So I had this older lady who was hospitalized for pneumonia. All evening she was very pleasant and even offered chocolate each time I went in to see her. It was mentioned to me at the beginning of the shift that the night before she had gotten out of hand and I thought this lady is so sweet I wonder what they are talking about. Well at 6am I found out. She was screaming down the hall that if someone doesn't get her water right now there is going to be a dead patient. I go in the room and her eyes are red and puffy and she starts screaming at me saying I am a horrible nurse and I neglect her and this is a horrible hospital. When I asked her why she was so upset and what she needed she started screaming how she hasn't had a bowel movement in 2 days and I don't care because I'm not calling the doctor. (The night before I did give her something)
I wanted to tell her the reason she isn't going as frequently is bc she won't get her butt out of bed! She refuses to get up to a commode or a chair. But I wasn't going to fight. She yelled for us to get her fixed up in bed so we pulled her up in bed and I laid the blanket on her and she said "this is how you're gonna leave me, you aren't even gonna make it nice." Omg! I wanted to just tell that lady to cut the crap bc she was just out of control but I know we are supposed to be cordial with the patients.
Has anyone ever told a patient to just cut the crap and stop being nasty?
Have I mentioned lately that I love how good nurses think?
Heron, you took the thought right out of my head. I've run into the reaction that some (most?) elderly have after surgery and anesthetic, but not the situation described by the OP. Everyone on this board teaches me so much about how to think. Thanks to all!
Specializes in Emergency Department, Surgical Step-down.
Have you ever been taught that some patients' states of mind/levels of awareness can be static? Have you ever heard of Sundowners' Syndrome?
Have you ever been taught that a sudden change in personality can be a sign of a physiological change? UTI? Sodium level?
I find your post more than a little disturbing. And no, I have never told a patient to "cut the crap and stop being nasty," nor do I recommend it as an effective way to communicate.
Wow. I find your post more than a little condescending and not very helpful at all. When I read the post, I gathered that the OP was asking for help in therapeutic communication (not medically diagnosing a problem). And let's be real. We are all nurses here (for the most part). Our job is to care (literally). Yes, maintaining a professional demeanor is obviously an integral part of the job (but that doesn't mean we are all immune to insults and demeaning behavior - even if it's the disease talking - not the patient). Nurses are people too. And this is a nurse peer group - we are here to help each other get through hard things and hopefully become better nurses - not put each other down.
Specializes in Emergency Department, Surgical Step-down.
Yeah - I'm going to go out on a limb when I say that I read something COMPLETELY different. I read frustration from a nurse who wanted help (not condescending judgment) from a group of her peers. Call me crazy! Maybe I was just giving a fellow nurse the benefit of the doubt in thinking that after coming home from a long night of verbal assaults and caring for people who are sick, this OP was just looking for help in becoming a better nurse and knowing what to say/do the next time this happens. This isn't a contest of "who is the smartest nurse in the room." None of us were there and we don't know the entire story. OP wasn't asking about your assessment skills or medical diagnosing skills. Regardless of what illness the patient had, the question related to therapeutic communication.
Yeah - I'm going to go out on a limb when I say that I read something COMPLETELY different. I read frustration from a nurse who wanted help (not condescending judgment) from a group of her peers. Call me crazy! Maybe I was just giving a fellow nurse the benefit of the doubt in thinking that after coming home from a long night of verbal assaults and caring for people who are sick, this OP was just looking for help in becoming a better nurse and knowing what to say/do the next time this happens. This isn't a contest of "who is the smartest nurse in the room." None of us were there and we don't know the entire story. OP wasn't asking about your assessment skills or medical diagnosing skills. Regardless of what illness the patient had, the question related to therapeutic communication.
So ... while you're railing at us for failing to answer the question, I notice that neither have you.
The OP - who seems to have seagulled - presented very little information other than a pattern of behavioral outbursts at night and the implication that the pt's behavior was enabled by her co-workers. For me, when faced with such a behavioral change, my very first reaction is to ask what's going on here. I've found that approach to be very helpful in not taking things personally, which is step one in the therapeutic communication process. What else would you suggest?
Wow. I find your post more than a little condescending and not very helpful at all. When I read the post, I gathered that the OP was asking for help in therapeutic communication (not medically diagnosing a problem). And let's be real. We are all nurses here (for the most part). Our job is to care (literally). Yes, maintaining a professional demeanor is obviously an integral part of the job (but that doesn't mean we are all immune to insults and demeaning behavior - even if it's the disease talking - not the patient). Nurses are people too. And this is a nurse peer group - we are here to help each other get through hard things and hopefully become better nurses - not put each other down.
You took the words right out of my mouth. It's easy to judge a situation and carefully think of what we'd do and say in a certain situation from the safety of our computer. Because of all the bashing, I started a thread with the intent of starting a discussion on ways we all cope and draw boundaries with our patients. Instead it was mistaken for advice seeking on a certain situation. I just thought, "I give up."
Specializes in Emergency Department, Surgical Step-down.
So ... while you're railing at us for failing to answer the question, I notice that neither have you.
The OP - who seems to have seagulled - presented very little information other than a pattern of behavioral outbursts at night and the implication that the pt's behavior was enabled by her co-workers. For me, when faced with such a behavioral change, my very first reaction is to ask what's going on here. I've found that approach to be very helpful in not taking things personally, which is step one in the therapeutic communication process. What else would you suggest?
Unfortunately, I do not know what "to have seagulled" means. However, based on the presented scenario, I would offer additional education and research in the field of therapeutic communication. Here is one that I just read:
Yes have had difficult cases. Most recently I was passing meds with a student, my sixth student that day and we were late on 0900 meds. One lady just started yelling her meds were late, didn't we know how critical her meds were etc etc. Colace, lasix, most were just daily, but we broke her routine. I apologized to her, said of course she was correct, and we were working on speed, and we had her meds here, was she ready to take them. She proceeded to ask the student what each med was and why was it needed. She said she realized students needed to learn, and later the student returned to her room to spend time with her. She was mostly lonely I think and needed to feel like she still had control. I gave her the control. The student had a good learning experience.
Yes have had difficult cases. Most recently I was passing meds with a student, my sixth student that day and we were late on 0900 meds. One lady just started yelling her meds were late, didn't we know how critical her meds were etc etc. Colace, lasix, most were just daily, but we broke her routine. I apologized to her, said of course she was correct, and we were working on speed, and we had her meds here, was she ready to take them. She proceeded to ask the student what each med was and why was it needed. She said she realized students needed to learn, and later the student returned to her room to spend time with her. She was mostly lonely I think and needed to feel like she still had control. I gave her the control. The student had a good learning experience.
Nice anecdote, but when it's patient after patient, day after day...it can really wear you down. That's why its nice to have a place such as this where others can relate and we can just vent. Then go back to work hopefully a little more rejuvenated.
Specializes in Gerontology, Med surg, Home Health.
Since I live in a place with hundreds of seagulls, I can only guess being seagulled means getting pooped on. Just a guess.
I've dealt with all sorts of patients as we all have. Sometimes there is a reason for their behavior-you can't fault someone with dementia or psychosis for their bad behavior. Therapeutic conversations do no good when the patient thinks you're their cousin Tilly who stole the boyfriend in 1945. As long as they're not assaultive, I go with the flow. Who ever said call security has never worked in a SNF. We have no security.
There are people who are just plain nasty and they get worse when they're in the hospital or SNF. If they are alert and oriented, I have no problem politely telling them to stop treating the staff like servants. Oftentimes they threaten to call the DPH. Go ahead...what are you going to tell them? that you called a 22 year old young woman a *&^(^ because you thought she was too slow?
And, although if alert and oriented there is no excuse for bad behavior, being sick, in pain, dependent, and not in control can make even the most polite of us slip up and snap.
Sometimes just saying it out loud helps. Frustrations of the day will always be there, but just saying it out loud really helps. I found that when speaking frustrations out loud to be careful where you say them. Don't be in a crowd and let the other person know that you just want and need to say this out loud. The purpose is to get the steam out.
Yes I have told someone to cut the crap. A 3-4x a week drug addict that spied a new med student, and tried for a Percocet prescription. Also a drunk post MVA that had been driving home from a strip club, and thought the nurses were just more civilized whores. So,at times, enough is enough. But not in the case the OP described. I'd be thinking something along the lines of well geez, this is not going well, but also looking for the cause. The more unexpected the confusion is, the more suspicious I'd be that the patient was physically ill. For me, the more I can chalk it up to illness, and not a personal reaction to hurt me, the better I cope. So I look hard for illness. That strip club drunk got treated like my best friend, I held his hand, until he got a normal head CT back. Skeevy weasel that he was...and no it's not unprofessional to think that, or come to allnurses (this should be a safe spot), just don't say it out loud.
Maybe I was just giving a fellow nurse the benefit of the doubt in thinking that after coming home from a long night of verbal assaults and caring for people who are sick, this OP was just looking for help in becoming a better nurse and knowing what to say/do the next time this happens. This isn't a contest of "who is the smartest nurse in the room." None of us were there and we don't know the entire story. OP wasn't asking about your assessment skills or medical diagnosing skills. Regardless of what illness the patient had, the question related to therapeutic communication.
heron, ASN, RN
4,653 Posts
Who are you addressing?