Alarming

I work at a skilled nursing facility. This means, I see a wide range of patients every day. About half of them are long term patients. This is their home. The other half of them are straight from the hospital, sometimes with a considerable length of stay. Some are broken, some are sick, they are all living there temporarily to receive physical, occupational or speech therapy. Some come to us after a traumatic fall, or a car wreck, with reconstructive surgery. Some come after strokes, heart attacks or ischemic bowel repairs. Some come after a simple elective knee surgery. At times they come to us scared, and often very confused, as their post operative anesthesia has not worn off yet. They all come to us seeking to be well, to be whole.

Sometimes they are so confused, they cannot remember the physicians orders not to stand up on their newly repaired "non-weight bearing" legs. We frequently have patients who fall. We tell them "don't stand up without assistance" and "use your call-bell". Imagine being a 90 year old who has lived through a world war and being told to wait 15 minutes for some 20 year old nurse's aid to come help you to the toilet.

But we want people to be safe. So, sometimes these very confused adults have alarms placed on them. Alarms that beep when they stand up out of bed by themselves. Alarms that ring when they make a move out of their wheelchair. Alarms loud enough to hear across the hall.
We tell ourselves it is to keep them safe, to keep them from falling. We tell ourselves we are doing them a favor, keeping them from breaking another hip, or damaging the new one that was just replaced.

Just this week, I heard a long term patient of mine talking to another staff member. This woman has a degenerative neurological disease that has made her unable to care for herself. She is able to control some of her movements, but many of her movements come involuntarily. She is still at this point able to adjust her position in her seat. She was telling this staff member that every time she adjusts in her seat, the alarm bells go off. How annoying is that?

On the other hand, this woman came down to our SNF because she had multiple falls while staying in her assisted living apartment. She has had no falls since being in our SNF.

So, I sat down and spoke with her and her spouse. She wanted the chair alarm removed. I was afraid of what injuries might occur should we remove her alarm. As I thought more on it, I realized; This woman has a right to fail! This woman has a right to fall! She has a right to be unrestricted, come what may! She has a right to make her own decisions and to learn from them.
Sometimes I wish that I had alarm bells in my life. Alarm bells that would warn me and those I love: You might fall! You might get hurt! Don't do it!

How often I try to control my own situations, thinking my way is the best. I go about my day placing alarms here and there. Trying desperately to keep away hurt.

While keeping someone from falling may keep them from getting hurt, it also denies them the freedom of growing, of learning. The freedom of living life in all its dirty, glorious, messiness. That is not something I would want to deny myself or any of my patients.

I removed the alarm from my patient's chair, and validated her feelings. As I did, tears welled up in her eyes and she grabbed my arm saying "Thank you!" I could immediately see her dignity was restored. She became more whole.

I have to say I teared up a little myself. This is what being a nurse is about.

Now, if I can just remember this lesson to let go of those fears and celebrate grace, I will be on the right track.