false reassurance

[psu_213]

Hi all--

Just wondering if other nursing schools made a point bringing up false reassurace when talking about communication issues, specifically to stay away from it. An example: pt will be having open heart surgery in the morning, is crying and expressing fears about what may happen; the nurse tells them "it will be alright."

The reason I ask, I have heard many nurses I work with say somethign similar to this to pts and it really bothers me when they are dismissive toward their pt's feelings. (and I'm not trying to say that they are not good nurses by saying this--many who have said this are otherwise great nurses)

Thanks in advance, interested to hear what others have to say....

[Chin up]

I just have to add this, with the knowledge that I am taking the risk of being tarred and feathered by you guys...but I hate HATE HATE it when someone tells an anxious pt to "just relax." Like being in a situation requiring health care is somehow conducive to relaxation.

Give me some bait, a nice breeze and some deep ocean reefs and THEN I will "just relax".

OK, rant over. I will go stand in the corner now.

Too funny!

[juzme]

we taught to say something like, yes, it's ok to be nervous for any procedure you are going to have, but is there any particular thing you are nervous about or do you have any other questions you would like to ask?.....I remember my instructor telling us, you better not tell them it will be alright, but no surgery is routine and sometimes things are not alright...that kinda stuck in my head, so I pretty much did varying versions of the above...

[juzme]

"1. A few years ago, I saw a teenager who was about to undergo surgery. She had an INCREDIBLE anxiety about her procedure (a partial colectomy). She was tearful and obviously scared. Her mother was with her at the bedside. Nurse begins to interview pt and mother. Rather than asking the pt to talk about what was the scariest part of having surgery, the nurse tells the pt to "get over it, you will be fine. Time to put on your big girl panties. This is part of your disease process, and this is likely one of many procedures that you will have. Better get used to it." OK, pause for a second, because this is hard to digest...I know. I think that this nurse was trying to do the tough love thing or something, but it left the pt TERRIFIED and the mother OUTRAGED. "

Wow, that actually brought tears to my eyes! I can't believe any nurse would say that to her patients! that nurse truly did not understand therapeutic communication! My teen daughter couldv'e ended up with a colectomy, luckily her Chrons went into remission....she was so afraid and the nurses were so wonderful in answering all of our questions.

[msn10]

OP

3 years ago on Sept 11, I went to the hospital because my husband (an MD) thought I was having a stroke. I was having symptoms like that TV news reporter did (Serene Bronson) the one who could not formulate her words, I had a headache, and my left pupil looked like it was blown.

After being rushed to the hospital my husband works at, 3 nurses and 2 physicians saw me walk in and rushed me to the ER. The ER physician did a quick assessment and didn't even do labs, he just sent me to CT. I knew what I was possibly facing, but I hopefully asked the ER MD if it could be anything else. He said "No, with your symptoms you are either having a stroke or an aneurysm." I have 3 young kids, I started balling. I started thinking about what my final words would be to my children and what my family would do without me.

The MD left, my nurse however, leaned over, looked me straight in the eye and said, "I know you must be scared, but if this has to happen, you are in the best place because we have all the interventions possible to help you and we are going to take care of you like you are a member of our family."

Thankfully it was just a migraine and the CT revealed no problems. The (very young and inexperienced) ER physician also learned/got an earful from the neurologist that night :) about migraines and bedside manner.

However, I will never forget how the nurse treated me that night. No BS, but she acknowledged my fear and I felt like she would do everything in her power to get me through that night. She will always have a special place in my heart.

[GHGoonette, BSN, RN]

excellent responses, canoehead.

also:

"dr. dud has performed this surgery nearly a thousand times...

and has only lost 3 pts, tops."

leslie:D

I agree, both Canoehead and StCroix gave the type of responses that I usually give to pre-op patients. Yours is another example, except I leave out the bit about how many patients he might have lost; definitely information overload

2. Pt comes in for an emergent D&C. She is tearful, her husband is tearful, and she is in shock that she must undergo ANOTHER D&C. Nurse comes in to interview the pt. She sits down next to the pt, introduces herself. She does not beat around the bush, but instead says, "You are going through an incredibly difficult time in your life now that I cannot even begin to understand. What I can tell you is that we are going to do XYZ in XYZ order. It is clear to me that you are scared. Do you think that you can pinpoint what is scaring you so much? Is there anyone you would like for me to call? Would you like for me to call your husband when we are starting surgery and again when we finish? I CAN assure you that I will be with you the entire time you are in surgery...I will not leave your side. When you wake up, I will be there, and when you have recovered in the PACU, the nurses will call your husband back as soon as they can. If you would like for me to arrange for a grief counselor to talk to you and your husband, I can do that for you. Now let me tell you what to expect while you are in the OR.

"

This is how it should be done; a scheduled pre-operative visit by the circulating nurse. I would suggest that any ward nurse who encounters a fearful pre-op patient should arrange a visit from theater staff, if it's not already routine practice.

We have a treasure of an EN who works absolute magic in the pre-op room, on the occasions when she is assigned there. If I could clone her so I could have top-notch round-the-clock coverage, I would. She has a true gift for allaying fears, which incidentally makes the job of the PACU nurse far easier. The fears a patient goes in with, come out with them, and can lead to some...interesting situations post-op.

[mama_d, BSN, RN]

In a situation where it's an upcoming surgery or procedure, I'll usually say something along the lines of "Of course there are always risks, but this is a procedure we have a great deal of experience with and the vast majority of the time nothing happens except the pt goes home a few days later feeling much better." Something like a CABG I'll say something like "I've sent several pts up to the OR for Dr. Jones to do this on, and he's got a great success rate...you probably won't believe how much better you feel once you recover." Nothing that would indicate a 100% guarantee that all will be well, but enough to reassure them It also helps that our docs are pretty good about ordering sleepers and anti-anxiety meds for the night before a big surgery. "Once you're in the OR there's nothing you can do to help, but getting a good night's rest as peacefully as you can will really help prepare your body for what it's about to go through. Would you be agreeable to me giving you a pill to help out with that?" After acknowledging how it's normal to feel that way first.

The hardest is not with our pre-op pts, but with those who have just gotten a cancer diagnosis or found out they're terminal, IMO. Those pts get me in a chair at the bedside and a good amount of time. I'll read the oncologist's note first to see what they think the prognosis is, and talk the pts through what their path may be, and answer any questions I can to the best of my ability. With those pts, it's frequently NOT going to be okay, so platitudes just won't work. I've gained more so far as therapuetic communication goes in the last several years working oncology than I ever dreamed was possible.

[Altra, BSN, RN]

I find it helpful to remember that some recognition of the fact that there are uncertainties inherent in procedures and treatments is probably an appropriate response on the part of the patient. I don't necessarily consider it realistic to allay all fears.

I strongly encourage patients to ask questions, and I get them answers in whatever format they need for understanding. I try to "pump up" their own sense of inner strength to deal with whatever outcome may present itself. And I strongly encourage positive family dynamics so that the family feels like they are a "unit" supporting the patient and using a team approach to problem solving.