Beyond the Bodily Fluids: Dignity, Duty, and a Very Long Cleanup

 

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    The relentless beeping of monitors slices through the ward's stillness; each call light, alarm, beeping, or ring is a reminder of the fragile balance between life and crisis. The telementy unit is beginning to wake as the night shift ends, their twelve-hour march wrapping up bed baths, answering last-minute call lights, updating charts, sending blood samples off as the tube station “sucks” another carrier off to the laboratory, the nurse scurrying to complete the previous night's orders. My fatigued mind, belly full of at least one cup of coffee, heart pounding and racing in anticipation of what to expect after the report from the nightshift nurse, and the handoff is complete as the outgoing nurse says under her breath, “Good luck.” I can now hear an echo of the tension that fills the air. It's another day on the telemetry unit, a haven for patients grappling with cardiac disease and a host of other health challenges.

    The telemetry unit is composed of patients with cardiac disease and a myriad of other health issues. Most of the patients have uncontrolled blood pressure, out-of-control diabetes, struggle with their weight, and are non-compliant with medical prescriptions and medicines. Most patients, but not all, are ESL (English as a second language) or limited English speakers. Considering language barriers and a general literacy that falls short of a standard American high school education, one can see the dilemma of administering clinical therapy to these patient populations. As nurses, we all take courses and education to provide culturally competent care, because every human being has the right to affordable, high-quality care.

    Take, for instance, an elderly patient in her late sixties, female, from Guatemala, who struggles with both high blood pressure and diabetes. With limited English proficiency and understanding of her treatment plan, she often misses taking her medications, leading to frequent hospital visits. Her story exemplifies how communication barriers can significantly impact health outcomes. To mitigate these challenges, healthcare providers can employ practical communication strategies, such as using interpreters to facilitate understanding, using language line services to teach back to confirm patient comprehension, and providing written instructions in the patient's native language. These efforts can help bridge the communication gap and improve the quality of care.

    In the telemetry unit, staffing ratios are increasingly stretched, and resources are limited, exacerbating the challenges of delivering effective care. This situation highlights not just an individual crisis but a systemic issue within the healthcare infrastructure.

    One particular day, I finally got a less-than-adequate report on my four patients from the previous night shift RN, who was also a traveler, and when a report from the previous nurse (whose report starts out, “I barely survived.”, you already know you are going to get hammered. An incomplete handoff not only adds stress to an already demanding situation, but it can also directly affect patient safety, potentially leading to dangerous oversights or mistakes. To mitigate these issues, adopting structured handoff protocols, such as SBAR (Situation, Background, Assessment, Recommendation), can enhance clarity and ensure critical information is communicated effectively. It's also essential to actively verify and clarify any missing information before the previous shift staff leave, either by asking direct questions or using a checklist to confirm key details. Advocating for a safer handoff process, for instance, through regular feedback sessions and training, can prepare staff to deal with existing communication gaps in real time.

    I had barely finished getting a report on all of my patients when I overheard “Who has room 94?” from the central nursing station as the night-shift staff lingered around like tattered zombies, wrapping up their charts and stumbling out of the unit with sunglasses on to avoid direct sunlight. I reply with a confident, “I do,” and one of the nurse assistants on the unit says, “The patient in the room, you gotta come see this!”

    I hightail it over there to the room, though not at a code-blue speed and certainly not at a stroll through the park pace either. I get to the patient's room, and the first thing I notice is a middle-aged, confused patient standing in front of the door, and the patient is buck naked. I did not know why the patient was naked, nor could I see where the patient’s hospital gown was located. I recalled, though, that the bathroom door directly behind the patient was wide open, and I could see a trail of toilet paper on the floor (and not in the toilet where it should be). The single detail of my observation that immediately caught my attention was a clear view of the patient's IV that is no longer in their vein but on their left forearm, hanging on by a small piece of tape, actively bleeding. Assuming the patient had pulled it out, my first steps were to ensure the patient's immediate safety and call for assistance from the team. I quickly assessed the need to prevent further injury or a fall and perform first aid on the now non-functioning intravenous line, the lifeline to saving any patient, which is a working I.V. line that was now self-discontinued. My training kicked in, reminding me to prioritize infection control immediately. I ensured my gloves and gown were secure before addressing the loose IV and the hygiene issues. Securing the environment was critical. It was crucial to maintain a calm demeanor amid the chaos to prevent further stress for the patient and ensure my actions were guided by established protocols. With the team's help, we systematically began restoring order and addressing the situation. Grabbing a blanket, I draped it over the patient.

    What sent my mind through the roof was the room's shocking state when I entered. The distinctive smell and aroma hinted at an infection, an all-too-common presence in hospital settings. Ask any RN, and they will tell you that dealing with cases like these is no easy task. The room was a scene of sheer chaos, a manifestation of the struggles we face. It was clear that the situation demanded immediate attention and careful management.

    There was poop on the side rails of the bed and on the foot of the bed as well as the sheets the patient had previously been lying on, and there was poop on the bathroom walls and the handles of the bathroom door. There was visible poop on both of the patient's hands and on the buttocks, of course, and on the patient's chest and abdomen. In that moment, a wave of frustration and helplessness washed over me. It was one of those rare instances where the magnitude of the situation felt overwhelming, challenging my patience and resolve. Yet, amid the patient's dire straits and confusion, I realized that confronting these emotions head-on was essential to maintaining empathy and focus. Taking a few deep breaths, I reminded myself of the importance of staying composed. I engaged in positive self-talk, telling myself that I could handle the situation and reassure the patient effectively, although I do not believe that the patient clearly understood the gravity of the situation. Later, I knew I would need to debrief with my team to process the experience and discuss any improvements for future incidents.

    This was the worst case of a confused patient I had ever been responsible for. I said to myself, 'How am I going to clean this crap up?' I meant that literally. I had never in my career seen more poop painted on the exterior of a hospital room. I took a deep breath, gathered some supplies, gowned up, and, with the nursing assistant, headed straight into the room to clean this patient up and to start a new IV. As we entered, we quickly assessed the tasks at hand and divided them efficiently. I carefully managed the patient's IV and monitored vital signs, ensuring the IV remained secure while adhering to infection control protocols. Meanwhile, the nursing assistant and I focused on cleaning the patient and addressing hygiene concerns, reassuring the patient throughout the process to keep them calm. We engaged our environment of care stakeholders to assist with mopping, wiping, and refurbishing, ensuring clean linen and toiletries for a clean bathroom and patient room, and allowing our housekeeping staff to bring the patient's room back up to a clean state. 

    This clear division of responsibilities enabled us to efficiently restore order in a challenging situation. This all happened before 7:30 a.m. Despite the chaos, moments like these reminded me of the critical importance of resilience and teamwork in nursing. By focusing on the patient's dignity above the mess, I learned that quality care goes beyond physical treatment; it involves providing psychological comfort in distressing situations. This experience reaffirmed my commitment to treating each patient with respect, regardless of the circumstances, and highlighted the importance of collaboration in navigating demanding scenarios.

Together in the struggle,

Brian