Telling it how it is.

[twistedpupchaser]

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?

[Chaya, ASN, RN]

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

[back2thebooks]

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]

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]

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.

[SuesquatchRN, BSN, RN]

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.

[nerdtonurse?, BSN, RN]

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]

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]

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.

[Batman24]

These Pt's are those that I have cared for and gotten to know and have felt comfortable to tell them.

What does everyone here think?

I think that's the crux of the whole scenario. You didn't know them for two minutes and start being blunt but had taken care of them for a bit and felt comfortable enough to be honest. You also threw in some humor which takes the edge off. As long as it's done with love patients seem to appreciate and understand it. They know what you are saying is true and often need the firm reminder that they need to start participating in their care as well.

[leslie :-D]

working inpatient hospice, it's not my pts who struggle with their mortality, but their families.

and when i see families interfering w/the pt's living and dying process, i tend to lay the cards on the table.

many times i have brought certain family members aside, to tell them in no uncertain terms that ________ was dx'd with________:

that his loss of appetite/hemorrhaging/projectile vomit/flesh-eating ulcers, etc are all symptoms of the trajectory towards his death...

and to stop telling him that it's going to be ok and to hang tough...

because he needs to die peacefully and if you can't accept this, i can't allow you to stay with him during this time.

that's the crux of my statements.

and i don't feel badly telling these folks how it is.

it's the pt's damned death, not theirs.

often, people need a loving dopeslap to regain perspective.

leslie

[soulofme]

that's the crux of my statements.

and i don't feel badly telling these folks how it is.

it's the pt's damned death, not theirs.

often, people need a loving dopeslap to regain perspective.

leslie

Amen Sistah...Amen:bowingpur

[Blee O'Myacin, BSN, RN]

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.

So you blame yourself for appropriate patient teaching? Did they even have heparin protocols after surgery 12 years ago? The way I see it is that you have to forgive yourself for doing your job and that your statement did not cause this patient to die. She would have thrown the PE anyway. Why would something you said affect an outcome like that? It's not like you put the clot there with your comment.

Blee (who apparently does talk that way to people...:nuke:)