[Sharon]

Think of an example of a decision you made at work; would the decision-making process have helped?

[Melanie]

Several years ago while working at the hospital, I was pulled from my unit to go assist on the Geriatrics Psych unit as they were short staffed and had high acuity that night.
I had only been given a tour of that unit prior, I had never received training or worked on the unit previously.

The 2 most senior nurses went on break together leaving myself and another nurse to watch the floor.
While doing the q 30 rounds I came upon one of the pts who is normally under constant care and always supervised as he had dementia and could get quite aggressive very quickly roaming the hallway very disoriented. He was not steady on his feet and was talking loudly to himself. I was hoping to get him to quiet down as to not wake the other patients while calmly approaching him and talking to him. He turned around quickly and tried to run but tripped on his slipper and began to fall. In a split second I decided to block his fall and he landed on me. Not the smartest decision, but having to act quickly, that was the decision I made. I had hurt myself in the process and the patient was also in pain as he’d hit one of his elbows on the hard floor. I called out for the other nurse to come and assist me, she couldn’t hear me as she was at the nursing station and we were on the other side of the unit in the hallway. I ended up having to keep calling out until one of the patients across the hall woke up and heard me then went to alert her.

The decision process would have helped for sure in this situation. I should have been involved in making the decision to go to that unit instead of being told to go.

The 2 senior nurses should not have been allowed to take a break at the same time.

I should have been properly oriented and trained to work on this unit. I also should have been asked if I could go work on that unit and not been told I had to go. I wasn’t given a choice .

Doing the rounds, the other nurse who was familiar with the unit should have accompanied me.

I should not have used myself as the “Cushion” to break the patients fall, but I made a very quick decision in that moment in order to not have him seriously hurt himself.

There are several issues here that could have been avoided had a proper decision making process been allowed and followed.

[Sandra]

I will say I understand completely where you are coming from working on a unit you don’t know or have been trained on. Unfortunately in the Hospital I work at every day and every night the nurse manager on call calls the units to see how many RNs, RPNs and PSWs there are working. They will pull the person with less seniority to go and help out another unit and take a patient assignment. Unfortunately the hospital does’t care of you are trained or not they tell us a nurse is a nurse and the nurses get sent to any floor weather it’s psych, respiratory, critical care, surgical, medical or palliative.

[Suzanne]

Sometimes in the moment we do things because we have to think on our feet. This is why reflection is such a huge part of nursing, it is important to reflect about situations so that we know what we might do differently next time a similar situation occurs.

[Sandra]

I now work on a geriatric unit it’s for the elderly that we are to rehab to go home or to assisted living instead of hopefully not going to LTC. I would say that 75% of the patients are confused some just in a delirium state which hopefully they get out of. On this unit we don’t use restraints unless it’s the last resort so some patients do fall unfortunately, we have bed alarms but again the patients can be faster then us getting up or out of bed before we can get there to stop them. Then I remembered working in LTC years ago and we had mats on the floor for when patients fell but we didn’t have them on this unit well I don’t even think the hospital has them. I went to my manager about hot I thought these mats would help somer of our patients that are confused and fall out of bed. We ended up getting a few of these mats for the unit. My decision about this process was definitely the right decision to help the patients and the unit.

[Heather]

You are so right in suggesting the unit use mats beside the beds. Falls are so common with confusion and delirium. I have previously worked in long term care and falls were so frequent with certain patients.

[Heather]

I recently had to decide which worker to send to a difficult dementia client and challenging family situation as their regular worker was going on an extended leave. I had a worker in mind that I thought would be a good fit for this client and family. The worker ended up being quiet overwhelmed by the client and asked to not be sent to this client. I think that the decision making process would have helped avoid this situation. I think at the very least I did not analyze the issues correctly and the care this patient needs. I think using the swot analysis would have helped with this.

[Melanie]

Working with clients who have dementia is extremely challenging. The decision you made may not have worked out but, you put some thought into your selection and picked the worker you thought would be best suited. It’s very easy for caregivers and the families to feel defeated and upset when dealing with a family member with dementia on a daily basis. Not everyone is able to cope and handle it. I, for one am grateful for the nurses and PSW’s who are able to work with these patients. It takes patience, devotion, compassion and hard work among all the other qualities and skills they possess.

[Andrea]

I agree with Melanie that not everyone is suited to working with dementia patients. I also agree with you that using a decision making tool may have helped. I find tools help me to focus on the qualities desired in an employee instead of just which person to try matching up with a patient. A more objectified decision. Maybe this would have given you more people to choose from?

[Andrea]

After recently injuring myself at work I reported to the nurse manager and received first aid. The nurse manager then asked me if I wanted to continue with my day or go seek further assessment of my injury.
I decided to continue with my day as I did not want to leave my coworkers short staffed or my patients waiting longer for their visits.
After completing most of my patient visits I was having more pain, so called a coworker to see my remaining list of pts while I headed to the emergency room. At ER I learned I had a fracture in my foot and am now on modified duty for the next couple of weeks at least.
On reflection I feel my decision was made in haste and without much forethought. A decision making process would have helped me to focus on what the goal was for the long run and not just for that day. I now recognize my coworkers are going to be short staffed for a few weeks and pts may have to wait a little later in their day for visits as a result. This would have been true for one more day (day of my injury) if I had gone to ER immediately, but maybe I would have protected my foot by getting off of it sooner.

[Suzanne]

I feel as though in our current nursing climate we often think about our absence affects our co-workers, oftentimes it is detrimental to our own health. Luckily you realized that you needed to be assessed yourself and took the steps to do so.

[Maame]

I currently work on a dementia unit in a LTC facility, I can recall a time I had made to make decision which was prevention of falls for a particular resident. This particular resident kept climbing out of bed and none of the registered staff were implementing the necessary steps to prevent the fall. I sent a referral to the occuptional therapist for a bed alarm, hip protectors and floor mats to prevent falls. I believe I actually implemented the decision process in this situation by first identifying the decision to be made, determining the outcome which was how the resident/staff benefit. The benefit for the resident will be prevention from injury and for the staff it would be being alerted when the resident is trying to get up. Lastly, evaluating the decision if it worked or not in which it did because all the preventative measures are now in place.

[Suzanne]

Years ago when I first graduated from nursing school I worked in long term care as a floor nurse. There were a team of psw’s that worked together to provide patient care. We did work the same shift together all the time so we’re quite familiar with each other. At one point there was a serious personality conflict between two of the psw’s and I took it upon myself to call a floor meeting to see how we could resolve this without having conversations with both parties to see how we could handle the concerns. Lesson learned from that situation to always get both sides of the story and see how the work environment could be changed so that it is beneficial to both parties.

[Author]

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