Bedside Report

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Specializes in ICU/ER, Maternal, Psych.

Hi all!

I work in home health and recently the pt has requested we pass along report in the same room as him. This makes for a somewhat sticky/uncomfortable situation because we all us nurses) feel it is relivant to discuss his emotional wellbeing as well as physical; this is difficult because how do you tell the next nurse you patient has been hard to deal with, snappy and generally distasteful in front of them?? His wife is a dr. and when one of the nurses passed on report she mentioned to me that he was in a bad mood and had snapped at her. Pts. wives mouth dropped... should she have really been that shocked???

are we supposed to give a candy coated report? Or do we explain to the pt (and wife) if they want a bedside report they have to be prepared to hear things they may not want to hear (all in a professional manner)

He is a new quad... he micro manages and can be cranky and rude. Expects us to read his mind and when we don't execute the TV remote or anything to that matter to his liking he snaps. This is information we all collectivity feel is necessary to pass on... advice???

MERRY CHRISTMAS! Make that holiday money in remembrance of HIM!!

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The only thing you can change is your own attitude. Report should be based on objective information and the client's goals, not the caregiver's judgements. A person who is adjusting to living with quadriplegia is learning to cope with frustration and grief at the loss of their independence, expressing anger is a normal response to their situation. Directing his own care to prevent secondary complications, is not micro-managing, it is self preservation.

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Specializes in ICU/ER, Maternal, Psych.
The only thing you can change is your own attitude. Report should be based on objective information and the client's goals, not the caregiver's judgements. A person who is adjusting to living with quadriplegia is learning to cope with frustration and grief at the loss of their independence, expressing anger is a normal response to their situation. Directing his own care to prevent secondary complications, is not micro-managing, it is self preservation.

I understand and agree with everything you are saying... which is why its important to pass along his emotional well being to the next nurse. Yes it is a struggle and a re learning situation for him, but when his days are better... we report a good day... when his days are worse we report bad days. My question is how do you report the negative and be political correct at the same time.

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Would it be possible to give the bulk of the shift report at the bedside, and either before or after bedside report, discreetly share information about more sensitive info like mood/behavior? I agree with the PP cautioning against injecting caregiver's judgements into report, but also see value in sharing objective & subjective info about mood/demeanor, which can provide useful data regarding coping and adjustment to new challenges.

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Specializes in Pediatrics.

If the pt was "cranky" or "snappy" you don't have to say those words to the on-coming nurse.

The pt isn't a child who you are babysitting.

If this is a newly quad, you report good and bad days... In a professional manor

Don't set the on coming nurse with a bias of how the patient will behave with them.

Pt tolerated repositioning well

Pt did not tolerate well

Pt was able to direct cares today....

Unable to direct cares today

If you had a bad day or were in a bad mood how would you want your nurses to discuss your information

Bedside reporting is very popular in the hospital setting and even on our difficult pt with challenging social situations there are ways to share that information

A quick "not a good day" before going into his room should suffice.

Does the on coming nurse need to know all the details regarding the pts temper tantrum over his TV remote 4 hrs ago? How will that change/affect the care that nurse will provide?

Have you taken care of many new quads? They need to grieve and accept their new body and way of life that can take years and part of the grieving process is anger at a loss of total control of their life and their body.

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I understand and agree with everything you are saying... which is why its important to pass along his emotional well being to the next nurse. Yes it is a struggle and a re learning situation for him, but when his days are better... we report a good day... when his days are worse we report bad days. My question is how do you report the negative and be political correct at the same time.

Is he currently having caregivers in his home 24 hours? Many people find 24 hour caregiving is very intrusive to their privacy and they prefer having gaps in their service, for example one caregiver comes in the morning, the next comes at lunch and the next comes for HS. In this arrangement the client is responsible for reporting or passing along pertinent information regarding any changes or concerns in their care. If his goal is to have more privacy and wean off 24 hour services, he can start by giving report now.

Most clients do not want to discuss their mood with every caregiver, they are more comfortable discussing their feelings with the caregivers with whom they have developed rapport and when they truly are in control of directing their own care, they do not give a self report of their mood to every caregiver that comes into their home.

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We give a heads up, or off the record report about those uncomfy matters right outside the door, beforee giving the official bedside report

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I would have a weekly team conference to discuss apporaches to caring for this patient and in bedside report I would include what types of things helped mediate patient's comfort ie how he likes the tv managed or positioning with pillows or how his food is prepared and provided. And I'd include him in the conversation.

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Discussion during a weekly or biweekly case conference can cover how to approach and perhaps a "code" can be devised. At any rate everyone knows his general mood by now so there is nothing new to be surprised about. In the past I have devised a reason to go to my car "I have those blank forms, dresses, shoes, (whatever) you needed, come to the car and get them from me", then I say what I need to say outside of the house. This technique can not be used every shift, or too often, of course, so it is better to devise a code, or otherwise just come to an agreement of what can be said and how to say it. This control issue sounds a little too much for day to day business if you ask me. In this case, I would exchange phone numbers with the other nurses and text away, both during their/my shift and otherwise. That is probably the easiest solution.

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Specializes in ICU/ER, Maternal, Psych.

I like this...

NO, I have not taken care go ANY new quads... this a learning and adjustment period for me as well. I do understand the process in which he is adjusting.

this is good advice thank you.

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Specializes in ICU/ER, Maternal, Psych.

Yes, this is a good idea. The bulk of the information and then meet her in the brake room to tell you simply that is was a bad day. thank you..

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Specializes in ICU/ER, Maternal, Psych.
Is he currently having caregivers in his home 24 hours? Many people find 24 hour caregiving is very intrusive to their privacy and they prefer having gaps in their service, for example one caregiver comes in the morning, the next comes at lunch and the next comes for HS. In this arrangement the client is responsible for reporting or passing along pertinent information regarding any changes or concerns in their care. If his goal is to have more privacy and wean off 24 hour services, he can start by giving report now.

Most clients do not want to discuss their mood with every caregiver, they are more comfortable discussing their feelings with the caregivers with whom they have developed rapport and when they truly are in control of directing their own care, they do not give a self report of their mood to every caregiver that comes into their home.

Yes, he had 24 hour care in his home. 3 shifts, 3 different nurses a day, 7 of us total. He cannot function without 24 hour care, his prognosis is dependent upon this fact. He is a C4 quad with autonomic Dysreflexia. His wife is a doctor and opened their own home health company with him as their sole client. This is a very wealthy couple who can afford the care. I have been in some facilities that don't have the amount of equipment as this man does.

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