Perceptions Equal Results: The Dirty Lowdown

How a patient perceives her care can create healing all on its own. The human touch is often ignored in this world that demands evidence and hard facts, but it's arguably the most important part of what we, as nurses, do. Nurses Announcements Archive Article

Perceptions Equal Results: The Dirty Lowdown

If we make the patients feel cared for and acknowledged, and meet them where they are, then we can get great results. If we let them guide the process, we can find out what they need from us. When they perceive that we have done that, relationships grow and they feel healed.

The presenting complaint was abdominal pain/constipation. I rolled my eyes to myself as I wheeled down a distraught 89 year old woman to the exam room to be triaged, accompanied by her anxious husband.

"You must help her, she needs to be cleaned out!" he cried.

They had been to 'the other hospital' in town a few days earlier for the same, they thought it had been all taken care of, she had been taking the prescribed remedies. He showed me the bottles, and the paperwork from the hospital across town.

I helped the slight, well preserved looking lady to the bed, beginning the triage process, while her husband paced around the room, demanding action. She was distraught, "No BM in three days!", she told me with her Spanish accent.

I patiently tried to comfort and sooth her. Suddenly, she had to go to the bathroom, we took the time consuming walk there, but alas, no results. The doctor was made aware that we had a very anxious husband and distraught lady in room nine, who needed help. This was turning out to be a high maintenance case, I was thinking. We considered starting an IV. We called and got records from the competitor hospital across town.

We got back to the room and I tried to make small talk.

"Where are you originally from? I asked.

The couple had Spanish sounding accents different from the local Mexican immigrants I was most familiar with. "Texas", the husband answered.

"We are both born in Texas" I laughed inwardly, for some reason.

"So, how long have you been married?".

"We got married in 1942", the husband answered. Meanwhile, I had helped the patient into her gown, taking care with the Rosary that she wore around her neck. I brought in a bedside commode, set the patient up, and she got up on it, moaning and wailing.

Finally, after some time, they pressed the call light. The room was filled with the odor of a large BM. I helped the patient back to bed, assuring the husband that I'd take it away.

"You HAVE to see it!" he proclaimed, showing me with his hands how large it was, as if describing a fish he had caught.

I dutifully peered into the commode, oohing and awing at such a fine specimen, then respectfully covered it with a towel for the trip to the dirty utility room.

The patient produced another excellent BM, felt totally better, and was ready for discharge without any other interventions. While giving instructions, I complimented them on their healthy appearance, and asked their secrets.

"We are very careful about what we eat", the wife said.

I discussed probiotics with them, telling where they could get this.

The husband said "Please write that down for me". Then he stood up very straight and said, "I have an announcement to make. From now on, this will be our hospital. We are not going to go to the other hospital any more" He wrote down my name, then I gave them both hugs and sent them on their way.

We had not done any tests, any procedures, nor given any medications. But we supported them and they perceived that our care was most excellent, and this most assuredly produced results!

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Emergent

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Emergency Room RN

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That was probably the most expensive dump(s) she's ever going to take.

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Specializes in ER.
That was probably the most expensive dump(s) she's ever going to take.

That would be correct. But, she was an 89 yr old woman and needed help. And, just because we ruled out something more serious, doesn't mean a close to 90 yr old woman shouldn't come in to be seen when in such distress.

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And unfortunetely, in a number of facilities, nurses are set up to not have the time nor the patient load to spend doing what a number of us came into this profession for, to show some compassion for human suffering, and take the time to care about patients as people.

Those of us who are still on that train of thought are being replaced by more and more nurses that understand that in the current health care climate dollars and the bottom line are replacing patient support and encouragement.

It doesn't seem like too long ago where a nurse's continuity of care, seeing patients and establishing theraputic trust and knowledge should they come back again, being able to assist with "remember what worked before" were a large part of a nurse's day. Now it seems we want patients to have the illusion that we care, but really, case managment are all over cases like these--a patient who arrives, has no interventions, gets on a commode and goes home. And that is perhaps the saddest part of what our profession has become.

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Specializes in ER.
And unfortunetely, in a number of facilities, nurses are set up to not have the time nor the patient load to spend doing what a number of us came into this profession for, to show some compassion for human suffering, and take the time to care about patients as people.

Those of us who are still on that train of thought are being replaced by more and more nurses that understand that in the current health care climate dollars and the bottom line are replacing patient support and encouragement.

It doesn't seem like too long ago where a nurse's continuity of care, seeing patients and establishing theraputic trust and knowledge should they come back again, being able to assist with "remember what worked before" were a large part of a nurse's day. Now it seems we want patients to have the illusion that we care, but really, case managment are all over cases like these--a patient who arrives, has no interventions, gets on a commode and goes home. And that is perhaps the saddest part of what our profession has become.

Ah, but the bottom line might be ultimately served by this patient encounter.

Here you have a couple who are close to 90. After this visit, the husband proclaims that he is switching hospitals. They weren't in our system, that I know. The husband told me they had always gone to the other hospital. But, something about how they were treated there compared to the encounter with us made him change his mind.

Hospitals do compete for business.

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Ah, but the bottom line might be ultimately served by this patient encounter.

Here you have a couple who are close to 90. After this visit, the husband proclaims that he is switching hospitals. They weren't in our system, that I know. The husband told me they had always gone to the other hospital. But, something about how they were treated there compared to the encounter with us made him change his mind.

Hospitals do compete for business.

And that may in fact, be true. However, with the encounter as you describe one would be hard pressed to find any billable interventions or treatments. So this could be a free care situation. Unfortunetely, the culture seems to be that compassion doesn't pay the bills, and most hospitals would rather off-load the non-billable patients to any other hospital that will take them.

Personally, I think this is wrong on a number of levels. It is not how I like to practice nursing. However, this is the time of the dollar overtaking basic nursing compassion.

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*sigh* I really do hope that care is the core of the job, as it was able to be in this post.

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I think it was great that by supporting them they felt better and the patient improved. I agree sometimes that is all that is needed, sadly how often are we allowed the time to do this?? Hospitals do compete for business, but they also want that almighty dollar. I'm suprised someone hasn't come down and asked why more billable interventions weren't done.

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