Jump to content

Topics About 'Nurse Patient Relationship'.

These are topics that staff believe are closely related. If you want to search all posts for a phrase or term please use the Search feature.

Found 12 results

  1. 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? References 9 Types of Manipulative Patients- Know Their Tactics and Be Prepared
  2. 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.
  3. allnurses

    I Should Be in Jail

    This article was written by a member of allnurses. Due to the delicate and emotionally charged nature of the article as well as details, the member wanted the topic posted anonymously. If other readers have articles they would like published anonymously, please contact allnurses.com. My First Encounter As A Paramedic: Shaken Baby Syndrome Let's start out with my first encounter with a parent. I was a paramedic (a newbie..a rookie..an innocent) called to a home of a 4 month old that rolled off of a couch. The baby is seizing and the father is talking about how he was making the baby a bottle. He was alone with the kid and the mom was at work. He claimed to put the baby on the couch and the baby rolled off the couch. A short couch...onto carpet. The story didn't add up. The baby seized the entire 30 minutes it took us to get to the nearest hospital, and then later died from massive head trauma. Shaken baby syndrome. That was some fall. This was my induction into real life. I was out of my protective cocoon and my rose colored glasses cracked in the truth of real life. I have scraped children off of the highway who were unrestrained; I have whisked children out of homes that were besieged with fighting under the protection of cops; and I have taken children to the ED scared to be touched by anyone. The pressure of being a paramedic became too much, so I chose a new profession...pediatric nursing! (insert snarkiness here). My Many Encounters As A Pediatric Nurse Mom Brought 13 Year Old to ED Both Afraid Of Dad Mom did not have custody, and the dad was not happy the kid was in the ED. Dad, I am sure after meeting him, is in a gang. The cops were brought in, the mom asked to leave, the dad was cursing up a storm and I confronted him. "We will absolutely not tolerate that type of behavior in the hospital, in a CHILDREN'S HOSPITAL. If you don't sit down and be quiet, you will be escorted out." Nicer than a punch, and I kept my job. I myself was escorted by security to my car after work....fearing what may await me. 15 Year Old On Life Support OD'd To See If Mom Loved Her She did not want to die, she wrote me in a note when she was intubated, she just wanted to see if her mom cared. The child took a turn for the worst with multi-system organ failure. As we strived to make her comfortable and keep her body in a hypothermic state, the mom was mad at ME because the room was too cold. She tried to fire me from being her daughters nurse. This after she so nonchalantly said, "pull the plug". I stayed at the bedside and held her hand as she passed away, mom went to go eat. 13 Year Old Dying From HIV/AIDS The dad wanting to be at her side, the step-mom wanting to go do stuff. The dad confided in me once, when he was irritated with his wife, that his daughter was never treated fairly by his wife. He wanted to bring his daughter home to hospice and wanted to redo her room - a makeover - just how she would have loved it. The wife would not hear of it, since the girl was 'gonna die anyway'. And she did, in the hospital room with nursing staff at her side. 18 Month Old Beaten By Mom's Boyfriend The mother of an 18 month old who was beaten by the mom's boyfriend. The grandmother had unofficial custody since the day the child was born. She had unofficial custody of 3 of the children because the mom was always partying and never had time for the kids. When the family decided to remove the child from life support after the baby was declared to have brain death, the mother banned the grandmother from the room. That was the only time I did not let a parent help me bathe a patient after the patient died....and I gave them a time limit for grieving as well. The fact that the mother was holding her dead child and talking about going to Chili's and a movie later in the day sort of made up my mind, along with her acting like this was a party and yelling at her brother to "go get me a coke, hey, my baby just died and you need to be nice to me", and "hey, you know that **** was going to go get a new car today?" Absolutely no feeling at all about the loss of a child, but enough bitterness in her to block the one true person who cared for the baby from being at his side. 4 Year Old Who Was NPO For Surgery As usual, the patient did not go to OR before lunch and she became fussy and..hungry...I walked past her room to hear her father yell at her to "Shut up!" as she was crying. I went in right away and she was reaching for his lunch. His McDonald's fries and burger he was munching down on. I absolutely kicked him out of the room (sans roundhouse kick to the face). Absence Of Grief I know that people deal with grief in unusual ways. I have seen grief, I have seen the absolute absence of grief, and I have seen those who pretend to have grief. For me, the people who have not one ounce of compassion for the child who most needs their love are the ones who I cannot and will not ever understand. I know that people don't think beyond their own needs, even when a child is crying and does not understand what is happening. But it doesn't mean I agree with it, or have to like it. As a nurse, the hardest part of my job is to not say and do what I really think and feel. Or I would have been in jail a LONG time ago. What have you seen that makes you want to commit an assault?
  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. Joyful2bee

    I Had No Idea!

    H. was scheduled for the removal of a colon polyp after a colonoscopy failed to reach the tissue for biopsy. My husband was a very obese diabetic, who had recovered from a Wallenberg Stroke four years before with only a residual weakness in his balance center. His return to his job four months later demonstrated great determination and strength to endure the rigorous therapy required to achieve this recovery. These qualities helped him later as you will see. Responsibility, Loneliness, and Fear We arrived in the pre-operative area early for the prep for the surgery. I watched as the staff rolled my husband of 35 years away from me into an area where I could not go. I had been his advocate and caregiver after the stroke and felt very protective and responsible for him. I felt so helpless and anxious for his well being now. The thought that surgeons are human and can make mistakes hovered in my mind. While waiting for our son to arrive, I felt so alone and helpless. As soon as he arrived I felt his support shoring up my strength and calmness. A family member needs someone to help them spend the long hours that tick by so slowly during the surgery and recovery room care of a loved one. They don't know if there will be complications. Encourage them to call someone if they are alone. Regardless of years of experience and understanding of how things go in the hospital, I felt very alone until M came. Anxiety of Potential Complications So we waited. M, our son, was concerned that they might not be able to inflate the weight of his father's abdominal adipose tissue for the lap surgery. Sure enough, the surgeon came out and told us they needed to make a mid-line incision to reach the polyp. We understood and I gave consent. Soon an anesthetist came out and told us that three different anesthesiologists had been unable to put a central line in my husband's neck because it was so short and obese. I gave consent for a PIC line. Stress was mounting! What else could go wrong? What if he had another stroke? What if he had more complications? Even with the information given to the family, anxiety can run rampant especially when there are already complications. We soon found out about complications. After his surgery which actually went better than it started, there was no bed in ICU, so he was placed in CCU overnight for monitoring while on an epidural drip. Exhaustion His O2 saturation dropped into the 70s so he needed oxygen. He had a nasogastric tube and was supposed to be using his CPAP for his severe sleep apnea. Trying to fit a CPAP mask over a nasogastric tube was impossible to do. So we kept the oxygen flowing and raised his head slightly. I had been an ICU/CCU nurse for 17 years and didn't mind helping the nurses in the unit. During the night in a confused state, he repeatedly removed his oxygen mask. So about every 15 minutes the O2 saturation alarms declared his dropping oxygen level; I would hop up quickly and put the O2 back on his face. Finally, in exasperation or desperation, I ordered him to put his oxygen back on! He glared at me and said, "NO!" and removed it again! I am a very kind, polite and nice person, but was severely sleep deprived, had lots of stress, and worry that day. I said something I would never say normally. "Fine! Take the oxygen off! When you pass out, I'll just put it back on again!" I believe the nurses realized how exhausted I was and told me they could watch him so I could sleep. Yes, people do not behave normally when they haven't had enough sleep and are stressed out! Ask for a chaplain to help the family member be realistic about what they can do and how much sleep they need and make them leave for a while. Need More than Reassurances Please deal kindly and compassionately with the family's irritation or anger. Remember how many times someone has told you, "Don't worry, things will be fine." But they weren't? Words don't always help. Allow the family to express their fears to help them. It helps just to know someone is listening. Remember they are turning their beloved over to doctors, nurses and staff who they have never met before, who may be very busy, and who may not understand the patient's requests or needs. Then there are more "What ifs." "What if he develops another problem?" What if he won't be able to go back to work or his hobbies? What if...?" Believe me, there are many imagined "What ifs." That night one nurse did something I will never forget. My husband liked to be cold so there was a fan blowing on him. I like to be warm but I wanted to see him and him to see me at all times. So I pulled the recliner to his bedside and faced him. One angel brought a pile of heated blankets and without being asked to literally tucked me in! I never felt so cared for since I was a child! She understood and was so kind! I slept some after that. If you can, take time to listen or offer a small kindness for the family. Offer to call their pastor, the hospital chaplain, or the supervisor. Advocacy and Responsibility After a couple of nights, the epidural was removed and the doctor ordered Percocet two tablets every 4 hours for pain. I know the doctor was trying to keep him comfortable and considering my husband's size and history of back surgery and sciatica he ordered a large dose. The thing he did not consider was that my husband was narcotic naive. After one day H could not sit up; slept all the time; drank very little; and ate nothing. So on day three the doctor came and told my husband in no uncertain terms that he "had to get up." The doctor's tone of voice was the one they use when they are being firm with a manipulative or lazy patient. I was a bit upset that he assumed that H was lazy! But I knew something else had to be done. Since I knew H was not lazy. I began to worry that he might have had a second stroke. After several futile attempts by the staff to get H up, I spoke with the hospitalist that night. My husband had a high tolerance for pain, was very independent, and absolutely not lazy. I had to be his advocate. The hospitalist decreased the Percocet. As H came out of the drug-induced stupor he started acting like himself. He refused any more pain medicine as soon as he was lucid enough to understand what had happened. He related how he had been having hallucinations, confusion and terror attacks! Finally, he was moving around and helped staff get him up. He preferred to have pain rather than losing control of his own mind. It took physical therapy three weeks during his stay and after his discharge to increase his strength to near normalcy. Fears Being a nurse I know and understand that doctors and nurses are people and they make mistakes. We all do. But when my loved one has so many problems and complications I could not help but worry about mistakes or misjudgments being made. Plus there were always the questions that caused fear: How long will he need to recover? Will he be able to go back to work soon? (He loved his job.) I knew he had lots of sick time and had a good stable job but some patients don't. Some families may be very anxious about how to pay for the hospital stay plus the tests, IV fluids, lab work, radiologist bill and so many bills for so many treatments. Get them someone from case management to help them navigate this sea of bills they will receive. Reality: Complications After 11 days for what should have been a three-day stay, the staples were removed and H was discharged. But that is still not the end of this story. Three days after the staples were removed it was evident that his abdomen had not healed well. The wound dehisced in four places. The largest area was a tunneled wound 1 inch by 1 ½ inches and two inches deep in the middle of the incision. It took four months for the areas to heal. I cleaned and packed them twice a day for him. Imagine the stark terror of a non-medical person if they had seen their loved one's wound opening up and then having to treat it. Conclusion So family members need their own nurse? Well, not really. They just need lots of understanding and compassion from the ones caring for their loved one. We know nurses cannot do everything. When you cannot help in some area ask for help. But try to understand what the family is going through. Remember, "Walk a mile in someone's moccasins before you judge them." A lot goes on that we don't know about in the family's mind.
  6. 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.
  7. Let's talk dress code. I am certain that everyone has an opinion on this topic. We can discuss nursing whites versus colors or clogs versus gym shoes, but that is just too mundane! Let's dig deeper. Let's talk tattoos! Or, how about unnatural hair color? Oh, and piercings! That's right, let's talk about some controversial dress code topics. The Stats While it is difficult to find statistics on hair color, piercing and tattoo statistics for the general population is quite easy to find. It is estimated that 42% of all adults in the U.S. have at least one tattoo. 83% of all adults have had their earlobes pierced, 72% of which are female. There is an additional 14% of the U.S. population who have a body piercing other than their earlobes. What does this mean? Well, quite simply - it means there are a lot of people who believe that self-expression through body art is acceptable. It means that people, regardless of education, socioeconomic status or occupation, have tattoos and piercings. Nurses are no different. Many nurses, doctors, and other healthcare personnel have tattoos, body piercings and colorful hair. But, should they? Historical Perspective Long gone are the days of white uniform skirts, nursing caps, hose and plain shoes. The idea was that uniformity made nurses easy to identify. Hospitals and other healthcare facilities also used the all-white nurse dress code to reflect a certain image. After all, nurses were and still are the most trusted professionals around. However, over the years, colorful scrubs in a variety of patterns have replaced the traditional white nurse uniform. Now, in a society that supports self-expression and individuality, we are still questioning the role of the uniform for nursing professionals. Patients' Opinions While the research is limited, one study done in 2012 looked at how patients' perceived patient care providers with tattoos and or body piercings. In this study, patients were shown images of male and female patient care providers in uniform with and without tattoos and/or non-earlobe body piercings. The results? Patients perceived the patient care providers with visible tattoos and/or body piercings as less caring, confident, reliable, attentive, cooperative, professional, efficient and approachable. Patients perceived females with tattoos to be less professional than male patient care providers with similar tattoos. Patients also felt that female patient care providers with visible non-earlobe piercings were less confident, professional, efficient and approachable than females with no body piercings. Did the patients get it right? Most of us can think of at least one tatted-up nurse who can run circles around their non-tattooed counterpart, so is there any validity in this thinking? Is this where we are today? A New Era Some people may feel that we are on the verge of a new era when it comes to tattoos, hair color and piercing policies for hospital staff. According to Becker Hospital Review, as of January 1, 2018, Mayo Clinic has instituted a new dress code. Becker Hospital Review reports that under this new rule, tattoos "may be visible if the images or words do not convey violence, discrimination, profanity or sexually explicit content. Tattoos containing such messages must be covered with bandages, clothing or cosmetics. Mayo Clinic reserves the right to judge the appearance of visible tattoos". Mayo Clinic has long been known for its professional appearance and conduct of employees. The hospital continues to stress that all employees are expected to project a professional appearance and demeanor. Mayo Clinic is not the first or the last healthcare facility that will change their dress code policy. Industries outside of healthcare have been feeling this shift for many years. There are simply many people in healthcare that feel that allowing these forms of self-expression will make patients feel uncomfortable or less trusting of the staff in general. How Do You Feel? Do you have tattoos? If so, have you ever felt judged by administration, other healthcare professionals or patients because of your tattoos or piercings? Do you believe that nurses and other healthcare professionals should not have visible tattoos or piercings or keep them covered? I would love to hear how you feel.
  8. While working as a nurse-tech in nursing school, I would often get assigned the Psych patients or the HIPAA-No patients (usually those who were incarcerated or under some kind of police watch), who were admitted to our floor for their traumatic injuries. It seemed that if we had one of these patients, we had about 6 of them, all at the same time. One night, I was really tired and just felt I could not make it through the whole night, especially with these very needy and very draining patients. Well, I was in for some real introspection. In my upbringing and due to some very traumatic personal events in my family, I always said and thought I would have a very hard time caring for a patient who had committed murder or some other violent crime. What I didn't know was that I wouldn't always know what a patient may have done on their own free time. During this shift, we admitted a, "John Doe," who was under police watch and observation. I knew he was coming from the prison, but, I did not know any of his past history-just that he had sustained some injuries in a prison fight. When I greeted him, he immediately said to me, "You're the only one who has smiled and looked directly at me." I was a little taken aback, because I had not even realized I was doing those things. Throughout the night, as I cared for him, I made sure he had fresh water, snacks, and clean linen. He was handcuffed to the bed rails and there were always 2 or 3 officers with him. Since I'm generally not afraid to talk to people and I know most people love talking about themselves, I began to talk with "John." Me: "So, if you don't mind me asking, how did you get all these cuts on your body?" John: "Well, I was caught by two different groups or gangs. They was trying to teach me a lesson." Me: "A lesson? Well, I admit, I am a little 'jail-naïve,' but, it seems that if they cut you this many times, they were really trying to really injure you or worse." John: "Nah, not really. If they wanted to kill me, they could have and would have. They was just trying to teach me that the next time, it will be worse." Me: "Again, if I'm being nosey, tell me, and I will shut-up. I just like to get to know my patients a little more than what I read on paper." John: "Nah, you good. I appreciate that, really, 'cuz, most people, even doctors and nurses, don't really talk to me, so, the fact that you axin is different." Me: "I guess, what I really want to know is why they cut you all over your body like this?" John: "See, they wanted to get back at me for snitchin and they think I'm tryin to get out of stuff. It's just how it is, but, I ain't worried, tho, 'cuz, if they gonna take me, ain't nothing gonna stop 'em." Me: "Are you afraid? First, I would be afraid of going to jail; but, even more so, I know I would be afraid to go back to that environment where I knew my life could be ended in a snap." John: "Nah, I'm not afraid, not really. It just goes with the territory." He must have seen the look on my face and saw the incredulous look on my face, too. As we kept talking, I finally asked him, "What are you in for?" to which "John," replied, "I was accused of attempted murder." "Accused, or actually," I asked. "John," said, "Well, Ms. Evette, I can only say I was accused, 'cuz I haven't been tried yet, but, I was in a position where I had to defend myself from this dude who had a hit on me, and he saw me in a bar, tried to hit me, and I got to him first. That's all I can say." I agreed with him, but, when I left the room, I found myself talking to myself, and going back and forth between the ideas of justice, retribution, punishment, and criminality. I was also astounded that I did not feel conflicted about caring for this man, even knowing a little more of his history. The next day, "John," was discharged and as we walked down to the secure area to place him in the police van, he turned to me, looked me straight in the eye, and said, "Thank you, Ms. Evette. Thank you for talking to me, asking me about me, and just being real with me. I really appreciate you doing that. It meant a lot to me." Now that I'm an RN, I've been told, "Thank you," many times, and each time it is music to my ears. But, this time, this, "Thank you," cut much deeper!
  9. jeastridge

    Can We Talk? End of Life Discussions

    Jan busied herself at the bedside of her patient, a woman she had seen before during a similar admission for COPD. As the woman struggled to breathe, Jan could easily read the panic in her patient's eyes. She changed a sweaty pillowcase, put the head of the bed up slightly and readjusted the fingertip pulse ox that beeped repeatedly. She started to back away to look at the patient's med list and see what was due, when the patient caught her hand, "Can we talk?" Jan's mind raced ahead to the other patients she was responsible for, before settling back into place and focusing in on her struggling patient's face. She knew, in her heart, what this conversation would be about. It was important and not the kind of talk that could be rushed. She pulled up a chair and sat up to maintain eye contact. She held the woman's fingers and asked, "What have you got on your mind? How can I help?" "I don't want this," the woman said, while rolling her eyes in an arch to indicate the bedside with its surrounding drips and machines. "I want to go home." Broaching the subject of death is hard for anyone. Sometimes, being at the bedside, we are the ones that patients open up to. How do we handle it when it happens? Whether we are at the bedside in the hospital, or in home health, and even in an office setting, we can be at the front lines of a critical discussion. Do we know what to say and do? Here are some points to consider when we face a similar discussion: Be fully present Eye contact, physical touch, body posture all play an important part in sending the message that we are really here, ready to listen and help. Many of us feel distinctly uncomfortable about having end of life discussions-after all we work to make life better, to prolong active life, to maximize function. But there are times in our profession when we need to be the midwives that help our patients find their way forward when they feel they are at a dead end. If we are able to allow them to talk, help them express their wishes, we can help them find a way toward peace and hope even in the face of death. Listen and ask questions In nursing school we all learn about asking "open-ended questions." This is the time to employ that skill, allowing the patient to say what they need to say, even if it's not pleasant or even if it's not what you are hoping they will say. Being a good listener is hard work, especially when the person is struggling to express themselves or when we feel hurried by other pressures. Help define goals Goals can engender hope and focus. At this stage, the goals sometimes seem rather small-to get home and sit in a favorite recliner with their dog, to hold a grandchild, to enjoy some time on the porch. Knowing what they want can help us know how to proceed. But what if their wishes seem completely unreasonable given their fragile condition? Again, listening is key. Sometimes simply verbalizing their goals is enough to satisfy the longing for reality to be different; it can be enough to help them get through this day. Know your resources As nurses, it is important to know the resources we have available to us, whatever our setting might be. Whether it is a palliative care team, the hospice liaison nurse, the case manager or a physician, having a solid knowledge of how to proceed from this point can be valuable to our patients. Do you know the difference between Advance Directives and the POST form? Do you know what qualifies as a hospice diagnosis? Do you know what services are available at home for those who want palliative care while continuing to pursue treatment? Can we be gentle guides along the way as we help our patients understand what "Full Treatment" means vs. "Limited Additional Treatments?" Being well versed in this subtle, but important aspects of end of life care can make us even better nursing professionals. Gently direct Sometimes having this conversation can take a long time. It is important, critical really, to know how to direct the conversation and begin the process of referring the patient to the doctor or the case manager. Depending on the setting, we may need to continue to help the patient clarify their wishes or we may need to introduce the concept of another person who can discuss this fully with them, at length, and fill out the appropriate forms to document their wishes.[/indent] In a few minutes, Jan was able to ascertain that her patient would need further counseling and the opportunity to fill out paperwork. She outlined the steps she planned to take in calling the doctor to come in and discuss next steps. Then she went on to offer some medication for symptom management before moving on to her other patients. As she left with her cart, she looked back to see the woman breathing more easily and dozing off. End of life discussions need to happen, and sometimes we are the ones who are there. Being prepared and willing to listen, we can provide valuable care to our patients who desire to make choices about their end of life care. Joy Eastridge, BSN, RN, CHPN Reading a recent news article about a man who was found with a Do Not Resuscitate message tattooed on his chest prompted me to write this article. To read more about that news story, go to Living Will Tattoo
  10. 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.
  11. It's been said you can't teach an old dog new tricks. That's no excuse. We all can learn something new everyday and when we stifle ourselves, we wither away. The days are gone with party lines, manual typewriters, and rotary dials. It's the age of technological advances driving the future. What techy stuff have you learned lately?
  12. Eschell2971

    You Know It's True - Just Don't Say It!

    As nurses, we're taught that every patient has challenges, rights, and deserves our respect. And, this is true. But, it's also true that not every patient is respectful, cooperative, or just nice. Nurses are taught that we must be "therapeutic" in providing care; and we must learn to "put the patient's needs first." Many nurses do this everyday-we put our patients first, and push our needs to the back burner. We can't even go to the bathroom or enjoy our break, off the floor, much of the time, because we are doing just that-putting our patients' needs first. If we're honest, more often than not, as nurses, we are working through most of our shift non-stop, from the time we hit the clock, and even, after we hit the clock, our thoughts and minds are scattered with so much information and data bits that we can't even get a good night's sleep. And, I won't even mention trying to get a decent vacation without getting that infamous phone call, "Are you able to work an extra shift?" But, can I be real? Or, am I being selfish, petty, or "un-therapeutic" when I say some patients can be a real you-know-what! I know I'm not sounding professional and maybe I'm not being the bigger person. But, that's just it-I AM a person, with feelings, too. It's not that a particular patient can drive me crazy or be so difficult, rude, and downright indignant, what's more frustrating is when I go out of my way to provide the best service, the best communication, and prioritize my time to make sure I check-in on this patient a little more, purposed with a smile, and then this patient is still not satisfied. Also, it seems that in many cases, patients like this are not acting our or responding to their pain or present condition. No, these patients are acting like this because this is who they are-this is their personality. Even more, when I document the patient's rudeness and disrespect, supervisors and managers do or say nothing, nilch, nada! That is the ultimate form of professional disrespect, in my never-to-be-humble-opinion. Yes, we've all had stressful days and some days we just wanted to walk off the job. But, I believe the silence on dealing with these type of patients is contributory to the burn out and job dissatisfaction experienced by nurses and documented in many research studies. Research has recorded nurses as being, "Stressed out," "under-staffed," and with "too many patients." Also, research demonstrates why some nurses leave their professions because they feel, "burnt out," "dis-respected," "un-appreciated," or even ignored. Nurses have left their jobs or transferred out of a unit because they feel trapped and some nurses have stated they feel their managers and supervisors never defend them. Worse, some nurses feel their managers and supervisors only see them as bodies for the staff or census coverage. Should we as nurses toughen up? Maybe, in some cases we should. But, as professionals, we must be able to discuss touchy subjects with our colleagues and managers, and expect that they will listen. As professionals who want to better our units and our profession overall, we must be able to provide viable solutions that are able to address real-time issues when they happen. Sometimes, those issues include sensitive events regarding our therapeutic relationships with our patients. Please, nursing profession, if we want to attract and retain good nurses, who are happy with their jobs and feel connected to a unit, employer, profession, then, please, let's start having real conversations about issues that no one wants to talk about. Silence is not always golden!