Reflection #3- Listen To Your Patient
I imagine that in my nursing career, there will be times when I will feel completely overwhelmed. I imagine that most nurses have days in which they feel overwhelmed with the load of patients they care for, the amount of meds they have to pass to all of those patients, the calls they have to make and the procedures they have to perform within a certain time frame. Then the nurse still needs to make time to be there for the patient as a listening ear, an advocate and a coordinator of care. I’m sure that sometimes the 12 hour shift doesn’t seem like enough time to complete all that has to be done.
There may be times when the nurse takes shortcuts, or when he/she is in such a rush that he/she doesn’t stop and listen to what the patient is saying, especially if that patient is said to have “certain behaviors or characteristics” per the nurse on the shift prior.
I imagine that some nurses get focused on the tasks of the day and forget to tailor their care to each individual patient.
I imagine that some nurses keep moving forward with the orders the computer spits out because they’re trying to complete a task instead of truly talking to the patient. The nurse may forget that learning from human interaction is more valuable then what a computer can tell. Even worse I imagine some nurses may completely ignore what the patient is telling them, because “that’s not what the doctor order or computer says”.
Two weeks ago, my patient, we’ll call him D.W. was given two 5 m.g. Glyburide tablets, prior to receiving his dinner or having a blood glucose drawn. Glyburide is an antidiabetic used to control blood sugar in type 2 diabetes mellitus and one of the adverse reactions is hypoglycemia. The recommended dosage for a geriatric patient (D.W. is 72) P.O. is: 1.25–2.5 mg/day initially; may be ↑ by 2.5 mg/day weekly, per the Davis Drug Guide. That same night that D.W was given 2 tablets of Glyburide, he became hypoglycemic and his blood sugar dropped to 46 mg/dL. Worse then that, he had to experience the awful adverse reactions that accompany hypoglycemia.
I was not in the hospital when all of this happened, because it was after clinical hours, but as I was caring for D.W. the next day, the first words out of his mouth was, “They gave me too much Glyburide last night. I told them I only take 5 mg at home, but they said the order was for 10 mg.” Shortly after he filled me in, the nurse manager came in to tell me to hold his morning Glyburide pill and to make sure that he had food in front of him before proceeding with any antidiabetic meds. She also told me that we should taper the 10 mg Glyburide pill down to 5mg. I was the one that would be giving D.W. his medicine that day because it was the day of my formative evaluation and med pass. Even though the nurse assigned to D.W. would not be administering his meds, I felt that she needed to be aware of the new plan, because she was not in the room during my conversation with the nurse manager. I filled her in, and then she made a plan to call the doctor and have the order changed in the computer.
My clinical instructor and myself decided to do a little research of our own, so we found a computer and searched under the MAR and the home medication list. The MAR read: Glyburide 10 mg 2 tab p.o. BID ac. The home medication list read: Glyburide 5 mg p.o. BID ac. We found the discrepancy and reiterated to his nurse the importance of contacting the doctor to change his order.
When it came time to give D.W. his meds, he was a little anxious and very aware of every medication that I called out to him. He had me repeat the medications several times and then told me that two of the pills that I called out were pills that he usually takes at bedtime. I listened and set those pills aside. Then I placed the rest of the pills in the pill cup, and even after telling D.W. the name of each pill several times, he still asked me what each pill was as he took them one by one from the cup. I can’t blame him for the apprehension he felt because just the night before, he experienced a severe drop in blood sugar of 46, and all because he wasn’t heard by the nurse who administered the medication.
I was not present the night before my shift to witness what took place when the two 5 mg Glyburide pills were administered. The only thing I can go on is what D.W. was telling me, and that was the fact that he told the nurse that he never takes two 5 mg Glyburide pills, and that one 5 m.g. tab is his usual dosage. If in fact he really did tell the nurse this information, then I feel disappointed that my patient wasn’t heard.
It was a great reminder and a good lesson for me to witness. As nurses, we must listen to our patients, question what they question and advocate for them. Otherwise there could be a consequence, like a low blood sugar of 46, which could have been prevented. Beyond our busy schedule, our task list, and all the meds that need to be passed to our patients, we must stop, take time to listen and move beyond what the computer or doctors order says. Again, we must advocate for them. It’s our responsibility and honor as nurses to serve our patients and help them recover or deal with their disease process or illness. They rely on us for that, and we can’t forget the human that that lies scared and helpless in the hospital bed in front of us. They know much more about their meds, history and life (if they are cognitively sound) then a computer can ever tell us. I will take this lesson with me and remember to stop and take time to listen to my patients.