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?
Is it possible that she didn't "get" any more medications because she couldn't afford them? Didn't know about assistance programs? Maybe we shouldn't assume that she doesn't want to comply.
You did your job, carry on. Tough love. Its easier not to say anything but they need to hear it.
Granted there are definately ways you can buffer the blow... body language, phrasing, and instead of saying "YOU shouldn't do this, YOU shouldn't do that" simply keep it factual. "When the blood pressure stays high untreated for prolonged times it leads to bla bla bla..." Maybe she would feel less "targetted" that way.
The trick is to try to make them feel that they came to the same conclusion as you on their own. Make them want it for themselves (I realize as I write what an uphill battle this can be, trust me). Don't stress too much over it. Do what you can and carry on.
She already knew all that stuff, and you were holding her accountable. If she attacks you, you'll go on the defensive and she won't have to be defensive; thereby avoiding having to deal with her own problems. It's classic avoidance; yes we try to understand her, use different approaches, see the unspoken fear (my mother died of this), it all comes down to she doesn't want to face the reality and assume responsibility (I didn't stop, I just didn't refill; oh please).
The only thing I can see doing differently is asking how much she knows about the problem before automatically teaching; but in the ER we often only get one shot to provide info and we tend to go for it. I doubt you were nearly as "preachy" as you are being accused of.
Specializes in Peds/outpatient FP,derm,allergy/private duty.
It sounds to me like you talked to her in a way that what even, measured and calm. It was her own emotional state that may have perceived you as rude, preachy condescending or obnoxious, but I guess there isn't too much you can do about that.
Honestly, I applaud you as a time-crunched ER nurse for trying to reinforce the information for the lady, even if she had likely heard it before. If only we could get people to see their PCP even once a month it would avoid so many health crises like these. When her BP came in that high, I doubt she expected anyone to simply note the numbers and leave the rooom!
mwboswell
561 Posts
what about instead of "educating her" you simply said, "Is there something we can do to help you get back on your medications?"