I had one of the most emotionally draining nights. I spent almost my entire shift with a very young, very immature girl who had the most severe needle phobia I have ever encountered. Such a severe phobia that she never had ANY blood work done in her pregnancy. None. Zip.
Blood type? Don't know. Anemic? Could be, but don't know. Gestational diabetes? Your guess is as good as mine.
Preeclamptic? Probably, but don't know how bad. Can only gauge it based on her BP readings (bad), proteinuria (some), edema (yep), hyperreflexia (oh yeah), clonus (yep). Can't give her any good drugs for pain or anxiety, unless it's medications by mouth. Tried antianxiety medication by mouth, didn't touch her. She wanted an epidural eventually, but that wouldn't happen with such a severe needle phobia and no IV site.
I was hand picked by the midwife to admit this young girl, since I would be able to build the best rapport with her. We did build a good rapport and trust. She started out extremely scared and anxious of everything, and developed into having a good understanding of what to expect and what boundaries/privacy/power she had over the whole situation. We worked on building her trust in me, and I was actually very tempted to stay on overnight for the next shift as her nurse, because we did build such a good bond and level of trust.
It had gotten to a point that night, however, that she could potentially be endangering herself and her baby by refusing to get an IV site or labs drawn. She was a very sick cookie, and wasn't going to get any better without (gulp! yes...) medical intervention. She understood all of this, and agreed to it, however her needle phobia took complete control over her physical ability to allow the IV to be placed and labs drawn.
We ran out of options, when the legal department was brought in, and it was deemed that she was not in any immediate harm to herself or her baby, and thus, we could not take legal action to force her to comply.
I hate it when it comes down to that power and control struggle. What makes this unique, is that she is a minor, but yet she controls her own medical decisions. It doesn't matter that her mother wanted her to have things done. It didn't matter that her mother wanted to hold her down for us to do things to her. We cannot physically restrain someone who is of sound mind and able to make her own decisions. It is also NOT my nature to force ANYTHING onto ANYONE. Not to mention, it is assault if I force anything onto anyone. I could lose my nursing license and go to jail. It is just plain WRONG to force anything on anyone.
Yet......she knew it was important to not go home, since she stayed in her L&D room, and didn't threaten or make a move to leave. She knew the importance of the situation, and knew that things could go bad, leaving her or her baby in a serious life threatening situation. She knew. But, she had the mentality of a teenager that was in denial as well. I could see the stubbornness in her eyes, and I could also see the acknowledgment in her eyes that this was serious.
Her situation weighs heavily on my mind. I am seriously worried for her health, her baby's health, and their future outcome.