Tuesday, 11 March 2008

My first complaint.

Yes. I've caused an incident.

Back last week, when we had one patient on the way to death's door (they died, by the way), we had another who was not in a great way.


Already in a side room, due to the fact they were very open to infection, they started the week badly and got worse. They experienced a cerebral event on Tuesday night/Wednesday morning and a house officer on call (the same inept one from the day after) was little help. We think this may have been a TIA - transient ischemic attack, which is basically a small stroke. Still pretty nasty, mind you. The patient was placed on four hourly neurological observations, and was not completely coherent of their surroundings, asking where they were on more than one occasion.

The patient went from being reasonably self sufficient (i.e. able to get to their toilet alone) to relying on bedpans. After the cerebral event their use of bedpans was questionable, as they would often miss and urinate in the bed. The night of their event meant my mentor and I spent time in the patient's room, looking after them. The night after, however, was a lot heavier and we were dealing increasingly with another patient in another side room (the one who I have previously documented about and referenced above). The patient's urinating was still not under their total control, and they were complaining about some wetness. The first time, my mentor and I checked and it seemed to be just the top sheet that had become slightly damp, which we changed. Later, the patient urinated again and the entire bed was effected. Unfortunately, at the time, my mentor was busy, as was the only support assistant on duty. I informed the patient, as best I could, that I would get help and change them as soon as possible. It may have been twenty minutes before I came back with the support assistant to completely change the bed. This was between helping my mentor with the dying patient in the next room, and taking care of our other patients who did not have completely settled nights.

A complaint has been made against me by the patient (to their spouse, rather than the staff directly). I am accused of leaving the patient lying in their urine all night for no apparent reason, and making no effort to change this situation.

When the situation was first brought up, the Charge Nurse enquired what happened and what I remembered, to which I responded like above. This Charge Nurse suggested, with the backing of my mentor and themselves, speaking to the spouse to clear the air. During this discussion I learnt that the patient in question was now quite scared of me, and so whatever memory had been made was no ingrained. We explained the situation and apologised if it had seemed to have been a long time. The spouse (thankfully) was quite happy with this, and was glad to have 'put some faces' onto the problem.

In reflection, if a situation like this happened again, I would make sure the patient was certainly aware that I was aware of the issue, and reassure them (repeatedly, if need be) that it would be dealt with as soon as I found another member of staff to assist me.

(/report over)

Brackets aside, that is what will be going into my official reflective diary. I'll use this last paragraph to give the real skinny.

As previously noted, the night was more of a nightmare. My mentor who, especially at this part of my training, I "should" be training directly under, was busy trying to get the doctors to do their fucking jobs and contact next of kin. When she wasn't in the room with a dying patient, I would be there, doing observations and taking note of what the late arriving doctors had to say. In the meantime there were a fuckload of other patients around who were NOT fast asleep.

So, we were busy.

Additionally, the patient in question never used a nurse call bell. They would rely on shouting, which would be fine if I was within earshot of their side room, but otherwise, given my hearing is not akin to that of a bat, I might not be able to hear them.

The crux of my gripe is that this was not my fault. No matter how amazing I am as a student nurse, I'm not a nurse. Officially, I shouldn't be doing much on my own but A) I'm capable and B) I want to help, so I sometimes work on my own initiative. However, this patient was being looked after by the night staff as a whole, not just me. It's unfortunate he remembers me as this white coated monster, but - suffice to say - if this white coated monster wasn't on placement that night there would have been noone else and they might've been lying in their own waste for longer than 20 minutes.

It's hard to tell an upset spouse that their beloved isn't really with it. As stated in my official report, the Neuro Obs from the day before were seldom conclusive. The patient wasn't really sure where they were, or who the staff were, so it's not surprising that 20 minutes might seem like longer, and that events may have been warped from their point of view. Not surprising, but unfortunate all the same.

A bit of a fuss has been made over this. I'm not particularly bothered now it's over and done with, pretty much. Additionally, I have felt supported by both my mentor and the Charge Nurse who dealt with it today, so my confidence is unrocked. And as a student nurse, officially nothing is my fault, anyway, which is always a nice safety cushion. As mentioned, if I wasn't there the result could've been worse. However, I'm quite saddened that we can't make as big as a fuss over fucking doctors who can't get down to fucking see patients when we fucking bleep them. Ahem.

The result now is that I will not be nursing this patient again if we can help it. Personally, I think the patient is a disagreeable old so-and-so, thus I won't lose too much sleep over it. Professionally, I'm aware that the mental picture they have of me means it'd be counter-productive for me to nurse them again given the distress it would most likely cause. Despite my personal views on the patient, I'm sad it turned out the way it did. Before we cleared the air I was worried and anxious*, even more so because my mentor and the Charge Nurse didn't seem that worried. However, they backed me to the hilt and I now realise that it wasn't something to get overly worried about and is a part of modern nursing. Another piece of unique experience for me.

(* Often, patients ask me "Is it [working in healthcare] anything like Scrubs?" My standard answer is: Nurses mostly like their patients, like in the show. Doctors are sometimes annoying and arrogant, ditto. But there is no malicious janitor. The soul searching I did today made it feel a bit more like an angsty American emotional sit-com, for sure)


Zarathustra said...

I do recall an episode of Scrubs where they portrayed a radiologist as a bizarre little martinet jumping up and down on the spot shrieking, "MY MACHINES! MINE! MINE!"

I consider this to be an eerily accurate portrayal of some of the radiologists I've met. Though not as accurate as Dr Alan Statham in Green Wing.

OFMN said...

Radiologists get to wear little maroon stripes so, I get the feeling, the portrayal of possessiveness is not far wrong when it comes to some of them. Pride, mixed with strangeness, perhaps.