your very own personal crusade

rn/writer, RN · Sep 20, 2005

Quote: "I really get irritated when health care folks talk to the patients and tack, "Okay?" onto the end of whatever they're saying. "I need to check your blood pressure, okay?" "We're going to start you on a new med, okay?"
I do this, but not b/c I'm feeling submissive. I want patients to know that they have a choice in any procedure, even the small ones. Patients can feel so powerless in a hospital, so even little choices (or perceived choices) can make them feel more empowered & respected.

I'm in agreement about giving choices and have been a constant advocate for our grandson in that respect. I'm talking about saying okay at the end of nearly every sentence to the point where it becomes automatic and pointless. And truly, it is misleading if there really isn't a choice. Instead of saying, "I'm going to check your blood pressure, okay?" when I know the patient needs to have it done, I'd rather offer a real choice. "I can check your blood pressure now or after I give you your meds. Which would you prefer?"

One of the reasons the repetitive okay bothers me is because I don't believe it's a genuine question in many cases. It becomes almost like punctuation, something to tack onto the end of a sentence. Or it serves as filler. And often, I think it's done more for the practitioner's benefit, sort of leading the patient where you want them to go and coaxing them, one okay at a time, to follow.

I'm not thinking terrible thoughts about anyone or ascribing evil motives. I just think this is a bad habit to get into and we'd do well to eliminate about 90% of it in favor of stating whatever the plan is in plain terms and then at the end, asking a real question and waiting for a real answer. That seems less like baby talk and more like speaking with someone whose opinion you want to respect.

Tweety, BSN, RN · Sep 20, 2005

My personal crusade is Incentive Spiroment teaching. Almost every postop or trauma patient who needs an IS hasn't been taught properly. They take quick gasping breathes trying to get a high mark. Instead of the slow, full deep breath that's effective in preventing complications.

It's my mission to educate every patient on proper use and I'm supposed to inservice the staff. Problem is the respiratory therapy dept. does the initial teaching. My boss expressed my concerns to their manager and he blew me off. But my crusade will not end. :)

P_RN, ADN, RN · Sep 20, 2005

From a southern perspective.....I also like to use the Miss Susie and Mr Thomas.....it's how I knew them all my life. If it is somone new to me I just ask what they want to be called.....The older I get the less I like being called by my first name by someone in their 20s whom I have never seen before.

Also we say Yes ma'am and Yes sir.....that's expected common courtesy. I don't care if they're 100 or 20.

As far as diapers.....I don't like that term. I usually say Attends or Poise or underwear...to me briefs are those granny drawers with the big legs.....one person's opinion.

Bibs ewwwwww......how about dinner napkin....

I can't tell you how many times I have given out pre meal hot wash cloths and had someone say no one had ever done that before.

My BIGGEST is patients not being given analgesics because "she never asked for it." My MIL had parkinson's and was aphasic the last 4 years of her life. Lying in the hospital the last illness a nurse told me that......

I stayed and made sure the doctor wrote for ATC morphine. Good gracious she was 89, had sepsis, pneumonia, total renal failure, sat's in the mid 80s and the nurse actually said she would get respiratory depression from the 2 mg of morphine she'd had that week!!! At least I can say her last few days were very comfortable.

rn/writer, RN · Sep 20, 2005

My BIGGEST is patients not being given analgesics because "she never asked for it." My MIL had parkinson's and was aphasic the last 4 years of her life. Lying in the hospital the last illness a nurse told me that......
I stayed and made sure the doctor wrote for ATC morphine. Good gracious she was 89, had sepsis, pneumonia, total renal failure, sat's in the mid 80s and the nurse actually said she would get respiratory depression from the 2 mg of morphine she'd had that week!!! At least I can say her last few days were very comfortable.

That is sooo wrong. I'm so glad you were able to advocate for her (not to mention for common sense) and were able to make her passing a bit more bearable.

How about a cognitively delayed child of 5-8 years (my grandson with spina bifida) being put on a PCA pump for post-op nerve and bone pain. With no basal. He had at least a dozen sugeries in three years and many times my daughter and I were told to "just keep pushing the button if you think he needs it." We took turns staying with him to give each other breaks but we were both exhausted. We kept asking for a basal rate, at least at night so that he wouldn't suffer if we should fall asleep. The best we could do was keep after the nurses to bring in the PRN meds as soon as they could be given.

My other complaint was that the P in PCA stands for patient. Where is there any benefit in using a PCA with a child who a) doesn't "get it," and b) thinks that if he admits to having pain, he won't be allowed to go home. Shouldn't there be some type of assessment to see if a patient, especially a child, is a suitable candidate for PCA?

We were told having a PCA was part of the post-op protocol and had to scream bloody murder that one size does NOT fit all and it certainly didn't fit him. Finally, we found out the hospital had a pain team (by accident!) and insisted they be called in. Bottom line, in the future, post-op narcs will be written as PRN but given as if scheduled for a minimum of 24 hours and longer if the type of surgery warrants it.

We had to teach some of the nurses how to assess for pain in a child who can't or won't speak about it (or even use the pain faces accurately because only the happy face gets to go home). Tachycardia, tachypnea, poor O2 sats r/t shallow breathing, guarding, grimacing, dull look to the eyes, inability to concentrate, poor appetite, irritability, etc. Finally, we convinced the staff that we didn't want him to have any more analgesia/sedation than necessary but we wanted him medicated enough to be able to heal without being in agony. We also had them document the situation during a few stays and had the pain team make some permanent changes in his protocol. The last few visits have been much better.

I shudder to think of what kids go through when they live 200 miles away and their parents have to be away from the bedside for long stretches to work or care for other kids.

SharonH, RN · Sep 20, 2005

Two pet peeves: 1)addressing patients of any age over 18 by their first names without their permission. I have never done it and yet, it happens frequently to me. Why?

2)Dirty hands. Often patients get so much attention focused on their faces and their bottoms and when I walk into a patient's room they will reach out to me with these filthy hands. Lots of times the ones with dementia will stick their hands in their diapers. *shudder* So I will stop what I'm doing, grab a wash basin and stick their hands in some warm, soapy water and wash them and yes that includes under the nails.

Marie_LPN, RN, LPN, RN · Sep 20, 2005

From a southern perspective.....I also like to use the Miss Susie and Mr Thomas.....it's how I knew them all my life.

I do this too, after they say it's ok to use their first name. I'll also say a mix of Mr. or Ms. with their last name, and "sir" or "ma'am".

Tweety, BSN, RN · Sep 20, 2005

Two pet peeves: 1)addressing patients of any age over 18 by their first names without their permission. I have never done it and yet, it happens frequently to me. Why?

I agree. I quickly try to get on a first name basis with my patients. To me it seems to build a better rapport. If I'm going to be spending 12 hours with your, getting to know your intimate history, and seeing you naked and perhaps even touching your privates, it just seems natural to me to get to know you by your first name.

Everyone is different and has differing opinions. I'm 46 years old and a lot of trauma patients are younger than me. It's hard for me to call an 18 year old whose just had a motorcycle accident, is bloody and I'm giving him a bath, Mr. Smith. The elderly, I move a little slower at getting on a first-name basis, if at all.

A lot of these young patients call me "sir" (must be the grey hair) and I quickly try to get to call me by my first name.

The point being, I always get their permission to call them by their first name.

rach_nc_03 · Sep 20, 2005

I agree. I quickly try to get on a first name basis with my patients. To me it seems to build a better rapport. If I'm going to be spending 12 hours with your, getting to know your intimate history, and seeing you naked and perhaps even touching your privates, it just seems natural to me to get to know you by your first name.
Everyone is different and has differing opinions. I'm 46 years old and a lot of trauma patients are younger than me. It's hard for me to call an 18 year old whose just had a motorcycle accident, is bloody and I'm giving him a bath, Mr. Smith. The elderly, I move a little slower at getting on a first-name basis, if at all.
A lot of these young patients call me "sir" (must be the grey hair) and I quickly try to get to call me by my first name.
The point being, I always get their permission to call them by their first name.

Tweety has hit the nail on the head, in terms of my rationale for calling patients by their first names. When I think back (not too far back, obviously, as I'm a new grad), the last time I was in an environment with a large number of patients over the age of 50 or so was my first semester of nursing school. I did use Mr. and Mrs. with those patients- some requested I use their first names, some didn't.

In the job I had during school, we had a lot of trauma and various intercranial hemmorhage patients who were mostly unresponsive, or could perhaps only move a finger or two. If they were under the age of 60 or so, i generally used their first names, since they seemed to respond more to hearing their first names. If they used a nickname that wasn't in their chart, usually we placed a sign over the bed saying 'prefers to be called jimbo'. We obviously took cues from the family members, too. The relationship-building also came into play- usually these patients were with us for a week or more, so we got to know them- and their families- quite well. If the patient was conscious, i typically asked them what they liked to be called. also, i was present many times when care was withdrawn on patients (and family members weren't present), and I always used their first name when speaking to them as they passed away. I felt like the formality of mr. or mrs. was too stiff for a moment like that situation.

Speaking of that, it bugged me when some of the nurses would act as though the patient couldn't hear us, or wouldn't say anything before they started moving them around and undressing them. I had a few patients thank me after they regained consciousness, saying they remembered me talking to them, and using their name; i always said, 'john, it's rachel again...i'm going to have to turn you on your side so we can get your linens changed'.

On the flip side, in my current job, we refer to our patients by last name when we're speaking to each other outside the patient's room, or on the phone with the lab, a doc, etc- at first, it was weird to me to call a newborn Mr. Smith, but it makes sense, since we're speaking with someone who might be looking up patient records- which obviously are listed by last name.

Another thing that strikes me as weird when first talking to a parent of one of our kids...most people will say, 'you must be mom', not 'you must be timmy's mom'. It makes me feel like I'm asking if they're *my* mom. I also like to introduce parents to *other* team members as 'timmy's mom, cheryl', since much of the time, the last name of the parent may not be that of the child.

I'm certainly not saying either point of view is wrong...it's just interesting to hear what people think on both sides.

Marie_LPN, RN, LPN, RN · Sep 21, 2005

I can think of a few exceptions where addressing is concerned. I used to take care of a resident that i called "Grampaw." We'll call him "Fred" here.

Fred was in his 80's, had dementia, and when you called him by his first or last name, he would keep walking down the hall like he didn't hear you. Call him Grampaw, and he would turn around to see who said it. If you asked him a question starting with Grampaw, you'd get an answer.

His wife gave permission for that. She thinks he responded to that name better because he prided himself on being "Grampaw".

chris_at_lucas_RN, RN · Sep 21, 2005

There are ways of addressing people by their first names that is supportive, caring and appropriate--and ways of addressing people by more formal names, or sir or ma'am, that is condescending and tends to make them unsettled. We do a lot of intimate care for some of our patients. I'm not sure who we are protecting when we address them in ways that distance us....

As for the diaper issue, I've found "disposable knickers" works well. In Texas, nobody says "knickers," so it's a term that doesn't imply anything baby-ish. Here it gets a smile from a patient.

And isn't that what we're about--providing appropriate care in a manner that makes patients comfortable and relaxed and feeling secure.

Cheyenne RN,BSHS · Sep 21, 2005

For me there are a couple, or maybe I'm just anal. LOL.

1. Coming on shift with more than one IV beeping and less than 50 cc in the bag and the rate is 125. Like duh! Is it THAT much trouble to grab a bag for the next shift and have it at the bedside. I do it on last rounds and have for 20 years. That goes for any feeding tubes with no feeding solution in sight but the bags empty.

2. Coming back after 2-3 days off and finding the same dressing on a peg tube or decubitis that I placed on before I left with my same date and initials. The nurses will do the surgical dressings, so what's with this?

3. Finding the patients rooms in an absolute pigsty, specially if there are no family members in and out to watch over a patients care. however, the chairs pulled up to the TV and the patient is watching MTV. Yeah right!

4. Finding the med cart in an absolute mess. Nothing stocked, needle boxes slap full and closed but not replaced, and the trash crammed into drawers and on the sides about to fall out.

These are a few of my least favorite things.