Clinical Q: Suggestions for pt ?

athena55, BSN, RN · Nov 22, 2008

Lainith:

I think if you approach the person the same way you made your approach here, on All Nurses, it would be considered tasteful and tactful. I would broach the subject gently, perhaps by saying, "My goodness, but you sure have been thru the mill! You must have had a really hard time breathing, and then to realize that they wanted to put a tube down your throat to help you breathe. Do you remember any of that?"

I wouldn't advise that you say that you are asking because you want to write up a care plan (smile) but if you lead into ..."What helped you to cope with all that was going on with you" Who knows? She may want to disclose, she may not. But I applaud you, that you would want to ask her about her feelings....Sometimes speaking about death can be thought of as a taboo subject, or morbid. But if you take the time, sit next to her....your patient may feel like sharing. You might be the only person who has brought up the subject of death.

I had worked 18 years civilian oncology critical care and let me tell you....Talking with my patients or the family members about Death, dying....VERY emotional....I have cried buckets with my patients and/or their families.

athena

Daytonite, BSN, RN · Nov 22, 2008

I worked in nursing homes a lot. I would walk into her room and say, "What happened? You have got to tell me all about it!" just as if you were talking to any friend. You really want to hear her side of this. It is also an opportunity to do your ROS and exam. Make sure you get a good look at her sacrum to see if she has any skin break down. I would also make sure she got a big hug and a welcome back. That is some feat for an old timer.

lainith · Nov 23, 2008

I'm not really sure where to go with my care plan for my pt because while she has a lot going on, she refuses to participate much in "making herself better". She's pretty coherent and all. I just want to know how she feels about what happened I guess and want her to know that she has someone to talk to. Thanks for your help.

Lainith:
I wouldn't advise that you say that you are asking because you want to write up a care plan (smile) but if you lead into ..."What helped you to cope with all that was going on with you" Who knows? She may want to disclose, she may not. But I applaud you, that you would want to ask her about her feelings....Sometimes speaking about death can be thought of as a taboo subject, or morbid. But if you take the time, sit next to her....your patient may feel like sharing. You might be the only person who has brought up the subject of death.
athena

Daytonite, BSN, RN · Nov 24, 2008

i'm not really sure where to go with my care plan for my pt because while she has a lot going on, she refuses to participate much in "making herself better".

that is ineffective health care maintenance r/t spiritual distress aeb lack of interest in improving health. some nurses get hung up about the "spiritual" part. if you can come up with another word then it won't sound like it came right out of nanda, which it did. basically, the meaning is that she's lost her will to help herself and she's pretty much waiting for god or the great spirit or what ever she wants to call "the life giver and taker" to come and take her life. some people become suicidal--she's not--she's just given up, decided to just wait it out and not be too helpful about prolonging her time on earth. i guess its like euthanasia for the discriminating pacifist. i have to tell you that when i was diagnosed with my 3rd cancer i felt the same way. it is also an overwhelming sadness and depression which you may not be able to get her to reveal the reasons for. likely they are due to grief as a result of loss of role or feelings of worth. this is deep stuff though and requires lots of talking and interaction to find out. stick with the ineffective health care maintenance r/t spiritual distress aeb lack of interest in improving health for now.