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Topics About 'Nurse Patient Relationship'.

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  1. Story #1 “Oh, I work a couple of shifts per week. Just enough that I can get out of the house and feel like I’m contributing, but not so much that I’m letting someone else raise my children.” These words spoken to me in passing cut like a dagger to my worn-out-mama soul. Her innocent implication that I let someone else raise my children as a full-time working mother piled on to the thickly layered “mom-guilt” I already put on myself. The cruel irony of this moment was that the words came from the mouth of my hospital nurse, as I was recovering from surgery, unable to be with, much less care for, my children in my current state. I was already in physical pain, and rather than alleviate my pain as her job should have been, she added emotional pain to my heart and mind. I feel certain that the nurse did not intend to wound me with her words. She was just “making conversation.” But what she failed to remember was that just another day at work for her was a huge life-altering experience for me. A hospital is a workplace for many, but for those of us lying in the beds, it’s often a scary and intimidating time. I implore you, keep your words positive and uplifting, or don’t say anything at all beyond the standard phrases of patient care. What you say can be just as much of the healing process as what you do.” Story #2 “I was in a rehab facility recovering from surgery to repair a shattered leg. I was in a lot of pain and had the feeling I was being judged unfairly as a ‘complainer.’ I just couldn’t get comfortable and desperately needed to talk with a doctor who had the authority to make some changes. During my discussion with the bedside nurse, she said, ‘You’ll see. Good will come out of this. Just think positive thoughts.’ Yikes. I know she meant well but that was NOT what I needed to hear. It may indeed be true eventually, but what I replied was also true, ‘I don’t need to hear that right now. I need words of comfort.’ Honestly, I don’t know if she even registered what I said.” Improving Communication Our words matter, don’t they? These simple comments, probably intended as attempts to connect, are received in a completely different way by the suffering patients. Sadly, the words linger long after the event and sometimes are repeated often as the patient struggles to make sense of a tough time. How do we improve our practice so that we don’t commit these types of gaffes? Researcher Brene Brown says, “Rarely can a response make something better. What makes something better is connection.” Making gentle connections without adding to our patient’s pain is our challenge, isn’t it? While this type of sensitivity may come more naturally to some than to others, all of us can learn and become better nurses in the process. Keep it Professional When we are in the patients’ room, our conversation and concern should be about them. We are not center stage. If they ask personal questions, it is courteous to answer, but generally, they are just being polite and they don’t really have the energy to know or care about our extended family or our troubles with our children or whatever our concern of the day might be. If the patient is argumentative or disgruntled or venting, we can begin to feel defensive and be tempted to offer them correction (or more!). Once a friend taught me the technique of saying, “Hmm. I had not looked at it quite that way…” and then let the sentence trail off without engaging. Another tool that can help us here is to answer their question as succinctly as possible and then turn it back to them with a question that helps us understand them better. Be Empathetic Our patients are sicker than ever before. Their family members are often super-stressed. As professional nurses, our job is to care for them to the best of our ability while recognizing the strain they are under and giving them extra grace in their time of need. Sometimes simply being present, prompt and professional is our best response—no particular words needed. Repeat What They Said Many of us nurses remember learning in nursing school about being good active listeners and reflecting back what the patient tells us by saying things like, “So you are saying…” In other words, finding ways to clarify what they say to make sure we are on the same page. Be Genuine When we are confident and comfortable in our own skin, we transmit that to others and help them feel comfortable as well. Being genuine does not mean that we tell people what we think, it simply means that we acknowledge their inherent dignity as persons and that we care for them with competence and professionalism, meeting their needs in the best way we can. No One is Perfect We are all going to be less than stellar nurses from time to time, but we must also keep trying to improve as we move forward in our careers.
  2. J.Adderton

    9 Types of Manipulative Patients

    After 23 years of nursing, very few things drain my energy like a manipulative patient. This has been a constant regardless of the position or setting I was working. I expect to be hoodwinked when caring for someone with a substance use, personality or eating disorder. But, in reality, a patient with any diagnosis can hustle their healthcare team. Manipulation Defined I recently read an article, written by Dr. Jeffrey E. Keller, who works where some of the most skilled patient manipulators live- jails and prisons. Dr. Keller defined manipulation as: Recognition Leads to Preparedness The best way to keep your sanity when dealing with a manipulative person is to recognize common tactics they may throw your way. In his article, Dr. Keller describes 9 types of manipulative patients and their behaviors. Exaggeration This tactic is used when someone tries to make their circumstances special when compared to other patients. The patient will attempt to make their need or want worthy of your “special consideration”. “I have never experienced pain this bad” “I can’t go on hurting like this” “It’s so much worse now than it was last night” Belittling Manipulative patients will often attempt to make your contribution or job role seem unimportant or undervalued. “Nurse X knew exactly what to do to help me sleep” “The nursing care at Hospital X was so much better!” “The day-shift nurse would have called the doctor by now” Belittling is usually paired with splitting. Splitting This is when you're compared to another nurse who would (or did) give the patient what they wanted. It may be the nurse in another facility or on a different shift. “The other nurse pulled strings so I could move to a larger room” “I never had to wait longer than 2 minutes for Nurse X to respond to my calls”. Threatening Threatening behavior from patients can come in several different forms. Patients may communicate threats of physical violence either verbally or nonverbally. Verbal: “I will come right off this bed and at you if I do not get something for pain.” Non-verbal: Patient may clench fists, tense muscles or narrow eyes. A patient may also make threats in the form of complaints. “If you don’t give me what I want, I will go all the way to the hospital administrator.” “I have a lawyer and you will be hearing from her!” Fawning Sometimes patients use exaggerated flattery (fawning) as a way to manipulate you into getting what they want. We do not always know when we are being manipulated because fawning can be very subtle. “I am so glad you are here tonight! I sleep so good when you are my nurse and I brag about you to everyone.” Fawning can also take on a flirty or sexual innuendo. “You look so fit. You must work out every day.” “I love your cologne. What is that scent?” Filibustering Filibustering is especially exhausting because the patient is so relentless in their demands, you finally just give in. “I am going to continue to push this call light until I get what I want!” “I will come back to your office every day until I get a prescription for gabapentin.” The Straw-Man Victim A manipulator sometimes accuses the nurse of acting against a protected class instead of their clinical assessment or findings. Champions A champion is someone that pleads the patient’s case from the outside and is usually a family member. I recently cared for a patient who demanded a doctor look at his rash in the middle of the night. Even though the rash was barely visible and not causing discomfort, the patient’s granddaughter called the front desk also demanding that a doctor visit the patient within the next hour. Champions can be challenging since they often combine manipulative techniques, such as splitting, exaggeration and intense filibustering. Self-harm There are patients who deliberately harm themselves to force you to do something they want. Examples would include: A patient who deliberately falls A diabetic who intentionally causes severe hypo or hyperglycemia A patient who refuses venipuncture for lab work necessary for care Stay One Step Ahead It takes training, practice and experience to successfully deal with patient manipulation. If you are a new nurse, ask for help before you become overwhelmed by tactics your patients may use to get what they want. You can practice staying “one step ahead” by recognizing the different types of manipulation and having your response ready. What types of manipulative behavior have you encountered recently?
  3. Nursing My Way

    The Best Thing a Nurse Can Do

    As a nursing student about to graduate, I've seen a little bit of clinical experience. Take a minute to think about it. When we start our first clinical, we don't have an idea of how to talk or care for these people we call our patients. "Do you want more ice?", "I have to look under his gown?", "I have to get my teacher first", are all things that we have said. We had no idea what the nursing universe was like. As we grew into our new roles, we, also, grew confidence. We got better at our skills and less awkward with our patients. Some of us, however, lost the sense of humility. You begin to think that, because you've gotten more experience, your patients have, too. Wrong. Recently, I learned a great lesson in humility. I went to my facility and was to receive report and start the day. When asked about my patient, I was told how hard of a time they were giving the nurses. I was painted a picture of a horrible and dissatisfied patient. Anxiety rushed over me as I approached the room. However, I thought about my upbringing. My parents always told me to give someone a chance before forming an opinion. I took a deep breath at the door and prepared my smile. Walking into the room, I gave a hearty "Good morning!" and introduced myself. I started my assessment after we exchanged names. "Can you tell me where you are?" "They tell me I'm at said facility, but it feels like Hell." I can tell you, I gulped and hardened my heart. This was not a good start. I pushed forward, maintaining my smile, however. "Oh, my goodness. What makes you say that?" "I've been asking for a drink for two hours, I'm hungry, my nurse has woke me up all through the night, and I'm ready to leave." "Oh, wow. That is a lot. I know you must be ready to go home. What kind of drink would you like?" "Root beer." I checked her chart. Why hadn't she gotten a drink or food? There was no hold on fluids or foods. "I'm going to go see if I can find you a root beer and see when breakfast is." "Yeah, right. Nobody listens to me around here." Clearly, she had been having a very rough night. When I walked out, I checked her chart again and asked her nurse if I could get her a drink. She didn't see why not, there wasn't a hold on anything. When I walked back in the room, my patient stared as I talked and poured her root beer into an cup of ice. "Breakfast is coming in thirty minutes. Is there anything else I can get you?" "No, dear. I think I'm fine, now." Now that my patient was calmed down, I felt that maybe I could speak with her about one of her comments: that nobody listens to her. We talked and she aired out all of her grievances over the past two weeks that she had been in the hospital. I used the communication techniques my teachers taught me. I sat at eye level, smiled when she smiled, and clarified anything I felt I needed to know more about. Our day slowly began to get better, as each time I walked into her room, she started smiling more and more. By the end of the day, I told her I was leaving and how much I enjoyed her allowing me to be her student nurse. She asked me for a hug and told me that I really helped change her mood and feel better. I didn't get to do a lot of skills that day or save a life. I just made a patient smile. It is one of the best clinical experiences I have had, thus far. I encourage us all to remember that a sour mood can make a sour patient. We should practice the fundamentals they teach us, even after our fundamental semester is long over. We should practice fidelity and build trust. We should listen and offer ourselves to our patients. Most importantly, we should walk in and smile. A smile can change a mood. It can change a life. It can change your patients' lives.
  4. TiaKay

    Till We Meet Again

    It seemed like it was going to be just another usual Sunday night on our med/surg floor where I work as a tech prior to starting nursing school in the fall. A 3-11 shift doesn't include baths, but if the patient is incontinent of the bowel, there's a good chance that a tech will change the sheets, bath the patient, provide a clean gown several times in the course of the night. This can be an unpleasant task; let's face it, being up to your elbows in someone else's bowel movement isn't very delightful, especially if it is the liquid, odiferous, potentially C-diff bearing stool that was the case with this particular patient on this particular night. However, I do my darndest not to shy away from these situations, as I can only imagine how difficult it is for the patient to be so limited and to need that sort of personal care repeatedly. As I was getting the linens ready and running some warm water in the sink while preparing to clean up the patient, I began humming a tune. I'm a singer in my out-of-the-hospital world, and I frequently get tunes in my head, which I sing or hum. As I came from the bathroom, the patient this night heard me humming, and began to sing the words with me. I asked him if he knew the whole song, and he said he did, so we started off together at the beginning. He knew me only by my voice, as he was quite elderly and blind as well. We started talking about songs we knew and loved, and before I knew it, we started singing some of our favorite numbers from the musical "South Pacific." I was joking how, now that I was older, I was going to be too old to play Nellie Forbush, but instead would have to play Bloody Mary. That naturally led me into the song made famous by that character in the show, and we were laughing by the end of the bedding change. He had no control over the illness that was ravishing his GI system, so I was in the room several times that night. We sang songs from "Carousel", from "Oklahoma", from "The Music Man", "The Sound of Music", all of those oldie-but-goodie Broadway shows. There was a 45 year age difference between us, but we both had loved all those songs and had them tucked away in our memories. What could have been a distasteful and smelly task instead became, for both of us, a delightful break in the monotony of the long shift? When at shift's end I came to get his final set of vitals and to help him settle in for the night, I told him I'd thought of the perfect song to end the night's songfest, a lovely tune from the World War One era entitled "Till We Meet Again". Now, while the song's lyrics are written for sweethearts, and that wasn't our case, it was still a lovely thought to wish each other well until we were to meet again. We sang it together, and I wished him a pleasant good evening. Two days later, I had to come into the hospital for an educational meeting for techs. I wasn't scheduled to work again until the weekend, and I usually exit out the back door to the employee parking lot. As I was completing a cell phone call, I stayed on the main floor planning to exit using the door by the ICU (I never go out that door on a normal basis.) Glancing into the ICU waiting room, I saw his family, whom I'd met earlier that Sunday night when they came for a visit. Going to them, they told me how he'd slipped downhill rapidly on Monday, and things did not look good. I had their permission to visit their dad, so I went into his room. He was on a respirator and was completely unresponsive. It was evident from looking at the vitals and other info on the machines at the bedside that he was very critical. I held his hand and quietly sang to him "Till We Meet Again" one last time, and left. It seemed a very fortuitous choice of exits to me; otherwise, I'd never have known he was in the ICU. The next day, his obituary notice appeared in our local paper. I cried a little, and yet, it was a comforting thought to know that on his last aware night of his 88+ years on this earth, he sang the old songs he loved so well, had talked about his beloved deceased wife of 60+ years, and knew that while he was in a difficult care situation with the diarrhea he was suffering, that he'd given ME the gift of his music as well. Rest in peace, Mr. W.; until we meet again.
  5. In choosing a career as noble and honorable as nursing, having the responsibility of being trusted to care for those who are stricken with illness should always be considered the core of our profession. However, we sometimes overlook the feelings of patients as individuals in our role as caregivers. It is imperative that we, by whatever means necessary, take the time to remember that the duty of the nurse is the pinnacle of patient care. While physicians diagnose and treat illness, nurses are responsible for the care and wellbeing of the patient as a fellow human being. Far too often nurses become caught up in the institution of a hospital, and by that, fail to remember it is we who are the very heart and soul of that institution. We are the believers. Every once in a while there comes a situation that reminds us what it really means to be the patient. This is usually a rare time when someone else is responsible for caring for us. I have one such example which offered me an opportunity to take a step back and realize just how frightening medical care can be for the patient. I would like the opportunity to share it with you. I had a perplexing reaction in a doctor's office during an appointment to start the course of vaccinations required for my nursing career. Mind you, I have always had an uneasy feeling of the doctor's office stemming from my association of the white-coated doctor and paper covered examination table equating to something being wrong. My blood pressure skyrockets concurrently with an elevation in pulse but this is the extent of my reaction. That is until this day. As the nurse came into the room with a clipboard serving as a tray to five syringes I sat quietly without the slightest inkling that my calm condition was to change in the very near future. I watched the nurse as he prepared the first of the syringes, the tuberculosis test is given just under the surface of the skin, and offered my forearm up for the injection. As he inserted the needle I felt fine. It wasn't until I saw the bubble rise on the surface of the skin that things went downhill fast. Instantly, I went white with sweat running profusely from my face. I removed myself from the table and sank to the floor as my vision spotted white. I was terrified and I had no clue as to why this was happening. After reassurance from the nurse that there was no danger, I lifted myself into a chair knowing there were four more shots still to come. I closed my eyes, the sweat now making watermarks on both my pants and shirt and prepared myself as much as possible for the next shot. With each additional shot came the same terror. When it was over I was required to sit and collect myself for twenty minutes so I did not faint. It was one of the most traumatic personal events I remember in my adult life. After leaving the clinic I half racked my brain for explanations and half tried to think of how I could make it through the last two series of vaccinations I still had to complete my immunity. At this point, I had no answers. The next time I went I had my wife accompany me to see if that would alleviate the problem. It did nothing. During the span of the six months from start to finish I searched and searched for an explanation with no real answers. On the last visit, I only had one shot to get this time and willed myself to finish, I decided to ask the nurse why this could be happening to me. I told her I had not been afraid of needles since I was a child, having no trouble with even a shot in the eye a few years ago, but was all of a sudden deathly afraid of them again. I ended by telling her that I was quite embarrassed that I was going to be a nurse who was afraid of shots. This made her laugh. It was in her taking the time to sit with me and explain this both being a common occurrence and a manifestation drummed up from childhood that I found my answer. She said I was afraid of shots as a child, grew out of it as I got older, and something since the last peaceful injection resurfaced my fear of shots being unsafe. As I thought for a moment it became clear what triggered the fear reaction. Microbiology class! She was right. She gave me some exercises to do before the shot, talked me through the safety of what she was putting in my body, and calmed me by allowing me to face my fears and work through them. My shot was a breeze. I've had another since and still no reaction what-so-ever. Today I am still astounded that something I was afraid of as a child could surface so profoundly out of the clear blue as an adult but it has helped me to realize that we truly are a product of experience. I had a revelation from my experience which I will carry with me for the rest of my life. I learned the value of a nurse as a caregiver. In other words, within the care of two nurses, I was given insight into the difference between a "good nurse" and an "average nurse". I realized the profound effect that a "good" nurse can have far beyond the walls of a hospital in a patient's life. The nurse who continued to administer shots during my anxiety without taking the time to "care for me" made me feel as though I was being rushed through an assembly line while the nurse who was interested in helping me beyond the scope of the requirement for employment saved me from a considerable hardship in life which I may not have ever sorted out without her. In her taking the time to comfort me and help me to the best of her ability she alleviated my stress and helped me to solve a problem; both of which I will always remember and love her for doing. In retrospect, I can see that her actions were selfless and had benefits for me which she was never aware. Let me explain. Before going in for my last shot I made a decision that if the situation dictated the same result in anxiety as the previous ones, I was going to speak to a physician concerning the prescribing of something to help me cope with injections in the future. It was this nurse that helped me to circumvent this course of action and allow me to face a fear rather than just treat the symptoms of that same fear. I can only believe that each of us is blessed with the desire to go above and beyond what is required to do all we can for our patients. In the monotony of our work days that give them the illusion of running together at times, there are things which we must remind ourselves at all times are by no means monotonous. These "things" are not really "things" at all. They are people. They are individuals, each patient unique, which make them different from any other as well as from us. No matter if you have an example of your own that you use to remember what it means to be in their position or your welcome use of mine, try to remember the next time you see a face as you enter a room that it belongs to a human being and that human being is in dire need of all that you have to give.
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