Sunday, January 20, 2013

Third Shift Blues

By Chiqui Raveloski

Another hectic night on the telemetry floor. The usual patient load with many different attitudes to deal with. But, trying to be good tonight....I made my own attitude adjustment.  "Bahala Na", "May God be with us all".

Older adults have special powers. Growing up in the Philippines, we were taught to "respetuhin mo ang mga matatanda", "Respect your elders". Did not really know why, You just did. They were put on a pedestal, a throne, a powerful agent of  wisdom.

When I came to America, things were different. I still hold the same values for the elders, but. society has a different way of portraying them. Remember the commercial, "I've fallen and I can't get up !"? It was and still a humorized catchphrase due to bad acting. They are acting alright. Because older adults are capable of so much more than meets the eye.

When they say "Do not judge a book by its cover", they know what they're talking about. I'm sure fellow nurses out there, you probably had experienced what I am about to tell you.

Two of my patients that night were an 82 yo female, we will refer to as ET, with altered mental status, frail, refused to take medications. Another is an 83 yo female, we will refer to as "Mammi", weak, sweet, who likes to get out of bed to wander around.

ET was placed in a room nearest to the nurse's station during the day shift. She had been "off the wall", no regards for her safety, pulling lines, screaming , you get the picture.  She was placed on a very close watch. ET's family also paid her a visit and helped watch her. Day nurse said that the family approached her several times to see if ET can be off the IV fluids because she constantly tried to pull the line. Day nurse finally wrapped the IV site with soft gauze and placed mittens on both her hands.

ET's family left at the start of my shift. I checked on her often and  I can see her moving around the bed. Well, she wore me out. ET did not go to sleep. At around 4 am, "gut feeling" told me to check on her again and this time, I saw her biting off her mitten. ..What?!....pulling and tugging trying to free herself. And for what mighty powers she had, she was able to free one hand , pulled her briefs off and I caught it just in time before she can pull out her IV.

I summoned for help so we can get her situated. Got her out of bed to change the bed sheets quickly. My bad.....ET's energy caught me off guard that I almost landed on my face on her dirty bed. She was pushing, pulling, every which way she can . She was so wired up, nothing can stop her.

Finally calmed her down, and I heard a bed alarm, thinking to myself, Oh no not Mammi, Oh yes it was! When I got to her room, Mammi managed to walk to the bedside chair with her heel boots on!.....Can you imagine walking with those boots on? How?!..., sat on the chair, with her briefs off,  thinking she was in the commode... Really?.... Cleaned her up, got her safely back to bed, turned the bed alarm on, side rails up x4.
I'm worn out!!!

Excuse me, bathroom break.

OK I'm back So funny.
I was using the bathroom, and out of the corner of my eye I saw

this cat        

staring at me. Really?! My daughter's cat Mozart.

Hospital is a threatening environment for patients. Yet,  these ladies proved that no matter where and how, older adults have determination you do not underestimate. However, determination can sometimes go a little too far and safety becomes compromised.

As nurses, we respect the role of autonomy in older adults, maintaining their independence. At the same time, we are aware that a part of the normal aging process may present someone as incompetent.  In situations like these, safety becomes  the priority of care. A balancing act between autonomy and protection for someones’s well-being demands ongoing nursing assessments and interventions. Hoping...... desirable outcomes provide meeting physiological needs, security and self actualization.

Young at heart.