Friday, October 24, 2008

Safety Is Not in Numbers

So as I've said I work in a large inner city trauma center. We see about 83,000 patients a year in the ED. That's a lot. Not sure how many come in as trauma patients are sudden death but a fair number I'd imagine. Many of those are ones that I am directly responsible for in terms of providing family support. Lots of times, due to cultural reasons, every single relative and friend of the patient comes to the hospital. Frequently, this leads to a virtual wake happening in the family rooms of the ED. There is anger, falling on the floor, screaming, pulling of hair and gnashing of teeth. Sometimes it is managable, often it is not and becomes a safety issue.

I have found that I am less and less tolerant of out of control behavior. I respect culture, hell, I seek it out and find it interesting and enlightening. I gotta say though, is it really appropriate to disrupt an entire department by screaming and rolling around on the floor? I mean, I get it, I'm sorry for the loss, I am sure their heart is breaking but it scares other people, it escalates other family members, it often makes patients of family members. It makes it difficult to provide comfort. I also understand and respect that family wants to see their loved one, wants to be with other family members. I just wonder if it really needs to happen in the ED. We aren't equipped to handle 20-30 grieving family members whether they are in or out of control. We have two rooms, they aren't huge. They are far away from security and other staff, they are somewhat enclosed. We really have no idea who it is that we are allowing back into that area and what their intent might be. Our ED is in the inner city. We have gang members, we have many, many violent deaths. Often I am the only one down there with these people. I am not six feet tall. I am not muscular. My own children do not find me alarming even when I am mad. I am assertive but that is not going to matter to someone who is pissed off and wants revenge or has manufactured some sort of vendetta to avenge his father's death.

I bring my concerns to security who does not see an issue. This makes me so mad I could scream. We are not a rural hospital set in Amish country. Somebody did not get killed by being run over by a horse. They were murdered. They committed a violent suicide. They are part of the underserved population who may not have gotten appropriate medical care. They died at a young age, for a variety of reasons. Their families are pissed. Their families are shocked, they are at a loss, they are not very often in their right mind. Some families are okay to deal with. they cry, they may yell or scream, they may collapse but they do not adversely affect other patients or staff members.

A study was done at New Jersey hospitals using incident reports between 1992 to 2001 and it was found that 100% of the 50 hospitals in the study reported violent events in their ED's. 61% of employees reported threats, verbal abuse was reported by 90% of workers and almost one third reported assaults. Of assaults that occurred verbal or physical, 72% were not reported through an incident report. A survey of over 1000 ED nurses in PA indicated that during their careers 97% experienced verbal abuse, 94% had physical threats, and 66% had been physically assaulted. More than a quarter of psychiatric nurses believe that violence is to be expected in their line of work. So, really, I am not talking out of my ass. I value my life. I am the mother of three children who need me. I am not willing to risk my own health and safety because other people who do not do my job refuse to accept that allowing unrestrained numbers of people in an enclosed area is a safety issue.

Monday, October 20, 2008

Suffering is Over

A ten year old died today. It got me on so many levels. He was between the ages of my girls, he had blonde hair, he was cute, he had a terrible disability with many many surgeries ahead of him and multiple hospitalizations. He was apparently the life of the party, he was brave, he was the center of his extended family's life. He no longer has to suffer. It's possible that he is now standing and running on his own, he can eat by himself, he can breathe. I am hoping.

I cried right along his mother, I felt the despair of his father, I know his family will miss him terribly. I made them hand and footprints of his poor feet, his limp and white hands. The feet that never walked, the hands that weren't able to grip but were so loved, so treasured. His grandfather took the prints with love, he hugged me and kissed my cheek, he was so grateful for this small memory of his grandson's life. I was so honored to have made them, to have been able to be a part of this beautiful family for a short time, to have taken part in their grief and stepped over with this little guy from this world to the next.