Are you okay with bartering?

[DesiDani]

Is okay to promise a patient or their family members something in order to get to the goal you want? If the ends justify the means during that shift, is all good and well? Is it possible for bartering to lead to manipulation and a lack of control? If it does who is at at fault if chaos arises, the person who does not continue on with the bartering arrangement or the one who agrees with it in the first place? Lastly who does bartering benefit or harm overall the patient, patient's family, or the staff?

[vampiregirl, BSN, RN]

I work hospice so I likely have a different perspective compared to other settings...

Patients are involved in goal setting and the plan of care in hospice whenever possible. The disease process is so out of their control so we make an effort to allow them to make choices whenever they can. Goals are often changed per patient request. 

Safety, limitations within the realm of hospice care (no aggressive interventions), limitations of available services (visit times, specific staff, equipment provided) still come into play and goals must be reasonable (no pain at any time is not reasonable). 

I've been known to "sneak in" diet Mountain Dew or ginger ale to patients during the pandemic when visitors were restricted to hospice SN visits and this wasn't available at the facility in exchange for a complete assessment. Sometimes it's the offer of a fresh cup of ice (a favorite of a couple patients) when we complete a task. A foot/ leg rub with lotion is another frequent "bribe" for one of patients to assess his feet and change his socks (lives alone and sock changing isn't a priority for him. I had another patient that typically agreed to let me assess them because I always spent ~ 5 minutes doing puzzles with them after we completed the assessment and any needed blood draws. They weren't as cooperative with other staff who declined the puzzles. Her "rule" for me was that I "had" to place one piece. Even if I was pressed for time, I always was able to find 1 piece:)

I also frequently offer patients a choice of order of tasks to complete during the visit and barter in any tasks they aren't a fan of (skin assessment/ wound care tends to not be a favorite). 

Would I withhold the "reward" if the patient declined the task or procedure?  Nope! But I think all of us enjoy being rewarded. 

There are some patients who definitely fit the "give an inch and they take a mile". With these patients, I give when I can and then set firm boundaries.