Why don't they just call it how it is? How bad does it have to get. I float and watched a nurse take off a huge dressing on the patients bottom and saw a huge nasty sore with open areas and ooze. The discoloration was from the chemicals in the wipes we use and the open areas were skin tears. That is what she told another nurse doing an assessment, after they both got done refering to it as a pressure sore. She must have forgotten that CNAs don't change those dressings. So they decided to let it heal a week and documented how they hoped it will look. So we still boast no pressure sores. Would there be more documented pressure sores if CNAs just got blamed instead. We get blamed for everything, one more thing won't hurt. Then efforts can be made to treat them. Since that patients sore was not caused by pressure, even though it was, I heard them, they got defensive when I said I always find that patient flat on her back. She is not being repositioned. Wrong thing to say. The patient is on an air mattress, turning schedule and only up two hours. It is because she is not eating. And the way we are wiping the top of the bandage. Denying pressure as contributing to the worsening of her, I think they wrote abrasion, not sure, is preventing proper treatment. It will not get back to her not being turned, actually it has been denied. Maybe it is just where I work. I hope the big boss they are all hiding from does not deny it too.
On calmer reflection.
There are many reasons why patients develope pressure sores and they are all related to the blood supply to an area. Some are definitely due to neglect and others due to circumstances. Have you ever got a sore on your heel from improperly fitting shoes or a blister on your hand after using things like scissors or a screwdriver? these are all pressure sores and if you continue to do whatever caused the problem they will get worse, bleed and may become infected.
This patient is clearly seriously ill and although you don't say likely a patient in a nursing home. She is comming to the end of her life and all her vital systems are slowly shutting down which means her blood is not pumping round her body as effectively as yours is. blood carries oxygen and nutrients to all parts of our bodies. Her bottom is not recieving enough and in her weakened state there will be skin break downs in areas where a lot of pressure is applied. I can not judge if she is being turned or not but assuming she is it is likely she would also be at risk for sores on both hips as well and maybe elbows and heels, ears, cheeks, nose and anywhere else pressure is applied.
There is failure to provide proper care in residential facilities as everywhere else. i don't know if this is the case where you work. Nurses have to be very careful in the notes they make in a patients chart because of the ever real fear of lawsuites. That is fact not defense of what you saw.
Now what you saw was clearly a pressure sore. I don't doubt your word. the dressing had to be so large so it could be taped to healthy skin and not have the tape cause further damage. The discoloration you observed around the open area was probably not caused by the wipes you used to clean, if it was you would not be allowed to use them on anybody. The purpleish skin was further extension of the sore and will eventually open up too, it has to because it is dead tissue and it has to be allowed to slough off for healthy tissue to regenerate underneath. red bleeding areas are actually good news. it indicates that area is healthy and has a good blood supply. In very severecases the dead tissue may be surgically removed.
You mentioned this patient is not eating which indicates she may be close to the end of life. if you ever work in the home with dying patients you will be appaled at what you see when skelital patients cling to life for some reason and despite the loving care they are recieving their bodies will be covered in sores. the caregivers feel so much guilt and second guess many decisions but the experienced nurse is able to reassure them they have given the best of care and even if they had done the turning every five minutes the outcome would not have changed.
I can not judge the treatment the nurses you observed were giving. I was not there and have not read the orders for this patient.
You are a CNA with minimal training and I have no idea how much experience, and clearly want the best for your patients so do the best job you can in what you are trained for and the day to day responsibilities and remember to report anything you may observe so that the RN.s LPN.s whoever is ultimately responsible for the patient's care that day can alert the Dr. You have done your part. No harm in asking questions but don't accuse, that makes people defensive and you won't learn that way. if you plan to continue further in a nursing career everything you learn as a CNA will be invaluable. There is a huge amount of information on everything from basic nursing care to the interaction of drugs on the internet. Not only will it help you become a first class CNA but greatly assist in any future training you seek. I trained as a RN almost 60 years ago in the UK and in those days it was more like an aprenticeship where we started out doing CNA type things and a lot of cleaning because nothing was disposable, but were ecouraged to watch anything going on that our superiors were participating in. I know it is a different world but I have been retired six years and still keep up my research and interest though a forum like this. Good luck to you in the future. Keep questioning but don't jump to hasty conclusions learn a lot and when you are in charge make sure everything is done right.
We finally got it healed, but it was an ordeal as she always managed to peel off the bandaid and land back on her left side.
I guess what I'm saying is that sometimes no matter what you do or how hard you try those pressure sores can still pop up.
Calling a pressure sore a skin tear, though, is absurd.
Bedsores that develop in a long term care facility are a MAJOR big deal----they are reportable to the state & then the state will come & do an inspection of the facility. They'll find problems & cite the facility for the problems. The facility has a set amount of time to fix the problems or else they lose accreditation. Most places put on a big show when they know they are being audited & inspected---they put extra nurses & CNA's on duty, they fudge the staffing sheets to make it look like there are more working than there really were, staff gets told to be extra nice & know where the fire escapes are, & everybody acts like they are so vigilant. As soon as the inspection is over, everything goes back to the way it was. There is little oversight of LTC facilities. The state is supposed to oversee them, but the truth is that there are so many LTC places that it is impossible to keep track of them all.
When you live - as we all do - in a culture where people focus far too much on who is to blame for a problem, rather than on dealing with the problem, everyone spends too much time dodging the blame. Thereby they also dodge the issue. It is bad news for everyone.
It also makes it very hard to ask questions or make observations without causing an automatic, defensive reaction: this leads to poor communication, which leads to poor care.
In a neutral world, you would be able to state calmly "this patient has developed a pressure sore" and all attention would be focused on getting it healed and attempting to prevent further ones developing - always bearing in mind, of course, that in very frail, ill patients it isn't even necessarily possible to achieve that. In our sad world, as you have so clearly described, half of the nurses' time and expertise is wasted on polishing the patient record. It is infuriating, it is wrong, it is detrimental to patient welfare.
Much cleverer people than me are doing their best to sort it out, with some success in some hospitals for example, and that is the most hopeful aspect I can see of the whole sorry mess.
What you are now experiencing is probably simply grief.
Was this your first death?
Everyone experiences grief differently but look up stages of grief and you will find it takes a particular course and every stage has to be experienced. It is different for everyone and each stage does not have a predetermined length.
Once you begin your next assignment it will be easier to move forward. Every caregiver feels a sense of loss when they loose a patient but professionally you have to move ahead and file these feelings away in your inventory of experience. Some patients you will remember for ever others not so much. Now you have written about your feelings it will be easier to talk to your husband.
Thank you very much for responding to my post and thank you for the hug. Yes, this was my first death. I have experienced death in the past of friends and family members but I was not the caregiver and did not experience the transition to end of life. I will always remember this particular person. I actually learned so much from her during the time I took care of her even during the transition and I thanked her for allowing me to help her even when I knew she had no hearing left. You make sense in that I am grieving though I did not think I was grieving. I will let myself feel the way I feel and perhaps my new assignment will help me move forward. I start this Thursday. I feel so much better now having read your response and having answers to my questions from you as to what I am feeling. I think I was so used to going to my little lady's home each day and seeing her husband, her friends, her doggies and caring for her that it became such a huge part of my life and perhaps I was even in some denial about her life coming to an end. But yes, you are right in that professionally I must move forward and file the feelings away in my inventory of experience. The way you said this makes sense to me. File it away and move onward. Maybe I will talk to my husband one of these days about this experience but right now it just feels so intimate and personal and that is why I turned to this group as I knew I would be able to write down my feelings with other professionals and get the help I need. Thank you Veronica. Sending a big hug back to you:) I hope we can stay in touch. Sincerely, Elizabeth