Fine line between 'education' and "preachiness"

[Btrfli BSN-LMT]

I work in a large public hospital, last week while in triage, I encountered a woman of age 64, who c/o of flank pain x 2 weeks. Her b/p at that time was 204/130. She told me that she had not been on meds for more than a year for her bp. "I did not stop taking them, I just didnt get any more...":confused: Now, as nurses, we tend to educated regularly, whether the pt. is knowledgeable or not. I explained to this pt. that her b/p is dangerously high and consequences of a high, unregulated b/p includes kidney failure, heart attack and/or stroke. I informed her that if her b/p can be managed on meds she may have to take them for long periods and when she is down to her last weeks worth of meds, she should be proactive in refilling her meds before the supply is depleted. This woman became emotional, stating "I dont need you to preach to me, I have somthing to live for, my mother died 30 years ago the same way from kidney failure, how dare you lecture me!" I explained to her that I was providing educational information that is specific to her circumstance, but I in no way intended to sound judgemental or preachy. I do not get out the "soapbox" on a regular basis, but maybe she felt like I accused her of deliberately causing her illness. How do we as nurses deliver the message without sounding condescending, rude and obnoxious?

[morte, LPN, LVN]

perhaps it wasnt you at all, but her own guilt...

[GilaRRT]

perhaps it wasnt you at all, but her own guilt...

Could be, sometimes when the shoe fits, patients take it out on you regardless of how diplomatic you are in delivering the news.

[Meraki]

I find that it often works best to educate by asking instead of telling, or at least asking to find out what they already know and what you need to tell them. All the info you shared was obviously pertinent but maybe she had already heard that many times and there is another reason other than a lack of education as to why she hasn't taken her meds. Maybe its a lack of finances or transportation, maybe she's depressed and doesn't have the energy to look after herself or anyone of a host of reasons. Finding out from her why she hasn't taken them and what would support that happening might have come across better than what she perceived as a lecture.

[VickyRN, MSN, DNP, RN]

I have found, too, that a lot of patients just aren't willing to take responsibility for their own health. Our society has almost a "nanny" edge to it, and people ultimately want the "system" to take care of them to magically fix chronic or acute health problems resulting from decades of poor personal healthcare decisions. You were honest, direct, and caring. You did nothing wrong in reminding this patient to take ownership of her health before it's too late.

[NanikRN]

I blame it on my job description. As in, " you know, I bet you know this stuff backwards. But I have to cover myself cause my job's on the line if I don't do it--etc"

And I agree with previous poster. She's most likely projecting her guilt, or fear of being considered ignorant onto you.

[mamamerlee, LPN]

As a home health nurse I tried to avoid being 'preachy' or judgemental. But I blew it big time once. I had a patient who was on home O2, 3-4L, ran sats of 86-88%. Would turn off the O2 to smoke - chain smoke 3-4 cigarettes at a time. Had packs of cigs everywhere. Stated she couldn't afford her meds. I told her the meds were more important than the cigs. She told me her friends bought the cigs and gave then to her. I strongly suggested they buy her meds. She didn't appreciate my suggestion......! Last time I saw her, they were loading into the ambulance....!

[sethmctenn]

I agree with the morte. You told her something that she already knew to be true from her past experience with her mother. She likely had negative feelings about her self-neglect. The situation was ripe for her externalizing her own negative self-judgement onto you.

I do think that it is important to say things in ways that reduce defensiveness so that you can truly be heard. Sometimes, though, people just aren't going to be able to hear what you are saying.

[Footballnut]

I doubt if you would have had a different response no matter what you did with this lady. She had layers and layers of pent up feelings around this issue. However, research shows that presenting the benefits rather than the dangers is more effective. For example, I generally say to smokers that quit in the past and are now smoking again, "I bet you felt better when you quit for a while." They generally agree with me with a look of recognition on their face. I figure it gives them a few seconds to remember that good feeling and think about quitting again.

[nursej22, MSN, RN]

It is easy to jump to the conclusion that someone doesn't practice healthy behaviors because they don't know what they are. I know I should more veggies and fruit and less processed food. Having someone lecture me about the benefits doesn't make me want more salad, it just irritates the cr@p out of me that they think I'm stupid.

We are learning a new education method on our unit called "teach back". If the person already has some knowledge, you ask them to explain it back to you in their own words, so you know what their level of knowledge is and how you can add to what they already know.

"Mrs. Jones, what is your understanding of high blood pressure and the importance of treating it?". "What are your goals and how can I help you to achieve them?"

And I agree many people are looking for someone else to blame other than themselves.

[Lunah, MSN, RN]

I find that patients who know they are neglecting their health or who are non-compliant are usually the ones who get defensive. I am a big fan of personal responsibility, and sadly enough, many patients deny all responsibility for their own health and well-being.

[Virgo_RN, BSN, RN]

I agree that there is a general lack of accountability for personal health behaviors, but I think there is also a tremendous lack of knowledge as well.

Counseling a 30 something man on bland diet (for N/V):

"Scrambled eggs have protein?"

Counseling a 40 something man on low fat diet for pancreatitis:

"What about cheeseburgers? Can I eat them?"

Counseling a 50 something man on metoprolol as an anti-anginal (who keeps halving his dose against the advice of his cardiologist, then coming to the ED for chest pain):

"I know all about metoprolol, my friend is a radiologist!"

Seriously?