...at my new fangled healthcare job that is...not in life...gawd no...in life, i've come across many, but as a freshie RN, recently released on my own sans preceptor/mentor, this was tough.
my first night of 3 in a row and i had 6 patients...4 of which were in a "high observation" room, meaning that a clinical assistant (CA) is always in the room as these 4 patients are prone to being agitated, pulling tubes out, at an extra high risk for falls, or some other reason that they need 24/7 watch.
as i walked in the room, one of these women is already quite agitated and insisting she leave at once. but you see, this woman has a brain injury, and her communication was a word salad at best.
funny thing is, i could totally understand what she was trying to say most times, just by her tone and intonation, and the odd word that came out correct (she hated me, that part was clear)...but for the most part, i can only imagine how frustrating it must be for her to not have the right articulation.
the CA was having trouble keeping watch over 4 patients and trying to keep this woman in the room, so two CAs got her in to bed and applied the wrist restraints.
wrist restraints already come with a whole not-so-nice-human rights-ish vibe to me, let alone the ethical issues...i have a fantastic team and there are a couple of charge nurses that i felt really comfortable talking to, despite my being new.
because not only did i have to restrain her for most of the weekend with physical restraints, but after coming back for saturday night and finding out that other staff was pissed that i didn't give her the haldol on saturday morning, which apparently then caused her to be "restless and agitated and exi-seeking all day" (like she wasn't already) on sunday morning 4 of us had to hold her down, give her the IM shot of haldol while putting on the wrist restraints...
so not just physical restraints, but medical restraint...straight out of a 1950s "insane asylum" movie.
it just doesn't feel right to me, but my charge's counter was that she was not safe in the outside world because of her lack of communication, and obvious brain injury.
point-counterpoint.
oh, and did i mention she was mrsa+?
uh, yeah.
that news came in on saturday, in the middle of the night.
so not only do we have to keep her on the unit, we have to keep her in her room, and not let her touch anything...
rrriiiigghht.
monday morning i decided not to give her the haldol.
she was redirectable to an extent. she was exit-seeking, but willing to stay sitting on her bed. she was under the CA's watch.
she was o.k.
so i mentioned it to the charge, then i mentioned it to the RN covering during report and shift change. all was fine. all was good.
3 nights of craziness and i went home to sleep like a log.
fast forward to dinner time, where my man had come home from work wanting to take me out to eat.
i was on the phone with fido, so bob turns on the 6 o'clock news while he's waiting.
bob (poking me and pointing to the tv): uh, uh, hey babe?
me (finger over lips, mouthing): shhh. i'm on the phone
bob: but, um, hey...look
me (giving the angry eyes, mouthing shut up)...
bob: you might want to see this
at which point i turned to the tv to see a fuzzy security camera pic of my crazy lady (!!) exiting the hospital entrance in her gown, sunglasses, lei around her neck, purse slung on her shoulder...
me: holy crap! hang on (i yell to the poor fido rep)
bob: i kinda had a feeling that's who you were talking about
(note: even though i tell him random stuff, i still keep a certain standard of confidentiality...yes, yes, i do)
me: that's her! that's my girl! oh my god! what did they say? did they say when she escaped? what's the story?
bob: i don't know. i couldn't hear because someone was on the phone. (smart-ass -ed.)
i freaked out a little, thinking because i didn't give her the haldol that morning, she had escaped during the changeover when there is way less staff on the floor...but no, she left in the late morning, when the CA had let her walk out and not called security.
so she got free.
(they found her later in the afternoon, at a friend's house in the east end. how the taxi driver knew where to take her is beyond me. what does that say about our city's taxi drivers? wow)
i must say, i am so impressed by her determinism.
scary, but she is just so damn resilient.
it's amazing, really.
i have had her as a patient since then. just yesterday, in fact.
still as exit-seeking as ever.
on 1:1 constant observation.
even in 4 point leather lockable wrist restraints.
they discontinued the haldol, because really, what's the point? it didn't even work for her.
when i came in yesterday she only had one restraint on, her left wrist.
and she managed to contort out of it by mid-morning.
if you can believe it.
it didn't really surprise me.
security was called twice.
first time, we gave her ativan.
didn't work (surprise!)
second time, we held her down to put her in restraints.
and she cried.
and i almost did too.
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