Gut Feelings....

[Mandychelle79, ASN, RN]

How often do you all just get a gut feeling that something isnt right? And how in the world can you describe it to the doctor when updating about a patients condition?

"Hey Doc, I am calling about Joe, hes just not acting right... what is he doing? Nothing really, just not the same guy I talked to at length last night. Whats going on? I dont know, I just dont like the feeling I am getting right now. To the point that I was walking backwards up the hall so I didnt turn my back to him, Im getting freaked out. No not acting out, just acting weird. There is something going on in his head but I have no clue what it is but I dont like it." Luckily the doc last night trusts my gut instinct as much as I do, and knew if I was calling in the middle of the night (and walking down the hall backwards) that there was something not right and gave me orders.

[WillyNilly]

I think we get them for a reason. I describe what signs and symptoms I see, check to see if the patient has any medications to help with the signs and symptoms and keep a good eye. If it is a spiral of medical, I obtain current vitals with a witness and call for house doctor.

[Psychopath, MSN, RN, CNS]

Sometimes a gut feeling or an intuition may just be what saves the day. Trust also in your clinical risk assessment and judgement, if you don't think you can, always good to double check with another member of your team like you've done.

[amoLucia]

I don't do psych - but I have had that gut feeling in MS & LTC. I have pleaded my case to MDs sometimes with my last entreaty to them as "to just trust me, it's just my nursing intuition" or "to please just humor me". I have ALWAYS been correct when this happened & they acquiesced to my requests. The pts subsequently crashed afterwards off my unit. I felt vindicated.

And Mandy - it would just be as you described when I'd be calling the Doc.

[Retired APRN, MSN, RN, APRN]

Gut feelings are often a nascent clinical sense. When I was a young floor nurse, I was taught on an acute adult inpatient psych unit I was taught to review carefully the context, the detailed situation in which I got that gut feeling. Joe is weirding out? What is he doing that's different? Is he wearing his clothes differently, is it his posture? What about his facial expression, his gaze? Is Joe unusually silent or especially verbal? What is he talking about, what kind of language is he using? Is he sitting in a new spot in the day room? How have his interactions with his peers changed?

All of these tiny details combine to give a clinical picture. Then I can call the doctor, especially a doctor who doesn't know me well or who doesn't trust nurses' assessments, and tell her, "Something is going on with Joe and it's making me fell very uneasy. He is sitting very still and not watching the television, even though he usually enjoys this show. His hands are in his pockets and he seems to be clenching and unclenching his fists. His eyes dart from object to object but then he focuses very intently on one person. When he focused on me I was worried enough to back away from him. He is muttering under his breath, but responds to questions by saying everything is fine in a monotone."

Okay, that's a pretty blatant example, but with practice you can pick up and describe more subtle changes. "Acting weird" covers a lot of territory. The doctor or NP can't order an appropriate intervention without more details, especially if they don't know the patient well.

The bottom line, though, is that the floor nurse is best placed to pick up on important changes in a patient's conditions. Communicating the changes clearly is an important part of his or her job.