A Nurse's Aide Scared to Tell the Truth
This investigation involved Kristine D., a thirty-eight-year-old woman who had come out of surgery following removal of an ovarian cyst at a hospital in one of the New England states. She fell while a nurse's aide attempted to hoist her out of bed about three hours after she returned from the recovery room. The nurse had received postoperative orders to get Kristine "out of bed as tolerated." She then sent in the nurse's aide to get the patient out of bed.
A few minutes later, the nurse's aide was calling for help, and Kristine was on the floor. The aide said that she had assisted Kristine in standing up and that Kristine had passed out cold. Being unable to hold the patient up, the aide insisted that she had eased Kristine to the floor while holding on to her left arm.
The x-rays revealed that Kristine had a displaced fracture of the jaw with the joint dislodged from left to right. Additionally, there was bleeding from her left ear, and the CAT scan revealed a hairline fracture of her skull behind the same ear. As if that were not enough, there was also a frontal fracture of the maxilla (facial bone holding the upper teeth) and two broken front teeth. This was proof positive that there was blunt trauma in three different places about the head: front, side, and back. The story of "easing her down to the floor" certainly did not explain this. From the injuries, we knew that Kristine had taken three separate blows to the head. Only the nurse's aide could tell us exactly how this happened. She was obviously scared to tell the truth.
However, without excluding the possibility of a criminal attack, I theorized that this was a bizarre accident arising out of the nurse delegating her task to a staff member who had no idea what to do. The aide was holding an unconscious woman by one arm when she fell and first hit her face on the arm of a wooden chair. The aide, still holding Kristine by the right arm, then unintentionally swung Kristine's head into another object, hitting first the left side and then the back (or vice versa), after which she eased Kristine to the floor.
In any event, the charge nurse could have avoided Kristine's trauma by one simple action. The nurse needed to be with the patient getting out of bed after surgery for the first time because the order stated "as tolerated." This required that the nurse make an assessment to see if Kristine could endure standing up and walking. The nurse would have accomplished this by taking the blood pressure readings immediately after Kristine sat up and stood. If there had been a sudden drop in pressure as there often is after surgery, then the nurse would have to abort the attempt to get Kristine out of bed and notify the doctor. Postural hypotension is what caused Kristine to pass out.