Today I had a weird moment and I'm in bed right now and I can't help but think back on it and kind of feel like i didn't handle the situation properly. I have a quadriplegic patient and he is fairly young and due to his tumor on his spinal cord he is in this situation. I think he has a fairly good outlook on things but I think he gets bad days which is okay. The family is fairly present and every time I come in the room, they always ask me what the medications are, which can become annoying after a while since they are always the same but expected as they are concerned. Today, I brought him the Pro-Stat, he hates it (like most of my patients) and he asks me what is it for. I tell him it is a protein supplement and encourages healing. Then he says, will it get rid of my tumor? I was shocked that he asked that and I blurted stupidly no. Mom was at bedside and she said why did you tell him no, it could diminish the size or encourage healing or something. She insisted that I should have said it will help the tumor. I was in a bind at that moment, I tried to backtrack. I said it is a supplement, it won't heal him but it allows him to remain healthy, keeps albumin at a good range and all that stuff, but I couldn't say it would affect the tumor because that would be a lie. I tried to direct the conversation away from the topic but I drew a blank. The family and the patient weren't overly upset or anything. They don't seem as if they're lingering on the topic as I interacted with them throughout the day. But I just can't let it go. It might seem like something small but I felt like I was really insensitive to say no like. It just won't let me sleep tonight. I mean did I make an already hard situation worse for someone?
thoughts are welcome. Sorry for the extreme length, I just needed to talk about it, I guess.
I didn't mean annoying as in I mind, maybe a different word could be used. I don't mind answering questions. It's a little much if i'm having the exact same conversation every single day. I guess i did make it about me but honestly i mostly felt guilty about the conversation and that i answered him too harshly.
Thanks for your comment
You did very well with a difficult situation. If they are asking WHAT the medications are, it's good practice, if not facility policy, to say "this is your [med] for [indication]" as you get it ready. If they are asking for more than that, it may be helpful to print out patient medication guides for them, to reduce repeated questions.
I think he knows more about his disease process than i do and that he has accepted it but to me as a fairly new patient of mine, i feel like our interaction are filled with minefield since i'm not sure where the emotional triggers are since they aren't the obvious ones you would think in such a situation.
Sometimes the best thing to do is admit to exactly that to the patient/family. I've had a family with a child (now an adult) who had been in and out of hospitals their entire life dealing with the same chronic disease process. I have gone in and said "I'll be explaining medications and other things throughout your son's stay here, and if you have any questions don't hesitate to ask. I also know that you have more knowledge about this condition, and if at any time you can teach me something, feel free. I look forward to learning from you."
Get it out on the table. You're a nurse, you're human, and you don't know everything. The most freeing aspect about getting through the first year is acknowledging that I don't always have an answer. That's okay. When your patient does try to teach you about something, listen and repeat it back so they know that you've got it. Say thank you afterwards.
Go so far as to be honest. "I feel like I've upset you, and for that I apologize. I feel embarrassed that this happened." You'll be surprised how quickly they will start talking once you're opened up about your own shortcomings.
This also makes it easier to forgive yourself and not dwell on it. Tackle the issue head on, save yourself from burning out.
How old is this patient? If he's 18 or over, Mom's feelings as to what he should be told have no bearing on the information that you should share with him. And, really, she's not entitled to any information unless he wants her to have it. (Side note, this is one of my biggest pet peeves with young adult patients. I work in a pediatric hospital that still treats many young adults. It drives me crazy beyond belief when I see a medical team rounding and talking to the 18, 19, 20, 21 year old [developmentally appropriate] patient's parent outside the room and not talking directly to their ADULT patient.)
The protein supplement is not going to cure his tumor. That is a fact. What kind of tumor does he have? Does he understand his disease/prognosis?
Just gotta say I wish I had the emotional control of some of the other posters here. I can't seem to control whether I get annoyed or not. I wish I could I'd be a much happier person and I'd like being a nurse a lot more. I spend at least 60% of every shift being annoyed about something, and some nights, it's a lot closer to 100% of the shift. I get exhausted being annoyed all of the time, not to mention the constant shoulder pain from tensing my shoulders all night.
...I still get the "You're such a wonderful person and so kind!" compliments from the EXTREMELY annoying family members at least once a week, though, so I guess I hide it well.
OP - you handled the question the best you could. You can only do what you can do, or as I like to say to my coworkers often, "But what do I know? I just work here." We can't fix patient/family communication with physicians. We can't fix denial - and sometimes the denial is so strong it makes me want to never go back in the room, knowing what I know. All we can do is be honest about what we are doing, and try to keep our pretty smiling actress faces on so nobody knows how frustrated we get dealing with everyone else's emotional stress as well as our own.
I don't have emotional control so much as it takes a lot more to get to me. My tolerance for people at their worst has improved so much that my go to response now is a sort of removed compassion. It's not so much empathy as it is just simple tolerance for the human condition. This change in my perspective has resulted in people reacting differently to me which improves everything in our contact. It's a pretty incredible thing and I would have thought you goofy as heck if you tried to convince me of this prior to my own arrival.
Depending on your relationship with your patient, maybe you could have engaged his game of humor if that's what he was up to. If he's a quad then his entertainment options are limited.
When he asks "Will this shrink my tumor?"
-No, we just give it to you because it tastes bad (to torture you, because you're our favorite patient, etc.)
This is a topic that pops up frequently in Pediatric Home Health.
On one case that i worked the child was brain damaged,with awake/sleep cyles ,and it appeared she was watching tv when placed in front of one even though her eyes were not tracking.
Most nurses would write in their notes"Child watching tv".
Other nurses told Mom that the child could see and hear and responds when the child likes something.
I really do not know what to think,because i notice in Private Duty Nursing that speaking and writing factually will get you sent out of the door.
I wonder if perhaps the patient asked the question in front of his family members because he wanted those family members to hear a nurse answer it. Sometimes it's not the patient who's in denial. Is it possible he was enlisting the OP to gently chip away at their denial?
Thanks. I think its a problem with me I tend to overthink things and worry over my day. I'm told that its being on the fast track to burning out but i can't turn it off. I worry about what i could have done better and i try to plan for the next day to avoid making similar mistakes. I honestly think it was me being taken off guard about being asked that question." I think he knows more about his disease process than i do and that he has accepted it but to me as a fairly new patient of mine, i feel like our interaction are filled with minefield since i'm not sure where the emotional triggers are since they aren't the obvious ones you would think in such a situation."
You did a fine job being honest with that patient.
It takes time, but eventually you'll learn to let the patient set the mood of some conversations. You say he was joking. That's fine, he's coping and trying not to cry 24/7. It's appropriate for you keep the mood light. You could have said "this is the stuff that keeps Superman strong" (or hopefully something less hokey) as you then instructed that it won't do anything for the tumor but it keeps your body strong and able to better fight the tumor. *Smile and Good Eye Contact* You have to find your own speed, but remember that a terminal illness doesn't mean the patient wants to dwell on it for what time he has left.
NotAllWhoWandeRN, ASN, RN
791 Posts
You did very well with a difficult situation. If they are asking WHAT the medications are, it's good practice, if not facility policy, to say "this is your [med] for [indication]" as you get it ready. If they are asking for more than that, it may be helpful to print out patient medication guides for them, to reduce repeated questions.