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Telling it how it is.

Specializes in Making the Pt laugh..

I have a question for everyone here and fully expect vigorous debate as well as some cranky remarks but here goes;

To start with I am a caring nurse and I don't want anyone construing my post to mean that I am not compassionate or lack empathy for my Pt's. I have found that I have recently started telling some of my Pt's the truth in a blunt manner laced with humour at times, with surprisingly good results.

Examples of this are: telling a Pt that if he didn't start with the exercises physio were giving him he might as well turn into compost, (this Pt instead of being home with his family was still in too much pain to move, this to the point we considered pressure area care until he was found sitting up to watch the football around a conveniently drawn curtain). He started doing his exercises with no further prompting.

Asking another Pt if he wanted me to pre-book his room becasue he would be back within the month. He was heard bragging about what he was going to do as soon as he left "this ......... prison" - no my ward is not that bad.

I have come out with these and a few other remarks. These Pt's are those that I have cared for and gotten to know and have felt comfortable to tell them. I was overheard by another nurse who said that we can't be blunt because it comes across as judgmental, I feel that whatever works (within reason) should be used in our Pt education, isn't this part of our advocacy role?

What does everyone here think?

soulofme

Specializes in dialysis (mostly) some L&D, Rehab/LTC.

Sounds like the kind of reasoning that we have to take with our dialysis pts...some "times" I have to be very blunt...but it falls upon deaf ears...

I agree with you.

The longer I am a nurse, the more blunt I become. I, too, find I am getting much better results with my pts.

I have even said to a pt "If you do not take care of this, and do what you are supposed to do, it could kill you. Wouldn't it be awful if your grandchildren did not have a grandfather/mother because you didn't (whatever)?"

It works. Not all the time or with everyone, but I'm getting much better results than when I used to tip-toe around and say things nicely.

So far, I haven't gotten in trouble (knock on wood).

iluvivt, BSN, RN

Specializes in Infusion Nursing, Home Health Infusion.

No I do not think it is awful....some people do not respond to reason or are too stressed to hear things. I have been in many stressful situations with multiple caregivers tending to a patient.....but the patient still had enough energy to complain about where i was putting the IV plus a few other things.

In a recent situation like this,I was waiting for a very experienced SICU nurse and a nursing professor as well,to say something to this patient. When she continued to argue with me about my site selection I really had it at that point and told her "you realize we are all trying to save your life here"....she looked at me and I said "do you want us to continue". She did want us to continue and handed me her arm and until we stabilized her she was an angel.

Granted,when we tell a competant adult the potential consequences of their actions,ultimately they make the decision.....but there is nothing wrong with telling them like it is if they can not seem to get it.

Saying things like they are to get your point across is one thing, being rude/judgemental is another. There is a huge difference between telling a pt, "if you don't take your meds xyz will happen" and telling them you are going to prebook their next stay... The former is the truth, albiet blunt; the latter is just plain rude and a bit condecending. A better way to address that situation would be to tell him he will be back or worse if he does not comply. Tread lightly in this area, stick to saying the blunt truth...

No I do not think it is awful....some people do not respond to reason or are too stressed to hear things. I have been in many stressful situations with multiple caregivers tending to a patient.....but the patient still had enough energy to complain about where i was putting the IV plus a few other things.

In a recent situation like this,I was waiting for a very experienced SICU nurse and a nursing professor as well,to say something to this patient. When she continued to argue with me about my site selection I really had it at that point and told her "you realize we are all trying to save your life here"....she looked at me and I said "do you want us to continue". She did want us to continue and handed me her arm and until we stabilized her she was an angel.

Granted,when we tell a competant adult the potential consequences of their actions,ultimately they make the decision.....but there is nothing wrong with telling them like it is if they can not seem to get it.

Great reply! I'll have to try it.:up:

What does everyone here think?

I think you're a great nurse. You sound just like me...:lol2:

SharonH, RN

Specializes in Med/Surg, Geriatrics.

Sure you can be blunt. You don't want to sweet-talk and enable them into their graves, do you? Blunt is the only language some people understand. How many times have patients called you into a room after the doc left and asked you to interpret what he/she said? Of course tone is everything......

A word to the wise is enough, and many words won't fill a bushel.

That's what Benjamin Franklin said, and he was right.

mama_d, BSN, RN

Specializes in tele, oncology.

Ah, I just got home from work. Had a patient who I told that if he continued to be noncompliant and refuse care, he would never leave the hospital b/c he would die before he got a chance to go home. I told him that we're here b/c we care, and to help him help himself get better.

He didn't like me very much, but his SO was grateful...she said it was about time someone told him the straight dope on what he was doing to himself.

When I spoke with the doc at the beginning of the shift to CYA and make sure he was aware of the issues, his comment was..."Educate him and document it so when he ends up killing himself before he leaves you're covered." Makes me feel great, knowing that the doc has already given up on him (granted, he's been dealing with him for over two weeks and I only had him for one shift).

Sometimes it's time for all the mollycoddling and p*ssyfooting around the elephants in the room to end and tell the patients exactly what they are doing to themselves, in a matter-of-fact way.

You care enough to attempt to reach the patient emotionally be it humor or throwing away the "niceties" of social interaction and being brutally honest. In stressful situations for patient and family such as hospitilization, this can help much more then cold logic and a shrug before writing in the nn "patient refuses", IMO it tells them you care.

alyx

Specializes in Geriatrics.

I'm a firm believer in.."It's not what you say but how you say it" and always "Speak the Truth in Love"...if it brings about results then great...we have become a whole society afraid of speaking the truth because of what others may think or say about us..it's time we all got back to speaking the truth in love. A doctor came in and told my dad..."you've got cancer and there's nothing we can do about it. You have 2-3 months", then he left the room and sent a nurse in to deal with his beating. What a jerk. Could have been done so much better. And it wasn't totally true either. We did plenty and he lived another two years. It wasn't what he said but how he said it. We can all do so much better with our patients. Thanks for sharing.

Chaya, ASN, RN

Specializes in Rehab, Med Surg, Home Care.

I think of it as giving them a chance to refocus their priorities. They get caught up and overwhelmed with the minutia while we as experienced nurses can see the big picture. Sometimes what they need to hear IS "Do you want to be there when your grandchild is born/ gets married" or whatever. That is what it's all about, for me.

Chaya

I think some patients/people need straight talk (of course, stated with respect). I wish you were my MIL's nurse! She is a train wreck by her own doing and continues along her path to self-destruction. I have a feeling that nobody has ever been straight with her (I've tried, but she doesn't take it very well coming from me). It is what it is. I agree with a pp who said "speak the truth in love."

Elvish, BSN, DNP, RN, NP

Specializes in Community, OB, Nursery.

I have, in the times I've used straightforwardness and sometimes even bluntness, had good success. It totally depends on the particular patient, your relationship with him/her, and the illness involved.

I had a patient in with ruptured membranes and preterm labor at 27+ weeks that insisted on wandering around the hospital, going outside to smoke, and generally not being in her room AT ALL. I liked the lady and finally I told her, "I'm not your mom. But I am your nurse and I do want you and your baby to be in good shape. The possibility exists that while you are out walking around, you will have your baby...wherever. Outside, in the cafeteria, anywhere. It could happen. And nobody will be around that can help you in a situation where seconds matter. Do you realize that?" And it was like a lightbulb went off. She didn't stop going to smoke altogether, but she did cut way back. So yes, I believe in being a straight shooter.

Pepper The Cat, BSN, RN

Specializes in Gerontology.

Be very careful of what you say.

I once told a pt that if she didn't get up and move after her surgery, she would get a blood clot and die.

The next time I helped her to the BR, she threw a PE, coded and died.

That happened 12 years ago and that comment I made still haunts me.

Be very careful of what you say.

I once told a pt that if she didn't get up and move after her surgery, she would get a blood clot and die.

The next time I helped her to the BR, she threw a PE, coded and died.

That happened 12 years ago and that comment I made still haunts me.

:uhoh3:

nerdtonurse?, BSN, RN

Specializes in ICU, Telemetry.

I had the same sort of thing in reverse. Had a 30-something that had back problems -- multiple slipped discs, multiple surgeries -- and she was in love with demerol. Yes, I know she hurt, but I told her she needed to increase her ability to deal with pain because she was getting such a high dose of narcotics that she was constantly constipapted, and would even result to golytely prep (!) to have a BM. She wanted me to get her a jug of it because she hadn't had a BM in 3 days (positive bowels sounds x4), and I told her that she needed to address this with the doc, because that isn't normal, and it wasn't safe. She didn't seem to get it, and I remember telling her, "if you don't stop taking so much demerol and morphine, you're going to kill your colon and end up with a colostomy, or worse." Well, when I came back in 3 days later, she had gotten her golytely prep to help her move her bowels, her bowel had ripped, and she was dead from peritonitis.

Virgo_RN, BSN, RN

Specializes in Cardiac Telemetry, ED.

I think there is definitely a time and place for bluntness, and a time and place for a little more tact. I've overheard doctors say some pretty blunt things that made my jaw drop, but the patient really needed to hear them.

locolorenzo22, BSN, RN

Specializes in Ortho, Neuro, Detox, Tele.

After surgery...I always tell my patients that if they don't move, don't keep ice on their knee/hip, don't keep their legs above their heart, etc...well, don't blame me when you have major pain and swelling. Patients will argue about moving after back sx, and I tell them, look, either it's move now or else you're going to get pneumonia and then where will you be.

Bluntness is the only language some patients understand....someone asked me why I'm not super nice to the VIPs who complain about their prescribed treatments. I said that it's because every patient is a VIP when I'm taking care of em.

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