october 26,2014 Husband to the rescue

Last week in stage, my first patient was having problem with her lung and her heart. At report, the nurse told me that the patient was not cooperative with the team and she didn't want to put her O2 mask on. I went to see her, introduced her in a calm way. Tried to understand her situation at first she didn't talk but I stayed in the room and she started saying that the nurses and doctor were not helping her. I resonated her and said that if they want her to have her oxygen mask, it's because she need it otherwise she will desaturate. She knew that but was saying that she had a lot of problems and wouldn't make it. I said that the oxygen mask will make her feel better and that it's a start. She still refused to wear it.
So I told myself that this is not helping her. I knew the consequences that could happen. I thought of whether I say these potential complications to her or I keep it for myself. I chose to keep it for myself because the patient was already negative about her problem and telling her what could happen if she doesn't cooperate could worsen and bring more negativeness in her mind.
I knew that by not telling her everything I wasn't respecting the patient's right but on the other side, she didn't ask to know it and I know it wouldn't make her situation any better. I went and talked about the situation with my nurse and she agreed that it wouldn't be a good idea to talk about the complications of not wearing a mask.
When I went back to see her, she had her mask on her, I told her it was a good thing and she said that when she called her husband, he also encouraged her to put it that is why she did it.

Qais Khedri
Nursing Ethics

Smoking breaks October 15, 2014

During my stage in the mental health unit, I experienced a situation where I had to advocate for my patient. I was on the evening shift, and as I got the report, the nurse that that my schizophrenic patient has had a bad behavior the day and that he was no longer allowed to have his cigarette break. I went and talked with him, he explained me the situation calmly  so I told him that on this floor, being allowed to go out and smoke is a privilege and the reason why he could not have this privilege was because he didn't behave appropriately with the staff. He continued saying bad words about the staff and I told him that I would let him have his smoke only if he stay calm,behave correctly and don't say bad words. He said that he would try. Then the smoking break time was starting and my patient did what I told him to do. At first, the nurse was not letting him go out because she taught he still was agitated and was aggressive, then I came and told him (the nurse) that I made a deal with the patient that if he would nice, then he would be allowed to have his privilege, The nurse still wasn't sure of letting the patient but I told him that I made a deal with my patient and it would be nice because I will have the patient's trust and that if he would not let him, the patient would get even more agitated. He accepted and let the patient go. After the break, the patient thanked me and continued being calm for the rest of my shift.

I believe I did the right thing because I thought of the potential problems that could happen if we would not let him have his cigarette. For them, going out for 5-10 min is a relief because they spend all their day in the unit and having the permission of going out make them feel better. One the negative side, we know that letting the patient smoke isn't good for their health but many of them were smoker before being admitted to the psychiatric unit. I think I approached the issue in the right way because at the end I got positive outcome. If he would still be agitated or aggressive then I would first not try to make a deal and it could have had bad outcomes because the patient would think that even if he misbehave, he is allowed to have his ''moment of freedom''. I learned that we can develop good relationship and having the patient's trust is important because otherwise, he might not belief what you tell him after (but this can also happen).

Qais Khedri

Nursing ethics

Patient in pain October 8,2014

I remember a patient that was in moderate pain. I was assessing his pain and I could see that it was unbearable. The patient had his medication an hour ago and on his prescription it was ordered to give the medication 1 dose every 4 hours. The patient really wanted me to give his pain medication even if I tried to resonate him that it was dangerous to give it now because of the effects it could have on the body (respiratory depression,death). I could see that the patient was suffering so I tried non-therapeutic management, I suggested him to think of something else (reading) he said no, Then a warm compress and put it on the area where the pain was. He said that it was helpful and relieving, 
I used beneficence and non-maleficence because giving him his medication could potentially harm him so finding other ways of doing thins was the best to do for my patient. The warm compress was helpful so I kept doing this until he felt asleep. Then when the time can to give him his medication, he took it and thanked me for what I did to him. 


I told him that I did what we is our duty to do. I felt happy bout myself because the outcome of my intervention was successful. I found it interesting because we can find alternatives and not only have the patient think that the only way to treat pain is medication. Showing the patient that you can control a situation like that is helpful because the patient has more a sense of trust afterwards.
Continuing learning more non-pharmacological techniques will be useful because if the one I did would not work, then I could try other alternatives.

Qais Khedri
Nursing Ethics

October 4th,2014 Who has the priority ?

This week in stage one of my patient was 70 years old. He was there because of he had pneumonia. Before meeting my patient I looked at the report to see if there was something to his profile. I saw in his profile that he could eat, mobilize, and go to bathroom independently. Then as usual, I went and met him, I took his vital signs and then observed him eating his breakfast. He actually could eat by his own but it was taking him time between each bite(he ate all his breakfast). Then during dinner, I entered in my pt's room and saw the PAB feeding him. I asked her if it was the patient that asked to  be fed, she said no. Then I told her that he can eat by his own, She said that ''yes but he's taking too much time and we need to send the tray soon,’’. I didn't say much in  front of the patient but really wanted to make her stop feeding him.  I was really surprised that she would prioritize ''her time'' instead of helping the patient's autonomy.

Following this, I asked myself that how can we keep the patient's autonomy if we do things that they are able to do. And in that case, the patient wasn't allowed to make his own decision. It was a form of coercion where she was forcing the patient to eat at her speed, thereby limiting his choice and freedom. The promotion of patient's autonomy was not met and the principle of beneficence by the PAB was not respected. I should have advocated more for the patient. She could have putted the pt’s interest before her own interest.

Qais Khedri 

Nursing Ethics