I had an admission today on a 2 year old little girl who had an abscess on her labia (suspected spider bite). She was in for an I&D by the surgeon yesterday and sent home the same day. Today, I was sent in to open, and pack her abscess with Iodoform (I took out approx 2" from the wound). The whole procedure was so traumatic to the little girl that I didn't feel comfortable completing the admission. She had to be forceably held down by her Dad and Uncle while I tried to pack this 0.2 cm opening with 1/4" gauze. I stopped the procedure, called my supervisor, and was told, or should I say "ordered" to open up the case and pack the wound. Not feeling comfortable, I called the Pediatrician who agreed that the toddler should have been admitted to the floor after the surgery. She told me to call the surgeon and see if he would do a direct admit, which I did. Although I couldn't speak with him directly, his secretary called back and told the Dad to bring his daughter to the surgeons office this afternoon. I (emotionally drained) went back to my office, and stood by my conviction that I was not comfortable opening this case, and was told that "sometimes in home health we have to do things we aren't comfortable doing". At this point, I pretty much stormed out saying, "well fire me because I'm not going to do that kind of nursing". Now I've been a nurse for about 8 years, but only 8 months in home health, but no matter what the field, I'll advocate for my patient to the very end if I feel strongly enough. In my heart I know I did the right thing (maybe not telling my sv to fire me...lol), but I could really use some support from felllow nurses, or some constructive advice if you think I was wrong.
As an added note, the little girl was refusing the oral abx, and as in many home health cases, not a very clean environment. The Pediatrician suspected a staph infection and there is also a 4 month old baby at home too. The whole picture just made me feel she was better off in the hospital with IV abx where she could get ATC care.
I think that you might have felt more comfortable had the child had something for pain before you arrived or when you arrived. Even in adults, the wound vac protocols state over and over that pain meds should be given prior to the procedure. More and more, those things are being done in the home. I don't believe we need to torture anyone when those things are available.
systoly
1,756 Posts
Your welcome. This was the second time I miscommunicated today, good thing it's almost Friday.