no consensus.
For me, it all depends on the clinical situation. For a pt who needs neuro checks Q however many hours, they are going to be woken up. I know the pt might not be thrilled about it, but this is a critical part of a pt's POC; although the pt can refuse (educate then chart the heck out of that one).
In general, however, I am not going to wake up every pt. True, even a 55 year old knee replacement pt who is going home in the AM could suffer an ICH during the night, but it would still not be practical to wake this pt up.
I really don't think I can come up with any firm rule on when pts. have to be woken up, other than neuro check pts. of course.
I won't attempt to wake a sleeping patient unless I have a valid reason. If there's no need to wake them, I don't wake them. Patients need quiet time to rest and that's often hard to come by on a psych unit. The lack of quiet restful time isn't necessarily from nursing staff providing care, as it is patients being loudly psychotic and waking up the whole milieu.
I work 23-07, and it's expected that we skip assessments on sleeping patients. If they're awake, then yes, they need to be assessed. If they wake up for more than a bathroom call or a drink of water, then they get assessed. Otherwise, as long as they're breathing and not in any distress, we leave them to rest.
If I have disturb them, I try to cause the most minimal disturbance possible. Obviously, I've got to get them really awake in order to do a proper neuro check. But if I'm going in to take vitals that can't wait or change an IV bag, I'm not going to stimulate the patient to the point they're fully awake: I'm going to go in, do what I have to do and leave them be.
Specializes in Surgical, Home Infusions, HVU, PCU, Neuro.
There are multiple hospitals where I live that make bedside report mandatory and have people go around during shift change to ensure that it is getting done. Their justification is A. You are including the pt in the POC, confirming they understand what is expected of them in their care and what is expected of us, caring for them. B. It ensures that all pt needs are met during change of shift so the pt doesnt have to wait for BR, med requests, questions answered ect. C. it establishes ( or helps) trust between the new nurse taking over when the previous nurse uses established rapport while introducing and including the new shift nurse. D. It establishes a LSN in the event the pt displays signs of neuro changes or things of that nature.
Having said that, I haven't seen supporting literature for this, nor do I always agree with this approach. Does your hospital have a policy and procedure in regards to this? If so I would think instilling the practice now is easier than trying to train yourself later. Just a thought
I am a firm believer that patients should not be woken up unless necessary. Reasons vary. One thing I make a point of doing at the beginning of shift is go over with my patients what they should expect out of me.
*I do not wake them up unless necessary, (Advise of scheduled times to be woken, ex: surgery prep) I will even ask if they want to be woken up.
*Advise of bedside report and why and what time. Some residents will refuse in advance.
I agree that waking a patient should be at the nurse's discretion and judgment. So what do you do when a doctor says "When I write for q4h, I mean q4h, not q4h at the nurse's discretion."
I agree that waking a patient should be at the nurse's discretion and judgment. So what do you do when a doctor says "When I write for q4h, I mean q4h, not q4h at the nurse's discretion."
Generally I think it should be up to the nurses clinical judgment to decide if he/she must wake the pt up for a routine assessment. If the doctor order is for q4h neurochecks, and the 4 hour mark is at 0200, I am going to be waking the pt up.
Ruby Vee, BSN
17 Articles; 14,051 Posts
I think the OP is looking for some sort of standard to teach her orientee, and using your critical thinking is indeed appropriate; but it would be nice to be able to teach the orientee a defensible standard. I haven't been through the literature looking for that particular standard in a VERY long time.
It's going to depend a lot on your patient population. I'm in ICU, and I always wake my patient for an assessment at the start of my shift. My assessment is due at 8, but if they're sleeping soundly, I may check the other patient first. If they're both sleeping (or if I have only one), I'll wait as long as I reasonably can to wake them for an assessment. ICU patients usually need something, so I make sure I have everything I need to do my assessment, flush any lines that need flushing, give them their meds, etc. so I only have to wake them once. Assessments are every four hours, so I won't do them more than an hour late or an hour early. On the floor, things may vary.