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?

[leosasha]

I prefer forthwright as the terminology. Blunt is too abraisive. Want to leave them standing. Occasionally I have to resort to it but not as a habit.

[Scrubby]

Often where I work patients don't fast properly so we will make them wait until they can be anaesthetised safely or just send them home if it's too late.

If they get too angry about it I don't ***** foot around. I tell them you chose to ignore the doctors orders not to eat or drink. If there is food or drink in your stomach when they put you to sleep you can drown in your own stomach contents. I'm sure you don't want this to happen.

This shuts them up every time.

[leslie :-D]

Often where I work patients don't fast properly so we will make them wait until they can be anaesthetised safely or just send them home if it's too late.

If they get too angry about it I don't ***** foot around. I tell them you chose to ignore the doctors orders not to eat or drink. If there is food or drink in your stomach when they put you to sleep you can drown in your own stomach contents. I'm sure you don't want this to happen.

This shuts them up every time.

absolutely.

pts need to know the consequences of their decisions.

leslie

[flightnurse2b, LPN]

i have never held back anything much from a patient or their family member, i suppose its because ive always worked in a pre-hospital and emergent setting where the truth is usually apparently obvious.

i think it's great! i truly do think honesty is the best policy when it comes to patients like those. it oftens annoys me when i see health care professionals poo-pooing bad behavior because they are afriad the patient will be upset. they have the right to be informed, right?

i had a patient once in the ED that was 26. he was 500 lbs. he was in holding about 4 days when he coded. that mother came after us and screamed and hollered that we killed her son. the doctor walked over to the trash can, pulled out bags from arby's, popeye chicken, mcdonald's and diary queen and put them on the overbed table. she said "we don't serve this here. we weren't the ones that killed him".

[VICEDRN, BSN, RN]

I don't have as much experience as others here but forthright is pretty much the only way I know how to be. Its a part of my personality.

It always worked with my clients in my previous career and I find in my limited experience that it works in this setting too.

Actually, I think people think that anything but total honesty (and bluntness depending on the person and your relationship) is a bit like lying. I notice that people trust me a whole lot more when they feel I have laid it on the line for them.

I bet you noticed that too. I bet you are a great nurse. If we run into each other, make sure you tell me how it is, I don't need any bulls***t in my world either.

[pagandeva2000, LPN]

I think that more patients need to be told the truth rather than to constantly entertain certain behaviors. Of course, it takes a critical thinker to be able to tell who can handle what, but I have resorted to telling the truth several times.

I have seen many patients 'misbehave' because they want attention more than anything, and sometimes, there is no time for it. Of course, this is not everyone, at all times, but enough for me to say to myself "This person is B-S ing me" and then, if all else fails, they just may get the truth. In fact, I believe that the truth is more caring in many cases, because this patient has the facts and is being brought to reality. An example is the other day, in my Coumadin clinic, I was doing a fingerstick when the machine malfunctioned. I did the same things that I do for each patient, but I suspected that this CoaguCheck is not really designed to handle the many patients we receive and sometimes, we have to play games with it to work. The patient said to me that she'd rather that 'someone who knows what they are doing service her', because I had to take 5 samples (mind you, she was only stuck twice), and then, she says that I am taking too long. I said to her "I have NO desire to keep you here longer than anyone else because then, I am subjected to your sarcasm and abuse that I clearly do not deserve. In addition, due to the seriousness of the medication, I think you want me to be sure that I obtain an accurate reading, but it is YOUR health...not mine. Now, if it makes you feel better to have someone else do it, that is fine with me. Just know that it will delay your visit even longer because I am relieving for lunch and the person just left. Believe me, it will not hurt me, but it may inconvience you. Now, just tell me which step you wish me to take". She sucked her teeth, rolled her eyes, and told me to continue. Did it sound cold? Probably. But, I know that if I just rushed and did whatever and she received the wrong presciption, then, SHE would have been in danger, not me. I could have just documented whatever mistake the CoaguCheck came up with and called it a day...who would have known? Because I had her safety in mind, I took her abuse. The next nurse may not have cared at all. People need to be reminded of that, sometimes.

[rngolfer53]

I believe that any competent adult needs accurate, complete information to make decisions about how to conduct himself, in health care matters as in other areas of life.

Different approaches are necessary for different people. Most of us hear mostly what we want to hear. So, it is sometimes necessary to use blunt language. I don't know about Australia, but in the US, it seems to me that we hedge our statements too often for the sake of sparing the feelings of people in the short term.

That said, I think it is very important to conduct a thorough self-examination prior to each time one uses such a blunt approach. It can be very satisfying to channel one's frustration into a harsh statement to a patient or family member, justifying it as in the patient's interests.

So the questions must be asked and answered about if it really is the best way to get the point across, what other methods have been tried, etc.

[lovingtheunloved, ASN, RN]

Blunt works. Especially with confused people. I have a resident who just today I told, "If you try to walk by yourself, you are going to fall and bust your face open." He sat his butt back down and waited for a CNA. No busted heads.

[purpleiris]

I was reteaching a 28 year old male diabetic patient on the proper diet. He had been diagnosed a year before and in the hospital 3 times for glucose levels over 600. I asked him if he had taken advantage of the hospital's diabetes support group for help working within the diet. He said no, but he knows the diet. I say, you know you cannot have cake or..when he butted it...I CANNOT HAVE CAKE???? I say nooo no cake, no pie, no candy. He said, "I am 28 years old, I'm cant live without cake". I said, "If you want to live to be 38 you will not eat cake!"

Sometimes I don't think patients are told of the consequences of not following orders at all.

[Jo Dirt]

I have a (former) smoker on my unit who is in the late stages of COPD. She is nonambulatory and when she gets off her oxygen for them to take her to the bathroom she will panic from the shortness of breath. She also has episodes where she can't catch her breath even while just sitting in her geri-recliner.

And she insists it is all due to allergies.

The other day, she kept insisting there was a kink in the O2 tubing, the machine wasn't working right, etc. etc. etc.. I was exasperated after checking everything and she still got no relief so I told her, "Well, with your condition you know it can only get worse."

She said, "Oh no! Don't say that! I'm going to DIE!!!"

I immediately knew that was not the right thing to say, so I sugar coated it the best I could and things settled down.

A lot of time, the patients are in so much denial they can't accept the truth or are not stable enough to handle the truth. My friend-who works the other hall-is known for her bluntness and recently told a drug seeking patient (who takes methadone, Lortab, Xanax, Soma and Tylenol in between) who asked her opinion on what to do about feeling so bad...she told her you don't need to be in this nursing home, you need to be somewhere drying out...you're an addict and you're slowly killing yourself...

The patient thanked her for her honesty and resumed as she had been doing before.

[nursemike, ASN, RN]

Blunt works. Especially with confused people. I have a resident who just today I told, "If you try to walk by yourself, you are going to fall and bust your face open." He sat his butt back down and waited for a CNA. No busted heads.

Looking at your specialty, I feel I have to accept that your are reporting your experience accurately, but my own in acute care neuro/neurosurg has been nearly the opposite. I can explain to an AOX3 pt that bumping their fresh crani may have dire consequences, but I've occassionally seen well-meaning people turn a confused/agitated patient into a confused/combative one in the name of honesty. I suspect this might be a difference between chronic and acute confusion, say a recent CVA vs late Alzheimer's.

Definitely not directed to the quoted poster, the OP, or anyone else on this thread, but I've occassionally seen nurses whom I am sure would say they were "just telling it like it is," who were unpardonably condescending and/or just plain rude. I particularly noticed this when my father, a competent adult who has taken care of himself for 72 years, was recently hospitalized. Most of his nurses were very good, and a few made me feel compelled to tell them that they made me proud to be a nurse, but there were a very few I would have encouraged him to refuse, if they were assigned to him again. And I have seen similar behavior--again, not all that often--toward patients to whom I was not particularly attached.

So, while I certainly agree that part of individualizing care is recognizing that some people need to be addressed forthrightly enough to get the point across, I also endorse the view that we need to be conscious whether we are addressing the patient's needs or just using it as an excuse to vent (and I know I've done some of both.)

Finally, and almost completely off-topic, may I just note that pussyfooting means "walking like a cat," and isn't at all dirty. And I'm trying very hard to not get a visual for what others may mean by it.

[Jo Dirt]

So, while I certainly agree that part of individualizing care is recognizing that some people need to be addressed forthrightly enough to get the point across, I also endorse the view that we need to be conscious whether we are addressing the patient's needs or just using it as an excuse to vent (and I know I've done some of both.)

Sometimes, I think it can make us feel better to think we are "telling it like it is." I've found that the reality is, more times than not, being blunt does little to get a point across and instead just creates feelings of resentment and hostility toward you. There are so many times I've had to painfully hold my tongue when I wanted to let it out so bad, a few times I let it out anyway, and I think it is only honest to admit we all have these feelings where we want to preach. Personally, I feel there are people/patients who should be offended, like the pregnant trash puffing away on cigarettes and you know full well she won't stop regardless of teaching. I wouldn't blame a nurse for showing and telling her exactly what she's likely doing to that unborn baby with her selfish indulgences.

Will it do any good? No. Did it do the nurse any good? Maybe a little. I can understand.