I had this one patient who had severe dementia. He was on the call light every other minute...and NO I am not exaggerating. Due to his severe dementia, even when I had just been in his room, immediate I walk out, the call light would go on. At the beginning of the shift, I went in, check vitals...give him water to drink, put chap stick on his lips, give eye drops, fluff his pillow, and anything he wanted. Before I left the room, I would ask, "Is there anything else I can get you?" And be reply, "I can't think of anything at the moment, except my call light." And I walk out, and 1 minute later, he calls and asks for his eye drops, he needs his pillow changed, he's thirsty. Anyways, at the same time, I was TRYING to discharge a patient, and kept getting interrupted by this call bell. (FYI, in this particular facility, the nurses DO NOT help each other. Once you get your assignment, it's the only people you tend to. Having a nurse help you is like pulling teeth. They would spend 10 min looking for you to tell you your call light is on, instead of going into the room to see what the patient needs - so..understand my frustration). I finally discharge my patient, and the call light has been on for like 15 min coz i just ignored it. So, now i'm getting irritated, I went to him and told him he is not my only patient (it's a tele floor) and that I cannot be in the room with him for my whole 12 hour shift. I told him I just gave him his eye drops, water, and his lips couldn't not have dried in that 1 minute. He says he's constipated and he wants an enema. I don't understand why old people obsess about having BM. He had had 3 ememas during the day with no results, and I refused to give him an enema. He said okay...and I asked, "is there anything else you want." He replies, "not at the moment." .and i step out. Again, 3 min later, the call light goes on. Can anyone guess what he want??? He's thirsty, wants his meds, his pillow changed and his eye drops. I told him I would round on him every 1 hr. and for the rest of the shift, that is what I did. OH...and his sleeping pill didn't work, nor did the dilaudid for pain (that were given at 10 pm) until 4 am.
So..have you ever taken a call light away from a patient or been really really tempted to? How do you reorient a dementia patient? do you go to the room every 3 min? this is a hospital setting.
p.s I just came from an night shift, so my english may be a bit off.
When my other patients are stable, what I've done is I take all my charting stuff into the room, sit down in the corner and try to chart while doing constant litany of "No, Mr. Smith, you've already had your eye drops...No, we just turned you, sir....No, it's 2 in the morning, it's not time for breakfast...No you're not in the wrong room, you're in your room, sir, you're in the hospital...No, John's not here right now...No, you don't have to get up and go to work..." It wears you to a frazzle and anyone who hasn't been in the situation has no clue how badly you just want to kneel in the floor and start banging your head on the tile until you knock yourself out. Last time I had one, (last weekend) the prior shift nurse began report with "...and we have the spawn of Satan in room X...."
I'm always scared to death that because I'm in someone's room every 2 minutes all night for NOTHING that I'm going to miss a critical life threatening SOMETHING on another patient. I've called the docs and told them, "Look, I've got a fresh MI, and evolving CVA, an exacerbated COPD'r who's on a Bipap he keeps pulling off and desating down to 78, a post colon resection who's having distention, pain, and no bowel sounds where I'm waiting for a callback from the surgeon -- and your patient is keeping me away from ALL of them. Now can you please give me something so your patient can rest and my other patients have a running shot of living thru the night?"
I've called the docs and told them, "Look, I've got a fresh MI, and evolving CVA, an exacerbated COPD'r who's on a Bipap he keeps pulling off and desating down to 78, a post colon resection who's having distention, pain, and no bowel sounds where I'm waiting for a callback from the surgeon -- and your patient is keeping me away from ALL of them. Now can you please give me something so your patient can rest and my other patients have a running shot of living thru the night?"
I laughed so hard! I wish I were as brave. Cheers!
I actually did once take the call bell away from a patient. We had an A&O 40-ish year old PIA admitted with elbow pain (yes, that's right). I had him his third day at our faculty (uh-huh-third), after he had made quite a name from himself with the nurses. Was rude, condescending and on the call light every 15 minutes.
While in the next room on first morning rounds, and helping LOL to BR, he sent his wife to her room (OMG) to inform me his water pitcher needed refilling, and I informed her I would do so when I made it to his room (I went there next). On entering room they were having a loud conversation about lazy, stupid nurses. After introducing myself, he pointed to his call light and proceeded to inform me that him and "his little buddy was gonna give me hell today" and he didn't tolerate "lazy ass nurses".
So, I said "oh, really?" as I unplugged the light and walked out with it in my hands. I went to the nurses station, were his MD and our DON happened to be sitting and told them about the conversation. D/C orders were written, and the DON discharged the patient.
But, for a disoriented patient? Never. I have a soft spot for demented patients, as I lived for a period with my grandfather after he suffered a stroke that affected his short term memory. If they are truly that demented, I try to get a family member to come in, or move them to the nurses station. Luckily, our nurses work together with patients like that too.
I actually did once take the call bell away from a patient. We had an A&O 40-ish year old PIA admitted with elbow pain (yes, that's right). I had him his third day at our faculty (uh-huh-third), after he had made quite a name from himself with the nurses. Was rude, condescending and on the call light every 15 minutes.
While in the next room on first morning rounds, and helping LOL to BR, he sent his wife to her room (OMG) to inform me his water pitcher needed refilling, and I informed her I would do so when I made it to his room (I went there next). On entering room they were having a loud conversation about lazy, stupid nurses. After introducing myself, he pointed to his call light and proceeded to inform me that him and "his little buddy was gonna give me hell today" and he didn't tolerate "lazy ass nurses".
So, I said "oh, really?" as I unplugged the light and walked out with it in my hands. I went to the nurses station, were his MD and our DON happened to be sitting and told them about the conversation. D/C orders were written, and the DON discharged the patient.
But, for a disoriented patient? Never. I have a soft spot for demented patients, as I lived for a period with my grandfather after he suffered a stroke that affected his short term memory. If they are truly that demented, I try to get a family member to come in, or move them to the nurses station. Luckily, our nurses work together with patients like that too.
And before anyone points it out, yes - I know it was a stupid and equally juvenile action I took. He could have easily faked a fall and sued claiming he had no way to call for help. I tend to be a little hot headed, and act before I think at times, especially with people that are trying to make themselves as difficult to deal with as possible.
We had a patient who was like that recently. Reading through his chart, on previous night, he got 10mg of Ambien, 50mg of Benadryl, and 2mg Ativan and was up all night crawling out of bed. Upon my initial assessment he told me he had a hx of arthritis and was up "all night last night with back pain." I got 1mg of dilaudid ordered and gave him that and he slept all night and told me I was his favorite nurse ever in the morning. If only we could always get that lucky!
nerdtonurse?, BSN, RN
1 Article; 2,043 Posts
When my other patients are stable, what I've done is I take all my charting stuff into the room, sit down in the corner and try to chart while doing constant litany of "No, Mr. Smith, you've already had your eye drops...No, we just turned you, sir....No, it's 2 in the morning, it's not time for breakfast...No you're not in the wrong room, you're in your room, sir, you're in the hospital...No, John's not here right now...No, you don't have to get up and go to work..." It wears you to a frazzle and anyone who hasn't been in the situation has no clue how badly you just want to kneel in the floor and start banging your head on the tile until you knock yourself out. Last time I had one, (last weekend) the prior shift nurse began report with "...and we have the spawn of Satan in room X...."
I'm always scared to death that because I'm in someone's room every 2 minutes all night for NOTHING that I'm going to miss a critical life threatening SOMETHING on another patient. I've called the docs and told them, "Look, I've got a fresh MI, and evolving CVA, an exacerbated COPD'r who's on a Bipap he keeps pulling off and desating down to 78, a post colon resection who's having distention, pain, and no bowel sounds where I'm waiting for a callback from the surgeon -- and your patient is keeping me away from ALL of them. Now can you please give me something so your patient can rest and my other patients have a running shot of living thru the night?"