By Beth Anne Algie, RN

I am a critical care RN, and I violated my patients’ rights. For decades, every day that I worked in the emergency department or the intensive care unit, I violated my patients’ federally protected rights to participate in their plan of care.

I didn’t mean to, or want to, but my tasks to maintain their life took priority over the obstacles to hearing them when they could not speak.

Almost every day of my career, I took care of awake and intubated patients with a tube through their vocal cords and with hands too weak, too injured, too full of tubes and equipment, or too swollen to write. Or I took care of stroke victims, unable to form the words with their mouths.

My adult patients have a right to communicate their request, consent or refusal of any treatment. They have a right to ask questions of a provider before consent. They have a right to change their advanced directives. They have a right to direct which visitors they want to see. They have a right to describe their discomforts, both physical and emotional, so that I could address them. They have a right to file a grievance. They have a right to ask for a clergy, even when their record says they are an atheist.

Sometimes, they just wanted to tell their family that they loved them one last time.

But I violated those rights. I did not provide the means of communication that their condition required. I evaluated their vital signs and neurological signs and injuries, but had little time to guess at their questions. When I could, I tried to anticipate their questions, and spent hours guessing. They often fatigued before I guessed correctly. I tried.

Some competent, but non-verbal patients wanted to change their directives for end of life. By not hearing their new choices, or by not informing them of choices in response to their questions, we assaulted them in their last hours.

If they spoke another language, and I did not provide an interpreter, or needed TTY or braille and I did not provide those, or if they could write and I did not provide pen and paper, I would be in violation of federal law. But if they needed a different technology to address another communication difficulty, I ignored them. The resources did not exist until recently.

There are now technology devices to allow patients to “type” on a computer screen by just looking at the screen. Each phrase they look at is recorded by the device. Each letter they type is recorded. There are fields to ask to confirm their choices. There are screens to assess their cognitive ability and orientation, which would not only meet their needs, but give me better assessment quality. (Stephen Hawking communicated on such a personal device.)

With these devices, patients can use a call bell, choose a pain level, ask any question they want, and participate in their plan of care – all with their eye movements.

I applaud all those technology companies developing those devices for hospital use, and I demand these are available for my patients. As a registered nurse, I do not want to violate my patients’ rights anymore.