Pt sat on the edge of the bed with a menu on his lap in "roll-a-joint" position.". He quickly removed "something" from the menu and placed it into his cigarette packet, which he then tucked away under the pillow on his bed. He then placed the menu on his table and sat back in the bed.
What I did not see:
Marijuana. Rolling papers.
What I know about the Pt:
Active AIDS. Cancer. Goes outside to smoke in his WC a lot. Enjoys IV morphine, Ambien, Ativan, and Norcos a little too much. He's a clock-watcher. Once smoked a cigarette in the BR of his hospital room while under the care of another nurse.
What I said:
Hey, it's a shame your doc cannot write you a prescription for "that," as I pointed to his packet of cigarettes. I give "it" here in the hospital in a capsule-form called "dronabinol." We discussed legalization of marijuana. I stated that he must not smoke in his room due the risk of fire, the fact that smoking is obviously not allowed within the grounds of the hospital.
What I did not say:
Hey, I see that you are rolling a joint with marijuana there.
What he did not say:
Yes, I was rolling a joint with marijuana.
My reaction and action taken upon the above discovery:
Nothing further than the above description of my implied knowledge of what he was up to and a genuine discussion of my true feelings towards legalization.
I'm just curious as to whether anyone else has experienced such an occurrence, anyone else's feelings towards this incident, and anyone's opinions on whether I acted well having been faced with this "ethical dilemma."
I have had to give milk and molasses enemas to a patient who turned out to have a serious bowel fetish (and masturbated! !! during the enema) I have walked into rooms and discovered NPO patients eating fried chicken.
Consider this...I walk in and the patient is slamming vodka. Am I being a prudent nurse by slamming IV morphine....
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I was referencing your use of "slamming" anything IV push.
In any event, judgemental or not, you found this situation to be an ethical dilemma. And unless you see this all with your own eyes, or test for it, you can not for certain say what this guy is doing or not doing. He could say he is king of the world, but it doesn't make it true.
You can only remind that smoking in one's room is not allowed.
What I would do, however, is stop having causal conversations about it with the patient. The "I know that he knows that we know" stuff will be what comes back to bite you if he is caught in the parking lot. You have not seen pot, him smoking pot, whatever--so you can assume--until such time as someone sees this-then, it can become an issue as it is illegal.
So I think you are absolutely correct when you state that you "don't want to know"--NO, you do not. Medicate per assessment and move on. Otherwise, I wouldn't poke the bear.
Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.
:)
I'm almost there. I just like to try and educate where I can. I just have a hard time believing that people can miss a point so far. Actually, I can't.
I don't think that anyone missed the point. You asked for opinions and you got them. Remember...you ARE dealing with nurses who are intelligent and opinionated. Nurses want all of the facts before we can given an educated unbiased opinion. Nurses have NO issue with giving our opinions.
I don't think that anyone lacked reading comprehension when pointing out details of your posts. We were using your stated "facts" (evidence) to give you the best answer we could based on the information provided. Your increasing use of profanity (prohibited by the TOS), however masked by the sites censors, diminishes your credibility and increases the chances of you getting into a heated discussion.
I am not sure how familiar you are with public forums. When you post on a public forum keep in mind that you will get many different opinions based on each individual's thoughts and experiences. Later in your post you mentioned getting into "trouble" and being involved when this patient is discovered...and he will get discovered...which is why I suggested to let your immediate supervisor know of your findings/suspicions. If you don't...you will look as if you were condoning this behavior.
Take from this thread what you want and ignore the rest. No one said you had to follow what was being said by others. I am curious, however, why the responses here surprised you?
When I read the OP, I understood "enjoys his meds too much" to mean nothing more than "takes a lot of them." I think, to be fair, give the OP the benefit of the doubt. If you read his response to the patient--tactfully opened a line of discussion with him in a way that was intended to not shame, but rather dialogue constructively and with an open, supportive attitude.
As to the OP's question, I would have probably done similarly. Just remind him of the facility's smoking policy, and ask him if his pain is controlled by his current regime.
Well of course I "know what you mean", but actually, I really dislike it when other nurses give me their judgments of a patient's character in report. I don't really need to know if the other nurse thinks the patient is a jerk or enjoys their medications "a little too much". It does not affect my care at all. All it really serves to do is give me a preconceived notion of what that patient is like, which can be counterproductive in establishing a therapeutic relationship with them. I cannot tell you how many times I have had another nurse tell me what a jerk a certain patient is, only to hit it off with them right away and get along with them just fine.
What is helpful information for me is telling me how the patient is coping. Do they appear anxious, angry, withdrawn? How is their family coping? Do they have a lot of requests, are they asking a lot of questions?
But no, I don't need to know what "type" of patient you have judged them to be (and it is a judgment, no matter how much you try to legitimize it by saying otherwise). It's not relevant to me, and honestly it's information that's in one ear and out the other.
IMHO I think we've all had these pts before. If he was a 20 year old crack addict in the same situation, the thread would've gone as planned but because he is literally dying so everyone reacted differently.
I'd be interested in the reaction of those with your point of view on this particular non-germane isse if I had describe a patient as someone who "enjoys his baths a little too much."
How can he "enjoy his bath a little too much"? He is dying! He deserves to be clean! How can you judge him on how much he is enjoying his bath!?!
I really don't think I would need to explain how a patient may enjoy a bath a little to much regardless of how deserving he is of his bath, as I would assume that any nurse would be able understand what that meant.
The point is, you didn't include anything about baths, because you weren't trying to show that the patient had a bath habit. You DID mention the narcs, because it sets the basis for what follows...the dude was rolling a doobie.
You're now mad because people called you out on it, when what you should do is admit you used a salacious stereotype in order to get your readers to think of this guy as a drug seeker, so that we'd believe you when you assert that he was smoking the ganja.
I would have warned him of the dangers of smoking in his room, for safety's sake. And then left him in peace. AND hoped to all that is holy that this poor man WAS enjoying whatever drugs he was getting--and as much as was humanly possible.
Specializes in LTC,Hospice/palliative care,acute care.
>>>>
Well now,that would depend on what you mean by "enjoy". Are you referring to sexual pleasure like my milk and molasses enema masturbator years ago? I want to point out I was very green, had only been a nurse for a few months. Initially I did not realize what the guy was up to, he was positioned on his side. It took me a minute or so to realize what he was doing and then I was so shocked I literally froze. When I gathered my wits I stopped delivering the liquid, withdrew the tube and told him to ring me when he was through and I would come back and finish to procedure.
I doubt there are many among us whom has not experienced a patient "enjoying" their bed bath a little too much.You hand them the wash cloth, tell them you'll be back when they are done and leave.
The point is, you didn't include anything about baths, because you weren't trying to show that the patient had a bath habit. You DID mention the narcs, because it sets the basis for what follows...the dude was rolling a doobie.
More that it just helps paint a picture of the patient.
You're now mad because people called you out on it, when what you should do is admit you used a salacious stereotype in order to get your readers to think of this guy as a drug seeker, so that we'd believe you when you assert that he was smoking the ganja.
A salacious stereotype? And I did this to influence my readers in order to have them "believe" me that he was smoking weed?
You got me. Well done, Sherlock Holmes. Look, I'll come clean. I did indeed post the OP with the intention of making a bunch of anonymous people believe that this patient was smoking weed. I told everyone he was a drug addict and then passed judgement on him for this. :)
This made my morning.
But no, I would not describe this guy as a drug seeker. I do know what a drug seeker is, however.
I really don't care if you or anyone else for that matter "believe" that he smokes weed or "believe" that he was rolling joint on the menu.
All I care about is if you have experienced anything similar (and the other stuff from the OP).
I included the dx's of aids and ca as I thought them relevent to the marijuana issue.
Would have been nice if this thread had spawned discussion on benefits of marijuana for ca, aids, and other patients.
I don't think that anyone missed the point. You asked for opinions and you got them. Remember...you ARE dealing with nurses who are intelligent and opinionated. Nurses want all of the facts before we can given an educated unbiased opinion. Nurses have NO issue with giving our opinions.
I don't think that anyone lacked reading comprehension when pointing out details of your posts. We were using your stated "facts" (evidence) to give you the best answer we could based on the information provided. Your increasing use of profanity (prohibited by the TOS), however masked by the sites censors, diminishes your credibility and increases the chances of you getting into a heated discussion.
I am not sure how familiar you are with public forums. When you post on a public forum keep in mind that you will get many different opinions based on each individual's thoughts and experiences. Later in your post you mentioned getting into "trouble" and being involved when this patient is discovered...and he will get discovered...which is why I suggested to let your immediate supervisor know of your findings/suspicions. If you don't...you will look as if you were condoning this behavior.
Take from this thread what you want and ignore the rest. No one said you had to follow what was being said by others. I am curious, however, why the responses here surprised you?
I was surprised to see a general consensus in favor of the guy smoking his weed and turning a blind eye. I was expecting far more responses along the lines of concern of overdosing the guy, as he is smoking weed and taking other meds together; the fact that he has an illegal drug in the hospital. You know?
kanzi monkey
618 Posts
Oh my goodness!!
Fried Chicken?!? When NPO?!?!
Good grief.
;-)