3 Toxic Patient Scenarios-Study Tips

Three Examples of a Toxic Patient- Nursing Study Tips.com Study Guide
[Use this section as a discussion guide. Consider and argue how it would be best from a nursing point of view to handle the following cases. Support your case with guidelines, advice from nursing hotlines, or hospital or facility policy manuals. ] Real examples of a “toxic patient’ follow.
(a)In a major metropolitan county hospital, one ward included a patient who yelled in the early morning hours about his transportation. Although it was only 2 or 3 a.m. in the morning, the patient got into his wheelchair and sat in the doorway of his room, bellowing about how the nurses needed to call the doctor’s office for the car to come and get him. His howling distracted nurses and completely disturbed any peace of mind for any resident for 500 yards in any direction.
In all of these circumstances, consistent reporting to the physician, explicitly detailed note taking habits, and attentive observation could have prevented anxiety and stress to all parties concerned. But some shift nurses didn’t bother to take the time to document correctly the times and frequency of the incidents. Many other patients complained but were discouraged by nurses uninterested in documenting problems with their part of the hospital. Escalating the matter to senior administrators might have cut down on the amount of total time this patient caused stress and anxiety to staff and patients around him.
Study Questions for Toxic patient Example A: Nursing Study Tips.com
(1) Should the Director of Nursing have forwarded this case to the resident psychiatrist?
(2) Should one of the nurses have called the whistleblower hotline for the Ombudsman?
(3) Why wasn‘t the patient shifted to the floor of the hospital specifically for Psychiatric patients?

(b) In another scenario, a male patient over eighty years of age was admitted to the nursing home by his family members after a brief hospitalization. He was documented as having entered the rooms of other female patients in the nursing home and acting in a socially unacceptable way. Despite his frequent habit of wandering all around for years, the staff of the facility grew used to him being up dressed and out of his room, unsupervised, at all hours. They simply grew too used to his walking back and forth and stopped keeping track of him.
One day the patient simply wandered out the front door to the street, and down the sidewalk. By the time a nurse noticed he was missing, the four nurses he had walked by couldn’t even remember what he had been wearing to describe to police. The security guard set by the door had been fired to cut costs. The housekeeping staffer they had appointed for that position had been called away to clean a shower upstairs. The long term care facility (nursing home) was on the hook for the incident. The nurse who was scheduled to be supervisor on duty was made redundant (fired), for cause.
Even though the nurse was busy doing ten other things at the time, and the situation was completely normal, institutional responsibility was suffering. Technically the nurse was at fault for failing to direct other staff to prevent this calamity. The nurse should have told others under her supervision to watch the person, follow him, or secure the door. Even though the facility had allowed the situation to deteriorate to a point where the nurses were no longer vigilant, the nurse on duty that day was termed responsible.
If the nurses previous to this incident had completed their shift with documented letters to their supervisors, or copied the Director of Nurses on their notes reporting such incidents, the ongoing risk would have been noted and set into the patient resident care plan. Except that high turnover allowed even veteran nurses to forget the poignancy of such a risk and go about their other business as if it were no longer their problem to watch this man and where he went. The Certified Nursing Assistants blamed the nurses for not reminding them. The nurses were blamed for not reviewing (and updating) the situation in the licensed nurse progress notes.
Study Questions for Toxic Patient Example B:
(1) was the nurse to blame or the nursing supervisor for the shift?
(2) Should the nurse (or the housekeeping employee turned security watcher) have been fired instead?
(3) Does the nurse who was fired have a case with the State Nursing Board to have the case reviewed for Unfair/Illegal Termination Without Cause?
Toxic Patient Scenario C – Nursing Study Tips.com
At a nursing home several nurses have been alternately assigned to “Jane Marx”, a patient who has a lot of complaints and irritations. “Jane Marx’ has gotten a bad rap from the newer nurses, while the nurses who have been employed a longer period of time have a much better grasp of the patient’s individual maladies. The older nurses know, for example, that the patient’s health had changed and that the patient had gone through a lot of painful operations and suffered through many unforeseen difficulties.
But ‘Jane Marx’ has a habit of putting complaints in writing to the facility administrator about problems that crop up. One of the problems she talks about is that one of the nurse consistency sleeps on the job, and watches TV and surfs the Internet watching Youtube. This nurse is older, and should know better. Other nurses have been fired for using their cellphones and none of the female nurses ever sit on the desk watching TV. ‘Jane Marx” was the patient who reported them. The current Director of Nurses has never lectured the sleeping nurse or cut his hours.
Recent staff shortages make the nurses recall other employees who quit recently. The staff discuss a very good nurse who left the facility months earlier, who got lectured by the Director of Nurses for being constantly late. Yet this male nurse gets to arrive late and wind the clock down doing nothing to ‘make up his time.” “Jane Marx “ has observed the elder male nurse staying late at night, while working nurses were busy, ‘to make up his time on the clock”. No other employee simply gets to arrive late, ‘Jane Marx” maintains, and stay after, doing nothing past their scheduled time in lieu of real work during their earlier scheduled time.
The nurses learn that ‘Jane Marx” has been raising the topic of the sleeping nurse in her care plan meetings. She has been consistently catching this nurse napping at night at the desk. No other employees of the facility ever sleep on the job. “Jane Marx” has been told that some of her treatment options are too time-consuming to pursue. Every night that “Jane Marx” comes out and find a nurse asleep, or twiddling his thumbs to “make up his time”, she argues there is time for her treatments and that the facility is not organizing its staff resources properly.
But “Jane Marx” argues that as long as nurses can “hang around watching TV” there should be enough staff to get the extra stuff done. The nurse in question often drifts around nibbling snacks and reading, waiting for the clock to wind down. Many employees dismiss the complaints of “Jane Marx’ on this topic due to her other many complaints. The day the Department of Health came around, asking questions, many nurses were startled. The agency was taking note of all this patient’s reported sightings of the sleeping nurse. The nursing home was cited and fined.
Study Questions for Example C, Toxic patients, Nursing Study Tips.com
1. Why Couldn’t Peer Pressure have kept the nurse from sleeping on the job?
2. What steps should the Director of Nursing have taken to prevent this situation from happening?
3.

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