[rn undisclosed name]

I was wondering if you had ever had a patient (or family) say that to you and how did you respond?

I work tele and received a new admission from the ER that I had to immediately transfer to the ICU. The pt had a possible bleed on the brain and was having visual changes. The attending wanted him moved to ICU for closer monitoring. As soon as he found out he was going to ICU he started getting scared and I tried to reassure him this was for his own good. The nurses would be able to monitor him much more closely than I could on tele. He didn't realize the severity of his condition until he was told he needed to go to ICU.

When we transferred him his eyes were tearing a little bit. When I transferred him the ICU nurse stepped out of the room for a little bit and I was alone with him. He asked me if he was going to be ok. I was really not ready for that. I don't like to lie to patients and tell them they are going to be ok if they're not and honestly I don't know if he is going to be ok or not. I said I'm sorry I don't know and can't answer that. I wish you luck and hope everything turns out well for you. After I had time to think about what I said I hated myself for saying that. I realized I should have said to him we are doing everything we can for you. Just to reassure him.

What kinds of things do you say to patients/family who ask those questions?

Kelly

[sharrie]

Originally Posted by kellykul

I was wondering if you had ever had a patient (or family) say that to you and how did you respond?

I work tele and received a new admission from the ER that I had to immediately transfer to the ICU. The pt had a possible bleed on the brain and was having visual changes. The attending wanted him moved to ICU for closer monitoring. As soon as he found out he was going to ICU he started getting scared and I tried to reassure him this was for his own good. The nurses would be able to monitor him much more closely than I could on tele. He didn't realize the severity of his condition until he was told he needed to go to ICU.

When we transferred him his eyes were tearing a little bit. When I transferred him the ICU nurse stepped out of the room for a little bit and I was alone with him. He asked me if he was going to be ok. I was really not ready for that. I don't like to lie to patients and tell them they are going to be ok if they're not and honestly I don't know if he is going to be ok or not. I said I'm sorry I don't know and can't answer that. I wish you luck and hope everything turns out well for you. After I had time to think about what I said I hated myself for saying that. I realized I should have said to him we are doing everything we can for you. Just to reassure him.

What kinds of things do you say to patients/family who ask those questions?

Kelly

It's always difficult when patients or relatives ask difficult questions. It sounds like you actually dealt with it quite well. I usually say that it is really early in the care and investigations and until we have a clear idea of what is going on it is too early to know what will happen but he is in the right place and everything that can be done will be done.

If it is a known poor prognosis then I try to be as honest as possible, there are ways of phrasing responses that will let you know how much they know and how much they want to know. It is an idea to start with asking them to explain what they understand about what has happened and build on that. It may be that they have already been told that the prognosis is poor but are not ready to accept it so will need sensitive handling. I will not lie to a patient or relative, if they ask outright then I would say that you / your relative is very unwell and it is possible this could deteriorate further, I reassure them that everything possible is being done.

[Christie RN2006]

I usually try to tell them something along the lines of "we are doing everything we can to make sure you will be ok" I never ever promise a patient that they will be fine because you never know and how bad would you feel if something did happen? Giving someone false hopes is never a good thing. For example... we had a patient that had a relatively minor surgery and was scheduled to go home within the next few days. This patient was doing great, but they suddenly started coding and died (we think they threw a clot or something like that).

If I have a patient doing bad, I will tell the family that the patient is very very sick at that moment and we are doing everything possible. One time I had a very critical patient that was going down the tubes fast and no matter what we told the family, they just didn't get it. I was watching the patients monitor as he was going in and out of crazy rhythms and I guess I must have been frowning... the patients family member said "why the long face" all I could think in my head was "because this person is about to die" but obviously thats not what I said to them :P

[shel_wny]

I usually just say, "Well...I'm not quite sure. You're in the ICU and you're pretty sick right now." Then I often look up at the monitor and tell them what is good and what our goal is for the end of my shift. My patients usually trust me and appreciate the fact that I am upfront with them.

I always start my shift with a goal. To improve his lung sounds is one (heavy pulmonary toileting, requests for Lasix if necessary, make sure we have a recent chest xray, use of insentive spirometer if they're awake, etc). I share this goal with my patient and allow them to participate. This gets their mind off of their problems and helps them take an active role in getting better.

[DudeNurseRN]

It depends on what you want to tell people. School tells you not to promise anything that you can't come though on. But we live in a world where things aren't always black and white, and sometimes the answer isn't always yes or no.

I try to think about what would help them out the most. Acknowledging the fear that our patients have is definately something that I advocate, as well as letting them know that not only is okay to be scared, but also letting them know that it makes sense to you that they would feel that scared. I try to make sure that my patients understand that I am there to go though these scary parts with them, although I can't take the place of people like Mom, Dad, their spouse or Bucky the family's pet dog, just to let someone know you are in their corner and you're there for them seems to help out oodles.

I know a lot of RN's that beat themselves up for stuff that they "could have said should have said" and so on. I see no use for it. Learning how to speak from the heart is something that must be found out on a personal level, and not something that can be taught.

[deeDawntee]

I think you handled it well. I am certain that your concern showed on your face as well and I don't think you should change a thing about that. We shouldn't try to hide the truth from our patients. I do think it is a very good idea to point out what the patient does have going for them. I do that a lot with families in the ICU. They just are asking for comfort and I consider that a big part of my job. You can offer comfort and reassurance without lying. Obviously, as the nurse transferring a patient to ICU, you don't know what the next steps in the process will be, so the best thing you can do is get that transferred safely. Good job.