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?
I completely agree that pain should be treated efficiently and appropriately. That being said, one of my favorite quotes from a very experienced Pain Doctor is that "in the history of man, pain by itself has killed not a single one." I moonlight in his clinic a couple of times per month, and let it be said that his patients are always polite, partially because in their initial exam this Dr tells them that if they are not, they will be dismissed immediately. However, I am aware that acute pain is a different beast, but never in my multiple natural childbirths or many kidney stones have a acted in such a foolish manner. Quite frankly none of us get paid enough to be verbally abused, and it is not "just part of the job". That society consumes multiple hours of so-called "reality tv" which promotes the most drama in life as being the most fruitful, is part of the reason the public has come to believe it is ok and even expected to behave this way. I love ER, been doing this 13 yrs, and work between 50-60 hrs per week, I'm not burnt-out and plan on doing this for years to come. But I will never accept that it is ok to verbally or physically abuse any ED staff.
I also need general advice on how to maintain my composure. One of my coworkers told me that if I start feeling like I can't handle the patient and that my patience has run out I should have another nurse take over the care of the patient. The patient ended up firing me which I was happy about. When I went in to give her pain medication after the outburst by the husband the tech was in her trying to calm her down and she was ranting on and on, I don't remember everything she said but at one point she said the nurse was ignorant. So I responded: "So do you want your ignorant nurse to give you more pain medicine or not." Then she started ranting about how the nurse was a "smart @ss." That was probably the only thing she said that was true the entire night. I went back in there to give her ativan and then she demanded that I leave her room and not come back. ?
Hi, I am not a nurse, but I have dealt with the public for quite a few years. I found that if you empathize with them and give them a plan of action from you personally, they seem to ease up a bit. For example, tell the person you can see she is in a great deal of pain, and that you are so sorry she's having to go through this. That you can see how it must be aggravating to wait for the doctor, and a bit frightening as well. Just agree with her. Then follow-up with your plan of action statement about the ice, etc to help her. At least this is what has worked for me. I just learned to shrug stuff off, the customers/patients don't know me at all, and if they did, they would not be speaking to me this way. They aren't particularly angry with you. There are occasions, about 1-2 a year, where I would sneak off to the bathroom and cry it out for a few minutes. Then I was fine. Hope this helps you.
BTW, I am not speaking about verbal abuse, that will never be tolerated by me (insulting, cursing at, etc). I will put someone in their place real quick. But if they are just cursing in general, speaking or yelling, then I can be empathetic with them.
Patients experiencing pain may exhibit regressive behaviors, causing care personnel to label them as "drug-seeking", "unruly", or "borderline". This is especially prone to occur in Emergency Departments, where there may be several critical situations happening simultaneously.
Passing kidney stones is an excruciating experience, and patients are likely to be terrified, particularly if their nurse withholds medication, or is not supportive of their emotional needs. Their behaviors may escalate dramatically, as the pain continues.
The care provider must medicate adequately, and be present to emotional and behavioral cues, from the patient, and her significant other.
I would suggest that you take a course in pain management, to assist you in gaining knowledge, and coping strategies for managing pain. Having worked in ED for years, I know how hectic it can be...however, advocating for ample pain relief, and being emotionally available to patients who are experiencing acute pain can help patients to move through even very painful events more ably.
I would never withhold pain medication from a patient! There was no order for more pain medication. This doctor does not do PRNs. The doctor and I were busy with a critical patient, hence I could not tend to the kidney stone patient's emotional needs. The husband showed up while we were busy in the other room. There was no chance to calm him down from escalating, nor were there any cues and if there were - I wasn't there to pick them up. He just blew up. Which is why I called security and the police - it could have been a lot worse. I didn't even go near him because I was afraid of what he would do. Once he got kicked out we were all scared he would come back with a gun. The patient came in agitated. I asked for pain meds before the pelvic, but the doctor just wanted to go ahead and do it -she was afraid the patient had an ovarian torsion. I gave her more pain medication after the pelvic and then the other patient crashed.
I completely agree that pain should be treated efficiently and appropriately. That being said, one of my favorite quotes from a very experienced Pain Doctor is that "in the history of man, pain by itself has killed not a single one." I moonlight in his clinic a couple of times per month, and let it be said that his patients are always polite, partially because in their initial exam this Dr tells them that if they are not, they will be dismissed immediately. However, I am aware that acute pain is a different beast, but never in my multiple natural childbirths or many kidney stones have a acted in such a foolish manner. Quite frankly none of us get paid enough to be verbally abused, and it is not "just part of the job". That society consumes multiple hours of so-called "reality tv" which promotes the most drama in life as being the most fruitful, is part of the reason the public has come to believe it is ok and even expected to behave this way. I love ER, been doing this 13 yrs, and work between 50-60 hrs per week, I'm not burnt-out and plan on doing this for years to come. But I will never accept that it is ok to verbally or physically abuse any ED staff.
Thank you for this. There is NO excuse for this type of behavior. Pain or no pain. Nobody deserves to be spoken to the way this couple spoke to us.
Specializes in Medical Surgical & Nursing Manaagement.
First of all..........I've had multiple kidney stones........and three natural childbirths and I would take childbirth over the pain of a kidney stone.
That being said, as another poster posted, pain to someone is an emergency. Patients can't be empathic when they are in pain and they don't want to be told about other patients. They want (need) to think they are the focus of your attention. I would have asked them not to yell out but to try to diffuse the situation by telling them what is going on in the ER is not their problem. Don't tell them what you can't do for them........turn it around and tell them what you can do for them, medication, show them the labs etc. The comment about the tampon.......I think if after a pelvic exam and my patient was bleeding, I'd offer her an abdominal pad
Hollybobs has some good points. If your patient is scared, angry or very stressed, you must calm down. Speak in a lower calm tone and have slower movements. Don't slow down just don't have jerky quick movements. The patient in pain is physiologically in a high alert situation.
When I had the most excruciating pain with my third episode of kidney stone, I could not speak for the pain. I could not think. When the doctor came in and asked me a question, I was in so much pain I could not comprehend what he was saying. It was awful. I received a shot of toradol and the pain gradually lessened and went away.
Anyone who is scared is in extreme stress and should be treated like a very frightened child or animal.
I just wanted to say one thing about this situation, and it doesn't really have anything to do with the initial question.
I have had dozens of kidney stones in my life, been to the ED for a few, became really good friends with my urologist (since he has had to look at my "privates" more intimately than my husband ever has), had several stents places & removed and have suffered through excruciating pain with them, as well the obstructions I've developed. NEVER have I ever had a doctor tell me he wanted to do a pelvic exam. For an ED doc to want to do a pelvic exam because he thinks somebody has ovarian torsion before giving them any pain meds is just downright sadistic. No matter what the situation is, pain needs to be controlled before anything can be done.
If you have never had a kidney stone & have never experienced the pain, you can't possibly know that you want to kill yourself & everybody else around you because it is excruciating & there is nothing else like it. I think that if any hair brained doctor wanted to do a pelvic exam on me while I was having 100/10 pain, I would punch him in the mouth. Kidney stone pain is a kind of pain all to itself---I've had ruptured ovarian cysts, a perforated gallbladder, post-op infection after exploratory lap/cholecystectomy, and NONE of the pain from any of those things is like the pain from a kidney stone. It is much faster to do a U/A, see if there is blood and WBC in the urine & give them something for pain, then do an X-ray or CT or U/S to see what's going on. Whether the diagnosis was a kidney stone or ovarian torsion, she was going to need pain medication either way. She would need an ultrasound to diagnose an ovarian torsion which would take time----was the doctor going to let her lay there in horrible pain waiting for an ultrasound?
I'm sorry---but how she was managed was wrong, in my opinion. You didn't do anything wrong, but this doctor sounds like he needs some CME's in medical emergencies. A pelvic wasn't even necessary in the first place----if the doctor didn't do the pelvic, she wouldn't have gone postal over the pad. It's a shame that we have to shoulder the B.S. because of crappy docs............
I recently (yesterday) had a patient raise his voice and curse at me multiple times because he was unhappy with his food. He was on a cardiac and renal diet. He was VERY upset because he read our menu wrong and though he had ordered a fish sandwich, which ended up being a small portion of battered and fried fish. He wife claimed after everything they had been through he deserved a hot meal. Because the hospital apparently couldn't provide that, she was going to have to drive to McDonald's and get him a fish sandwich. I did the best I could to put out the fire but to no avail, I walked out of the room feeling insulted, deflated, hurt and angry. Any suggestions on how to deal with an irate and upset patient over food? Any suggestions/words of wisdom on how not to let patients like this get under your skin?
I recently (yesterday) had a patient raise his voice and curse at me multiple times because he was unhappy with his food. He was on a cardiac and renal diet. He was VERY upset because he read our menu wrong and though he had ordered a fish sandwich, which ended up being a small portion of battered and fried fish. He wife claimed after everything they had been through he deserved a hot meal. Because the hospital apparently couldn't provide that, she was going to have to drive to McDonald's and get him a fish sandwich. I did the best I could to put out the fire but to no avail, I walked out of the room feeling insulted, deflated, hurt and angry. Any suggestions on how to deal with an irate and upset patient over food? Any suggestions/words of wisdom on how not to let patients like this get under your skin?
Ok, this is what works for me :)
How to deal with this patient at the time: Let them talk and shout. Let them continue to do this. Listen and wait. Let them do this some more. They WILL slow down. You can agree with them about what they've said i.e.. there had been a mistake, however it happened, it shouldn't have happened- don't say much, just look (and feel) concerned. They will talk themselves out. The wife might join in- apply the same process.
Eventually (again 99 times out of 100) they will both stop. Then you can introduce a calm and suitable solution (i.e. we will fill the menu in together tomorrow to prevent repetition of events). Maybe ask if there is any additional action they would like taken? At some point in the next few minutes to few hours they will probably feel very ashamed/sheepish/embarrassed and come and apologise to you.
(This can work with Dr's too).
How to deal with your reaction internally: Remind yourself that you don't know the real cause of the over reaction. He could be really scared about his health and the menu represents a small bit of control. He's been trying to put a brave face on his fear for his wife and so has she- all the pent up feelings have burst out about this fish sandwich. I don't know, you don't know but it is NOTHING that you have done wrong. You are there for him, as his nurse, to support him through all that vulnerability and hopefully you feel like you are doing a good job :).
You can tell him once things have calmed that there will be no more cursing, however. I'm not advocating that we put up with everything all the time.
As a L&D nurse, I was always sent into the rooms of the "Out of control" ladies. It took me a few years to realize about Healing Touch aka Therapeutic Touch, aka Energy healing aka reiki. I was a natural, able to calm a room of people quickly and get cooperation from everyone, well almost everyone, so it became my task to smooth things over in an anxious environment. With more training now under my belt, I always take the least desired assignment and handle it well, usually. There are a few, but they are seldom, which don't respond to my calm demeanor and a touch to their elbow, shoulder or knee.
As a L&D nurse, I was always sent into the rooms of the "Out of control" ladies. It took me a few years to realize about Healing Touch aka Therapeutic Touch, aka Energy healing aka reiki. I was a natural, able to calm a room of people quickly and get cooperation from everyone, well almost everyone, so it became my task to smooth things over in an anxious environment. With more training now under my belt, I always take the least desired assignment and handle it well, usually. There are a few, but they are seldom, which don't respond to my calm demeanor and a touch to their elbow, shoulder or knee.
How does you being supernurse help the OP?
Don't get me wrong, I'm glad for your sake that you are the nutso lady whisperer, but tooting your own horn isn't helping anyone.
How do you actually do it? Tips and tricks would be greatly appreciated.
ED-JUN-KY
2 Posts
I completely agree that pain should be treated efficiently and appropriately. That being said, one of my favorite quotes from a very experienced Pain Doctor is that "in the history of man, pain by itself has killed not a single one." I moonlight in his clinic a couple of times per month, and let it be said that his patients are always polite, partially because in their initial exam this Dr tells them that if they are not, they will be dismissed immediately. However, I am aware that acute pain is a different beast, but never in my multiple natural childbirths or many kidney stones have a acted in such a foolish manner. Quite frankly none of us get paid enough to be verbally abused, and it is not "just part of the job". That society consumes multiple hours of so-called "reality tv" which promotes the most drama in life as being the most fruitful, is part of the reason the public has come to believe it is ok and even expected to behave this way. I love ER, been doing this 13 yrs, and work between 50-60 hrs per week, I'm not burnt-out and plan on doing this for years to come. But I will never accept that it is ok to verbally or physically abuse any ED staff.