Tag Archives: Bobbi McCarthy

An Exercise of Compassion

An Exercise of Compassion

emergency

Image by Sebastian Gerhard

The ER is in total chaos today. All 23 rooms are full, the behavioral health suite is full, the waiting room is full, and even the hallway is full. Full of sick patients. The nurses are frazzled, working as hard as they can delivering treatments, hanging IV medications, soothing fears, charting and carrying out each order on every patient. There are 23 rooms in our ER. The waiting room has 12 triaged patients waiting for a room, the hallway holds 5 stretchers with sick patients on them and the behavioral suite has 5 patients in there (3 counted for in the room number). We are currently in a crisis situation~ we have 2 doctors, a PA and 6 nurses. Its only 9am.

At this point another behavioral health patient is brought into our ER by the state police. He is psychotic and half-dressed and screaming at unseen people. He was found in the park yelling at a tree. As the charge nurse I go out to assess him (the triage nurse is busy). I find him to be completely in need of psychiatric help and not suitable to be allowed to stay in the waiting room, (as you can imagine the other patients and their families were getting an eye full!!) BUT where can I put him to him safe and to keep the staff and other patients safe??? Shuffling of patients begins…

Our ER, like every ER across the country is facing these situations every day. The budget cuts to the mental health programs have resulted in catastrophic cuts in the community resources that our patients need to stay healthy and out of crisis situations. The ER has become the place to send all of these patients. Once with us, the truly ill might be kept in our ER for days while waiting for a bed to open up in a psych hospital.

Behavioral health/mental health patients are especially frustrating for us ER nurses for a few reasons. We are not psych nurses, so many times we feel overwhelmed with how to help them, they are hard to manage both medically and emotionally and at times they have multiple outbursts that are unsafe and scary, they take up many of our limited resources (staff and beds) so we again feel overwhelmed, and the frustration level rises every time we present their situation to another hospital hoping they can be seen and helped in the fashion they need~~~ and they get declined due to “that patient just doesn’t fit our milieu.”
compassion,jpg
With all of that said,  how can we as nurses see these patients through a new lense??? Since we have no control over the red tape of the Psych world maybe there is something we can do to see the patient as we do the chest pain, the trauma and the septic patient; we might have less frustration and feel less overwhelmed. I decided to try something…and it was an exercise in compassion.

I decided to be a mental health patient to walk a mile in their shoes, to see how it feels on some small level. With the ok from my supervisor and the help of the staff, I came into the ER and “signed in.” At first it was silly and giggles erupted from myself and the triage nurse…but then as I was asked the multiple intrusive questions, and brought to a room to change out of my clothes and given the blue paper scrubs to change into, things were not so funny. Out of respect for me the nurse didn’t stay in the room and watch me change, BUT if I were truly in crisis she would have had to do that!  Once changed, all of my belongings were taken from me, bagged and locked up. I had to be without my bra and undies – NOT COOL – and I couldn’t keep my cell phone either. I was then moved into the behavioral health suite, scary. I wanted the full experience so I was then put into 4 point restraints for “an unsafe outburst that put myself and the staff at risk of harm.” At that point I was scared… something happened.

I always knew that putting someone in restraints made me sick to my stomach. I knew on some guttural level how awful it must feel for that person. Now, I know why we do it and I’m not saying we do anything wrong, I am just saying that it is WORSE than I ever imagined it to be. I stayed in them for 15 minutes, and I was with people I trust… and at one point I had to tell myself to not freak out! My nose itched and I couldn’t scratch it. I didn’t like the way the shirt was slipping up off of my stomach… I felt so out of control… when I was released from the restraints I felt like crying. I had the luxury of saying, “OK, this little experiment is OVER!! I honestly can tell you that it was a good experience, in the fact that I got just a little taste of how the patient must feel…and it opened my heart as well as my eyes.

There may not be anything I can do to get the mental health patient to a psych bed any quicker…BUT I can have a better understanding of their situation and a bit more compassion.

Faith and Healing

Faith and Healing

In the process of returning from taking my lunch break and walking through the front of the ER by triage, I spotted one of my daughter’s friends sitting in the waiting area with her father. I went up to them to say hello and noticed how pale she was. I asked what was wrong, “I have a headache and I’m a bit dizzy” she replied.

“She had a seizure and passed out,” her father interjected.

After a quick triage of what had occurred, I got a wheelchair, grabbed the beginnings of her chart and whisked her into room one. This beautiful, young woman, with no history of any health issues, was beginning a shopping adventure at Walmart when she woke up on the floor. An attendant described to her what she saw happen and it sounded like a seizure. “I knew something was wrong…I fell to the ground with no control of my body and strange things were happening with my mouth…It was embarrassing but I couldn’t stop it…I couldn’t control it…it was terrifying.”

She had someone call her father and he then went to get her and brought her here. Read more…

Transpersonal Caring Relationships in Nursing

Transpersonal Caring Relationships in Nursing

raw_peppermint

I walked into room 15 to introduce myself to my new migraine patient and I found her rocking back and forth on the stretcher. Both of her hands were firmly pressed into her forehead and covering her eyes. The chart says my patient is 17 years old but her tiny frame all curled in a ball made her look 10 as she rocked in pain. An older woman sat in a chair in the corner of the room and looked at me with pleading eyes.

I quietly closed the door and moved to the stretcher. I sat the chart down on an empty chair and softly introduced myself to my patient and her mother.

“Hello (name), I am Bobbi and I will be your nurse today…I promise I will get you feeling better soon.”

“Please help me,” my patient answered without moving her hands from her head. I asked her to rate her pain on a scale of 1-10 with 10 being the worst pain. Read more…

Experience, Knowledge and Caring: Good Nursing Requires The Whole Package

Experience, Knowledge and Caring: Good Nursing Requires The Whole Package

Her little blue eyes darted from her mother to me repeatedly as tears built up and dropped onto her cheeks. I smiled at her and set my equipment down on the counter. Her little chin quivered with fear as she struggled to compose herself. Her mother quickly rushed to her side on the stretcher and held her tiny body close as she explained, “I’m sorry honey but we have to do this.”

IV insertion requires great skillI sat on the stool near the counter, a few feet away from the stretcher, waiting for this little girl’s mother to finish consoling her child. I was well aware of the fact that this little one knew all too well how painful things were about to get and she was trying so hard to be brave. (2 months prior to this date this child came in and had to have a large MRSA boil lanced and the IV didn’t go so well. Read more…

The Heart of a Nurse

The Heart of a Nurse

Something was said to me on Christmas that has left me pondering just why being a nurse is so wonderful. The comment was, “She is such a smart girl. She shouldn’t be in the nursing program. She should be a doctor.”

Well…Hmmmmmmmm. I admire the intelligence of some very fine doctors I’ve worked with over the last 23 years and this posting is in NO way a slam to any of them. The person speaking holds himself in high regard in his own profession and I don’t think he even realized what he was saying or how it sounded to a NURSE!

I’m not going to rant about how smart nurses have to be because we all know how smart nurses are. We nurses know that on many an occasion we save the patient from the doctor and we save the doctor from him/herself! I’m not going to go into all the technical things we need to know and all the skills we have to perform on a daily basis. Read more…

Holistic Nursing and the Surgical Patient

Holistic Nursing and the Surgical Patient

A category 2 abdominal pain patient was brought into room 5 from the waiting room of my ER. She was an early 20-something who happened to be 17 weeks pregnant. She was complaining of diffuse belly pain, fever and nausea that had escalated over 48 hours. I watched the tech wheel her by the nursing station to go into room 5. She was petite in stature, and even smaller in appearance as she hunched forward guarding her stomach with her arms. A very worried-looking older woman accompanied her.

I quickly exited out of my charting on the computer, grabbed her triage information and scanned it. I went to the med room and collected an IV tray, saline, and a Doppler. As I entered the room I quietly laid my equipment on the counter and walked to the stretcher. Worried eyes looked at me from the face of this attractive young woman. Read more…

Past and Present Reunite

Past and Present Reunite

I could hear her crying and screaming in pain as I entered the ER for my evening shift. The door to her room was closed but the bone-chilling cries echoed out beneath the wooden door and filled the airspace of the nursing station. I inquired about her. “She got here almost an hour ago and we cannot seem to get a handle on her pain…” I looked at the board to see her name—I knew her… My heart raced and I felt a lump gather in my throat…I hadn’t seen her for almost 9 years now. My mind sped back to the time that our paths had crossed.

I was doing home health nursing then and she was a teenager with a newly diagnosed sarcoma. I was to care for her while she received treatments. I was in her home several times a week for a several months. We bonded and I cared about her. Read more…

The Mind/Body/Spirit Connection

The Mind/Body/Spirit Connection

I went to room 13 to check on the patient I had just received report on… the ER was CRAZY but for some reason I felt the need to check on him first. Late teens, sick for 3 weeks with diarrhea, waiting on a stool sample (all other labs were back and relatively normal), loss of 20 pounds… I found him asleep on his left side with his left arm outstretched to expose the 18 gauge needle in the anticube with IV tubing attached to NS running at 400/hr (second liter). He was a handsome boy but pale and thin with dark hair all messed up, skin was dry and monitor showed a normal sinus with a rate of 96. His oxygen sat was normal at 99, blood pressure also normal at 120/76. The room was empty except for him of course and a purse…pink with brown trim (I’m assuming not his). Read more…