Nurses, Clients and Power

I don't feel I fit in any of those categories. Where is the Mutual Respect category?

:)

Tait

Or the educating to promote self care category?

I have done each one of these categories at some point or another, but cannot solely classify myself as any one of them. I think situations can dictate how the nurse can and should help the patient. Different patients require different tactics. I have never and will never try to convince the patient to do something that they are just totally against for whatever reason, but I will try to convince them that some parts of their treatment regime are necessary for the healing process. In the end, it is still their decision to say yes or no and once that decision is final, I can only accept it. I would not feel good about accepting it, though, if I haven't done my job of fully educating and advocating for the patient beforehand.

I have used every single one of those strategies lol. Although, the terms of endearment strategy was mostly used to cajole the drunks who were throwing things at me to sit down before we strapped em down :)

I think a big component of the nursing care I give my patients is reminding them that they are the boss of their care. I let them know I understand they may feel how they've lost a lot of their privacy/independence. I also emphasize that they still are in charge of their care and they can absolutely refuse a med/tx or whatever (and discuss the consequences of that choice).

We don't have the time (unless we make it... at the expense of other things that need getting done) to sit down and spell all that out as much as we'd like. When we do make that time, however, it's been my experience that the time taken was very well spent.

I agree with MoopleRN, the patient is the boss of their own care. I try not to make someone do something they don't want, but I do explain the conseuqences of refusing and we have sometimes made them sign a form for refusal of certain care.

In reference to the book "Nurses, Clients and Power" in part I do not think it just means the direction or the empowerment of a patients health. It also means the day to day interactions of any nurse with any patient which would include nurses working in private practice, floor, or a surgical nurse. A great example of a female nurse with a Foley catheter kit walking into the room of a male patient and that patient is embarrassed or even says is there a male nurse who can do this?

1. Usually the patient is never told that he might be getting the Foley.

2. Usually the nurse will just say I have done this a thousand times or I have seen it a thousand times or you have nothing I have not seen before. Classic example of what the book is talking about disregarding the patients feelings in order not to disrupt the routine because the routine of that nurse is more important then the patients feelings. The same goes for a male patient being prepped for surgery. I do understand every nurse is not like that but there are more situations like that then not. Do we all know a nurse like that, do you not think that is a bully tactic?

I absolutely agree to the patient's right to refuse any tx or med they want however why are you in the hospital if you are going to refuse everything?

& regarding #3...we were taught almost that exact phrase in nursing school to effectively manage time. Would you rather xxx or xxx? I'm sorry, I have 7 patients, if you want to walk and have your shower before 5pm then you have to pick one or the other now. This is not the Hilton, it is a hospital. You can sleep until noon if you would like but do not get angry when my CNA can not give you a bed bath the moment you wake up. We will be happy to get to it as soon as possible, please be patient with us.

Sometimes you have to use a little persuasion to get a post-op patient to use their incentive spirometer or get out of bed.

"I absolutely agree to the patient's right to refuse any tx or med they want however why are you in the hospital if you are going to refuse everything?"

Respectfully: Going the the hospital and maintaining the rights and priviledge to own your own body are not mutually exclusive. We are not asking for a lot. We simply want the ability to say "if this needs to be done, I would feel more comfortable with the same gender." Simple. All who post here regardless of career would expect the same rights out of a medical setting. We expect the same within.

We are all overworked, short staffed and underpaid. But we can not lose sight of respecting people's choices about their own body, no matter what we do for a living.

"Would you rather xxx or xxx? I'm sorry, I have 7 patients"

This is where the medical profession goes wrong, who fault is it that you have 7 patients certainly not the patients fault and I suggest you take that up with your employer. Are insurance is paying regardless if you have one patient or thirty. Maybe your employer could stop advertising on every billboard, magazine, or radio spot in your town claiming how there personal care out shines anyone of the hospitals in town. No hospitals are not hotels however it is a competitive business and the patient is the customer, and nurses choose to be nurses and if you can not handle the multi-tasking I suggest you become a junior high school nurse. STOP BLAMING THE PATIENT AND ACTING LIKE YOU ARE ALWAYS DOING THEM A FAVOR, YOU ARE JUST DOING THE JOB YOU SIGNED UP FOR. Doctors and nurses must stop telling the world how busy they are, the whole world is as busy as they are. Are nurses not aware corporate America has been downsizing for the last decade and most are doing the job of three employees? If other profession complained how busy they where to the customer they most likely would be fired. I understand some patients may be more difficult to deal with then others but I also deal with difficult customers everyday and the difficult customers also insure my family eats at night.

I respectfully disagree with you.

My post was not to say that I am one of those nurses that insists on providing care or that I'm not compassionate. It was just talking about the reality of the situation.

By the way, I do agree that we should respect pt autonomy as much as feasible in the hospital seting. I don't force my services on anyone (and never would put in a foley or whatever if the pt was uncomfortable but I WOULD say "Mr XX I'll be happy to have a male nurse come and perform this for you, I just want you to know that we have nobody available right now so you will have to wait until a male nurse can come up from another floor. Are you ok with waiting?" and then I call someone. I explain very nicely why I can't always operate on their schedule, and I do my best to accomodate requests. It isn't always possible and I am nice about it, even when they are being very demanding.

No, it is not the patient's fault that I have 7 patients. However, I am only one person. If they don't want to do x or y right now, when they DO want to do it, if I am tied up, they have to wait. I make that very clear so that nobody is surprised when it takes a while to get up for that walk or shower once they've called for me.

I firmly believe pts need orientation to the reality that exists in the hospital and that is, while I will make every effort to treat them as my only patient, many times they will have to wait because they are not my only patient. Most of them understand and the ones that don't...well, I'm sorry. I try. Until I grow more arms and legs, its just the fact of matter that I only move so fast.

Every time I am hospitalized (and I have been a few times for various things), I accommodate the nurse. After all, I am there for treatment and she is providing treatment. It may not always be convenient to be worken up at midnight for vital signs or 0400 for a lab draw, but its part of the information gathering process that needs to be completed so I can get the best treatment. It we operated on the times that the patient wanted blood drawn or did other treatments only when the patient wished, health care would be even more inefficient that it is now.