For this clinical rotation Dafne and I were on the geriatric psych floor. I enjoyed this area and the time with the patients as well as observing the new protocol for chair and bed alarms for high fall risk patients. We started the morning listening to the night nurses giving report to the day shift nurses. It was interesting to not only hear the medical side of the report but also the opinions the night nurses had of each patient. We were then told to sit in the day room with one of the patients on high fall risk status while the tech did 15 minute checks. We sat in the day room with the high fall risk patient in the recliner chair and a couple of other patients on the chairs watching a documentary on Neil Armstrong. Tristan then came in and asked the patient in the recliner if she was sitting on a pad. She said no, so he went and got one. When he came back and put the chair alarm pad on the chair and activated it, he explained to us that the hospital had started a new safety protocol for the high fall risk patients on the geriatric floor. The new protocol is that when a high fall risk patient is not in bed they must stay in the day room and have a chair alarm under them as well as having a tech sit with them and assist them if they need to go to the restroom; if the patient is in bed then the patient must have a bed alarm and a tech must be with them unless they raise all four bedrails. Tristan said this was tough for them to get used to because it left only one tech on the floor to do the rounds and assist the other patients on the floor, plus it made the nurses have to leave the nurses station and have them interact with the patients more.
We were informed of the newest patient admit over night and discovered that he was also on a high risk status. That meant that two techs were taken off the floor and must be with the one patient all day. Dafne and I then took turns following around the one nurse that was administering meds to the patients while the other one was in the nurses station working on a patient discharge. Dafne followed the nurse and observed the technique she used for medication administration and then we switched when the nurse came into the day room. I then followed the nurse as she gave meds to the rest of the patients on the floor and watched as she went to the new admit and gave him his meds. The nurse said that he had asked for pain meds and was going to give him his meds. She handed him some motrin and he asked if the doctor had said it was okay for him to have it because his personal doctor took him off motrin because it upsets his stomach. The nurse told him that the doctor said it was okay so he took it. About 30 minutes later when he was taken back to the day room he started complaining of a bad stomach ache. He told the tech that his stomach hurt really bad and wanted to talk to the nurse about getting something to calm his stomach and that he is not supposed to take motrin because it upsets his stomach. The tech looked at the patients allergy band and said he isn't allergic to it so it was okay for him to take it but he would tell the nurse about his stomach upset.
This situation made me upset for the patient, he had orders for tylenol in his MAR so the nurse should have given him the tylenol when he requested pain medication and specifically said that he couldn't take motrin. The patient said it more than once and was clearly in pain, he kept asking the nurse about the motrin and if the doctor okayed it. The nurse kept telling him yes and did not really listen to him about his concerns about the motrin. The tech did not understand what the patient meant when he said he could not take motrin and took it as if the patient was trying to say he was allergic to motrin. I was very frustrated for this patient and felt bad that he was now suffering from a stomach ache that could have been prevented if the nurse would have given him the tylenol instead. Today I recognized the RN's role as a patient advocate when I saw how blatantly she ignored him and was frustrated by him when he asked to go back to bed since he was so tired after being admitted at 2 am and just wanted to get some sleep. She failed in her role as an advocate and should have being more sensitive to his concerns and wishes despite being busy with other patients.
This event has taught me that even though the patient may be in a mental health department the patient still has rights and should be listened to if they have concerns about the medication they are taking. This patient was able to say he did not want to take the anxiety medication the nurse was going to give him and she withheld the meds but when he voiced concerns about the motrin, she completely ignored him and seemed bothered by his concerns.
I hope to use this situation in the future and in my current clinicals to ensure that I am a patient and family advocate. I hope that after experiencing this situation, I will listen to my patients concerns and if they are unsure of a medication then I would speak to the physician and see if there is a different or a better medication for my patient.