I recently had a patient in the ED who did have a lot of pain from her 1mm kidney stone. Understandable. However, the drama and borderline traits exhibited by her and her husband were highly disruptive to the staff and surrounding patients in the ED especially as we had a crashing patient who went into septic shock with a BP in the 50s before our eyes. The patient and husband were highly disruptive because of the perception that we were ignoring the patient and not taking care of her needs. I called security and the police who escorted the husband and another visitor out of the ED. I did not approach the husband as he was making a scene. We were all afraid he would come back with a gun. I did go back to the patient to give her more pain medication. This didn't stop the high drama from the patient. Besides for yelling about the pain, the patient was yelling that we didn't check her labs or urine (we did). She was also upset that we did not offer her a tampon or pad after we did her pelvic exam because she was bleeding. We never offer pads and I have never heard such an angry outburst over a pad.
Is there a one liner that you have in your back pocket that will help the patient and or visitors recognize their childish behavior and that we will not help them if they continue with this behavior.
Would something like this work? (Of course have security officer with you)
To the husband: Mr So and So, I can see that you are very upset. However, nobody deserves to be spoken to the way you are speaking. The other patients are disturbed by your outburst. If you want to be helped, you need to calm down and stop yelling. Yelling will not get you help faster. The doctor is with a critical patient at this time. I cannot give your wife a third dose of pain medication until there is an order from the doctor. I will have the doctor come check on your wife as soon as she is available. Is there anything else I can help you with?
To the patient: I can see you are very upset and would like more pain medication. As soon as the doctor puts in an order for more medicine I will bring it to you. The doctor is with a very sick patient at this time. Would you like and ice pack or some warm blankets to help manage your pain until we get an order? I will ask the doctor for some more medicine as soon as she is available. Is there anything else I can help you with?
...just recognizing that the younger generation of nurses are much more concerned with their own needs, Lord help the baby boomers!!! Apparently compassion is not taught (nor should it have to be) in nursing school anymore!
How old is OP? I must have missed that info in the post...
I have noticed that ER staff are often more compassionate to those who's situations are life threatening, must be the adrenaline rush associated with a code. Does not make others needs less important to them…
Have you ever worked in the ER? During a code, nobody has much time to be compassionate. After the fact yes.
She was also upset that we did not offer her a tampon or pad after we did her pelvic exam because she was bleeding. We never offer pads and I have never heard such an angry outburst over a pad.†Do you really think that outburst was over a pad?????? This woman went to a hospital to receive competent and compassionate care, and her pain, fear and humiliation of bleeding lady partslly onto her clothing that others could see is not even addressed! What kind of a facility will not give a patient a pad if she is experiencing her period and has none with her??? Where is the patient advocacy here? I would be extremely upset, being in pain, waiting for care, and the response to asking for a sanitary napkin received that haughty answer!!!! If I had been her nurse, I would have gone to my purse and given her one of mine. That's what nurses do, put their patient's needs ahead of everything else. Please do me a favor, let us all know what hospital you work in, so we can avoid it. Patients don't need this kind of demeaning care! No, this is not bullying, just recognizing that the younger generation of nurses are much more concerned with their own needs, Lord help the baby boomers!!! Apparently compassion is not taught (nor should it have to be) in nursing school anymore!
She was not bleeding into her clothes. She had some spotting. Tis all. Hardly enough to go through her underpants onto her clothes. I was there during the pelvic and she did not have a pad on or a tampon before the pelvic exam. Like I said she came in with some spotting. She did have a little bit of light colored blood which I think was traumatic from the pelvic exam since it was not frank blood. 99% of the time patients come to the ER with pads and if they ask for one we will give them one. If someone is bleeding frankly I will offer a pad. However, we do not routinely offer pads after pelvic exams.
Two things to consider. First, if the patient is in severe pain, they will not be yelling and cussing. My very experienced nurse aunt told me that the quiet ones with severe injuries or pain were the ones you had to be aware of, not the loud ones because the quiet ones were so injured that they couldn't complain. From my own experiences with severe pain, I agree. It takes energy and concentration to scream or cuss or yell, which someone in severe pain doesn't have. Also severe pain messes with your brain and makes thinking and speaking hard. Someone more experienced in ED confirm or contradict, please.
Second, unless the OP was in the room the whole time with the patient and hubby, there is no telling what wife was saying to hubby to make him ashamed of being weak or not standing up for her and he had to show her that he was a STRONG man by lambasting the health care staff. The real source of anger could have been with himself for not showing how manly he was to her (which could have an ongoing problem in her estimation of him and messing up their marriage) or at her for berating him and she was in pain so he couldn't yell at her. Lots of things going on before the ED visit, possibly.
Yelling that we didn't even draw labs or check urine to get attention from husband when we clearly did is exhibiting a borderline trait. Making a hissy fit over the fact that we didn't offer a tampon or pad - I have never heard such an outburst. Many people exhibit borderline traits from time to time doesnt mean they have borderline personality disorder.
Exactly. That's why you don't get to make those calls. It's unprofessional and belittling to those who suffer from them.
Specializes in Psychiatry, Community, Nurse Manager, hospice.
Expect people in pain and distress to act badly. Don't expect politeness.
Avoid judgment. Don't say, no one deserves to be talked to the way you are talking to me.
Avoid threats. Don't say, if you don't calm down, you're not going to get what you want.
Avoid criminalizing the behavior of people in distress.
After acknowledging feelings, pause and listen to give the person a chance to express their concerns.
Repeat back the concerns as you understand them, in list format, for example:
You are distressed because your wife's pain is a 10 out of 10. You are worried about her labs. You want her to have a pad and you want to see her. Does that cover everything that is concerning you?
When you've gotten through all the concerns, address your solutions one by one. If you don't have a solution yet, be honest about it. If waiting is necessary, be as accurate as possible about how long waiting will be.
Whenever possible, employ the help of distressed family members. Send husband to the store for pads, for example.
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Julius Seizure
1 Article; 2,282 Posts
How old is OP? I must have missed that info in the post...