I was going to post this situation as a comment to Yang’s “Embarrassment” as the patient situation is quite similar – however this situation sparked some other issues which I thought were worth a blog.
On a general surgery placement I was treating an elderly woman following abdominal surgery. The first time I stood her following removal of her IDC she immediately said she needed to go to the toilet, and within seconds started losing the contents of her bladder. I was with my supervisor at the time and we noted that it was quite a large volume of urine that was expelled. The mess was cleaned up and we didn’t take too much notice of the situation the first time. However, when we saw her on the 2nd day, before getting her up we asked if she needed to go to the toilet to which she said no. However as soon as she stood she again felt the sudden urge to urinate and lost the contents of her bladder – again another large volume. Each time this happened the patient then became quite distressed and refused to ambulate. We realised we needed to do something about it.
I discussed the situation with my supervisor and together decided the best solution at this stage was “timed toileting” and a bladder chart with nursing staff to ensure the patient voids 2 hourly and that volumes of fluid consumed and expelled were measured so that the toilet timing could be altered accordingly. We discussed with the nurse on that shift about starting the 2 hourly voids that day, and documenting this in the nursing care plan.
The next day we again asked if she needed to go to the toilet and again she replied no. However on standing there was a repeat of the previous days episode. We asked the nurse on this shift if the change was documented in the nursing care plan. She said it was not documented and she didn’t know anything about it (despite the fact that we had documented in the physio “plan” in her notes). We requested that she start timed toileting and document in the nursing care plan.
The change was still not documented in the care plan. By this stage we were very concerned about the patient over stretching their bladder and not ambulating as she was too distressed by the episodes of incontinence. We proceeded to discuss the situation with the nursing co-ordinator who promptly updated the nursing care plan and asked for the names of the two nurses who had not done it previously as she would ensure they had a “good talking to”.
I felt slightly bad for the nurses who may have gotten into trouble over the situation, after we effectively “dobbed on them” to the nursing co-ordinator. However I feel that going above their heads to the co-ordinator was the right thing to do for the patients sake. Despite the fact that there were then a few dagger eyes displayed by one of the nurses, after the timed toileting started the patient was up and ambulating and I’d gladly dob on them again if I had to.
3 comments:
hey
i was just wondering how you managed to do 4 blogs in 4 minutes?
any tips for helping me do mine that quickly?
I think you did exactly the right thing and if I were in the same situation I would have done the same. Even though you had to 'dob' the nurse in you had already spoken to them and outlined clearly your request for their nursing care plan and the reasons for this. While its always a good idea to have the nurses supporting you, thus having to be on 'their good side' its a two way relationship and they need to help you out as well. In this case the patient would have been the one affected negatively and therefore you needed to act as the nurse would not support you in your efforts to treat this patient effectively.
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