Things that make ya go Hmmmmmmmmmm

So I am on a hospice unit, my preceptor boasts that they are a zero restraint unit.

We go into a pt room and the pt is restless and half way out of bed and very disoriented.

We help him back in to bed.

Preceptor says, "Hey take those pads that are on the floor and stand them up on each side of the bed, then unlock those two high back recliners and use them to push the pads against the bed and be sure to lock the brakes on each chair."

I did as told and thought to myself....

Hmmmmmmmmmmm


legalese.....we restrain people all the time......even sleep meds are kinda like restraint if ya think about it. Sounds like she was just using common sense. Like if we were doing this at home, 80 years ago. It IS less dehumanizing than actual wrist and ankle restraints, must admit.........

True, and you are spot on about sleep meds, ativan, etc being restraints. I agree with you one hundred percent. However, if they fancy themselves a zero restraint unit they shouuld not be using any of thngs for the purpose of controlling a patient. Yes? No?

mindlor,HMMMMM is an understatement!!!!!! WHY NOT JUST SAY NO? I AIN'T DOING IT!!!!!!!!!!!!! You have the right to refuse to do something you no is wrong, or that you no could hurt the patient, or yourself!!!! NO ORDER, NO DEAL!!!!!!!!!! And, what MD, would order something like that? None I presume!And, even if he did, then, say, I am not comfortable with that order, can we try this instead?... By law, you must report any elderly abuse you witness. Be careful! Just my .

That was 100% a form of restraint! Unsafe as heck too. I agree with being careful, it's your license. I work in a psych hospital and they want to be restraint free, but that is not gonna happen. It's county psych too. I don't understand all of the hoopla. I don't go to work hoping to put someone in 4pnts and when I have to, it's for the shortest amount of time possible. If a loved one is trying to climb out of bed and safety is an issue, I would want someone to do something before injury occurs. The use of siderails or putting chairs by the bed to prevent someone from getting out is a form of restraint for sure.

This patient might possibly have been terminally agitated if you are on a hospice unit. The proper course would have been to obtain an order from the MD for medication (probably Haldol or Thorazine depending on the MDs preference) and maintain a peaceful environment (quiet, low light, minimal stimulation). 1:1 sitter if available (our hospice has volunteers who are trained for this task). Don't be afraid to use your volunteers if they are available as per the conditions of participation for hospice a certain percentage of services are to be provided by volunteers.

Yes yes, haldol was ordered and given. They were also on a huge amount of morphine. And indeed, the term, terminal restlessness was mentioned....Now for more details....the patient was moaning in agony and holding his abdomen. I should also state that this patient is considered palliative and is still receiving treatments that prolong life.That said, i observed the nurse....one, they never addressed the patient directly, the nurse would talk to me about the patient. I addressed the patient and they were responsive and able to verbalize their pain level etc...Not once did the nurse assess bowel sounds...I did and they were off the charts hyperactive in all 4 quads...I asked the nurse when the lat BM was and they said EIGHT days ago. PT is passing gas so no ileus. Not no ileus does not mean no impaction. I mean for god sake right?The nurse says we dont want to do anything to help them have a BM because we are waiting for radiology to read their films...Any of you guys ever had really bad gas cramps? It sucks. I should also mention that I am a student and not yet licensed.

Quote from mindlortrue, and you are spot on about sleep meds, ativan, etc being restraints. i agree with you one hundred percent. however, if they fancy themselves a zero restraint unit they shouuld not be using any of thngs for the purpose of controlling a patient. yes? no?

OOohhhh....It DOES get uglier to hear that the patient WAS AWARE ENOUGH to verbalize the source of their discomfort and your preceptor had no idea how to communicate with this poor patient!!!!!!!!YUCK! And this is hospice??Ugh. Nuff said. I feel your agony. We live in such a dehumanized place sometimes. You did well.....you listened to the patient. At least, YOU will have the sense to prevent these kinds of options in the future!!! oxoxox

Again, uh, what is the problem with at least trying a suppostitory to feel for impaction.....and then just "whisking" around a little bit. I think this preceptor knows very little about true nursing; more than just the rates, numbers, rythyms, lab values....etc. Palliative is comfort. If that has to do with at least attempting to unleash a turd.....and someone can't helped with a gloved hand, than what is the point? ....I am just flabbergasted..ugh

so that nurse should have gotten her butt on the phone immediately to radiology to make sure those films are read. 8 days of no BM would have me climbing the walls. Shame on her for just blindly corralling him in instead of looking at the big picture.

The term zero-restraint can be a little tricky. In most facilities, in my state at least, there are levels of restraint, going from chemical restraints, to physical restraints along the lines of side rails, body pillows, mittens, lap belts, and then going up to a more extreme level, such as four points. Most of the "zero-restraint" facilities in my area, maintatin a strict policy not to use the latter, but can resort to the chemical and some less invasive forms of physical restraint with proper documentation that it is a last resort in a long chain of attempts with other types of restraints. I don't know the ins and outs of official policy so am not sure how acceptable that is officially. But it is what facilities do.The more extreme the restraint the more difficult it is to justify so facilities that say they are zero, usually are very careful about exhausting all efforts, and may even transfer a patient out before relying on any kind of restraint.With hospice patients, however, chemical restraints can become necessary. I have had hospice patients become so agitated that I was worried they would kill themselves before they were ready to die peacefully.What you are describing sounds horrible and unconscionable, though.At any rate, I remember one SNF I worked in, we had this patient who was extremely complex, lots of tubes, co-morbitities, highly acute issues, and completely out to lunch. Was incredibly agitated and kept trying to find a way to fall out of bed. Staff ended up putting him on a low bed with side rail, and alarm, which was a restraint, but there was plenty of documentation about how dangerous the patient was to himself. He really shouldn't have been there, but this was one of those facilities that will take anyone and then just jerry rig a safety policy.I had never worked with the patient, but one day I picked up a night shift and he was on my watch. I had sat down to take report and heard him yelling from his room. I went in there and saw that someone had parked a locked wheelchair by his bed to prevent him from crawling over the side rail and onto the floor. What had happened is that he had attempted to crawl out of the bed, was completely tangled in his feeding tube, and his head was lodged between the side rail and the wheel of the wheelchair. His neck was lying on top of the side rail and he was in the process of strangling himself and could not unlodge himself, fortunately he was able to shout because otherwise by the time I got back there he would have been dead.I never forgot that incident. Still sends chills up my spine.