¶ … Diary Entries
Diary Entry
When we first start out in the nursing profession, there are often incidents that come about to test our ability to confront challenges head on. While these challenges often take the form of medical emergencies, they can also come from colleagues who may not always act in the patient's best interest. I experienced one such challenge early on in my student nursing career and the way I responded to it has weighed on my mind ever since.
What is the Problem?
As a young student nurse I encountered a man, Mr. A, who was experiencing severe arthritis related pain in his left hip. The discovery of this patient's condition and the ensuing conversation regarding his pain with the registered nurse on duty led to an ethical dilemma when she refused to administer his pain medication. Ultimately, this led to me feeling as though I had let down the patient because I did not stand up for his individual rights.
What Was My role in the Situation?
I was the nurse who discovered him in bed in the morning and the one to whom he expressed that he was in pain. It was then my responsibility to assess his condition and check to see when his meds had been administered. I was able to discern that while the regular dose of oxycodone had been administered at 0600, he had not been given a breakthrough dose since the night before when he had twice required it.
What Was I Trying to Achieve?
It was my intention that Mr. A should be immediately relieved of his pain by receiving the breakthrough dose as soon as possible.
What Actions Did I Take?
Since, as a student nurse, I was unable to administer the medication on my own, I informed the registered nurse who was responsible for Mr. A's care of his situation and the need to administer a breakthrough dose as soon as possible.
What Was the Response of Others?
The registered nurse replied rather curtly that she was very busy and, since he had already received a regular dose at 0600, he was not in need of another. She then sent me to help out elsewhere and I left, shocked, without knowing if Mr. A would receive the extra dose of medication he needed.
What Were the Consequences for the Patient?
As a consequence of this exchange, Mr. A was, at the very least, forced to wait longer for his breakthrough dose than was necessary and may not even have received it for several hours. This left him dealing with considerable pain that was normally relieved the breakthrough dose. So a patient, who could easily have been relieved of his pain, was left alone to deal with it.
What Were the Consequences for Myself?
For my part, I was left feeling guilty that I had not done more to relieve Mr. A of his pain. Also I was left intimidated by a registered nurse on duty who should me and the patient little concern or respect. All I could do for the patient was tell him that his meds were on the way, but even that did little to alleviate my guilt since I was not sure if this was true or not.
What Were the Consequences for Others?
The registered nurse was exposed to no consequences at all, that I am aware of, for her role in failing to promptly administer the breakthrough dose. Also, I am sure that it reinforced her belief that she was in charge and no student could tell her what she should do.
What Feelings Did It Evoke in the Patient?
I am sure that, for Mr. A, there were just strong feelings of anxiety as he waited to receive the medication that he knew could quickly relieve his pain. It may also have led him to distrust much of what he was told by the nursing staff in the future.
What Feelings Did It Evoke in Myself?
This entire episode evoked strong feelings of resentment in me towards the way the nurse had treated both me and Mr. A. This incident must have evoked similarly strong feelings of guilt for not getting Mr. A his medicine and not being completely honest with him about when it would be arriving.
What Feelings Did It Evoke in Others?
The registered nurse was already feeling annoyed and overburdened by her duties but having to deal with a nurse telling her what she should do only exacerbated those feelings.
What Was Good or Bad About the Experience?
The negative aspects of this experience are readily apparent. Mr. A was denied quick...
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