Type C

[Davey Do]

Years ago, I attended a great seminar on the subject of stress, given by a speaker who was a Psychologist. The Psychologist made a statement that forever changed my perspective on Patients.

He said, "All Patients are Type C and all Type C's are victims".

The speaker illustrated this point by saying that the Patients are victims of an accident, illness or disease, whether due to a smite by the hands of The Fates, or because of their own self-destructive actions.

He encouraged us to start viewing all the Patients that we serve as victims in order to raise our consciousness in understanding their responses to their situation. With that understanding, we would be able to better deal with their behavior.

We easily feel empathy when an injury affects a Type C child, yet feel some apathy when a Type C adult suffers the ramifications of their imprudent inaction or self-destructive actions. Both or either could be our Patient, and it is our duty to provide quality care in an objective manner.

Providing care in an objective manner isn't easy when our emotions are triggered. We will easily kiss the boo-boo if a child, yet feel righteousness in chastising the behavior of a treatment non-compliment adult.

These are thoughts that I wanted to express and will pause before continuing.

In the meantime, please share your thoughts, if you will.

[JKL33]

I prefer to look at it like every patient has some kind of situation in which I will try to provide therapeutic nursing assistance.

I was convinced in my original nursing education that some of nurses' empathy could come through recognizing that every patient is having a bad day/the worst day of their lives/etc. when they meet us, and that the stress they are experiencing dictates that they will not be on their best behavior.

Problem is, none of that is necessarily true.

For me the most simple and straightforward (and least problematic) thinking is to just have empathy for people as fellow human beings and then immediately jump to figuring out what their specific health-related situation is and what I can do to therapeutically assist with it. Everything else is bloat that gets emotionally complicated very quickly.

 

[Daisy4RN]

1 hour ago, Davey Do said:

He encouraged us to start viewing all the Patients that we serve as victims in order to raise our consciousness in understanding their responses

I can definitely see how this would help a nurse/caregiver understand pt actions/responses and respond to a pt in an objective manner. But this also would need to be set against the backdrop of particular pts and their responses. For instance we can kiss a child's booboo but if that child starts overreacting in the future over every little booboo boundaries may be needed. You have parents who continue to hover and parents who say... you are fine, you fell, get back up and go play. A healthy balance is needed for both children and adults to grow and thrive. Personally I have always treated pts the same no matter why or how they ended up being my pt, I have always given some wiggle room for the inappropriate responses and attitudes (bc of the situation) but there is definitely a line that must be drawn to what is acceptable/tolerable no matter what their problem is, child or adult!

[Davey Do]

2 hours ago, JKL33 said:

I prefer to look at it like every patient has some kind of situation in which I will try to provide therapeutic nursing assistance.

JKL, did I ever tell you that I thought your approach to matters was as logical as Mr. Spock's?

Only in this case, I guess it would be Ms. Spock.

 

 

 

 

1 hour ago, Daisy4RN said:

A healthy balance is needed for both children and adults to grow and thrive. 

Aunt Bea couldn't have said it better.

 

 

 

*wink wink, nudge nudge*

 

 

[Davey Do]

We can easily interpret JKL and Daisy's responses as those who choose to take the higher road, remain objective, and provide quality services to all Patients.

However, many of the responses from some of the members on these forums do not take this approach. Without knowing any more than the poster who minutely describes the behavior of a difficult Patient, the supposedly supporting members will name call and pigeonhole that Patient.

If this approach is taken as a tact to deal with, let's say a whiney Type C, then these negative subjective emotions must come into play in a professional real life situation.

 Often, I have read where the difficult Patient is symbolically knocked down and kicked. It doesn't take long before others join in and kick the Patient while they're down.

If no endeavor is sought to understand the reasons behind a difficult Patient's behavior on these forums, serious doubts arise that a better tact will be taken in a real life situation.

It is easier to appear anyway we want to appear on the internet than it is in face to face encounters. So, if an individual is going to respond negatively to an abstract situation on the 'net, chances are that individual will respond negatively in a real life situation.

We should always endeavor to find the reason behind an individual's behavior before we deem them unworthy of  our understanding.

[JBMmom, MSN, NP]

2 hours ago, Daisy4RN said:

Personally I have always treated pts the same no matter why or how they ended up being my pt, I have always given some wiggle room for the inappropriate responses and attitudes (bc of the situation) but there is definitely a line that must be drawn to what is acceptable/tolerable no matter what their problem is, child or adult!

I strive to maintain this approach as well. I figure if anyone is seeing me as their nurse, they're having a pretty bad day and if anything my responsibility as their nurse is not to make it worse.

Interesting time of this thread, just recently we have had a challenging patient that is really pushing everyone's boundaries. He's on a ventilator but nearly impossible to sedate well because of polysubstance abuse history. He is awake and alert, oh and has a felony conviction for assaulting a healthcare worker- cannot be treated at another local hospital. Just the other night I went in and was talking with him, he was indicating he wanted a foot unrestrained. I asked "are you going to try to kick me?" He shook his head no. I unrestrained his foot, was able to help him reposition and he was calm and cooperative for about three minutes. As I turned to move something from the side table, I saw his foot coming up. Missed my face by a couple inches. Stared him down and it was clear that as soon as he has a chance, he's going to try to hurt one of us. I no longer care what brought him there, will not be giving him any choices. He will get the competent care I must provide but that's all. 

[TriciaJ, RN]

19 hours ago, JKL33 said:

I prefer to look at it like every patient has some kind of situation in which I will try to provide therapeutic nursing assistance.

I was convinced in my original nursing education that some of nurses' empathy could come through recognizing that every patient is having a bad day/the worst day of their lives/etc. when they meet us, and that the stress they are experiencing dictates that they will not be on their best behavior.

Problem is, none of that is necessarily true.

For me the most simple and straightforward (and least problematic) thinking is to just have empathy for people as fellow human beings and then immediately jump to figuring out what their specific health-related situation is and what I can do to therapeutically assist with it. Everything else is bloat that gets emotionally complicated very quickly.

 

I agree with this.  Having empathy for fellow human beings and trying to provide the best care for the situation was they way I always tried to go.

Seeing people as primarily victims is fraught with pitfalls.  First, it incurs the risk of becoming condescending.  Second, it implies a certain helplessness and is disempowering for the patient.  People who readily embrace their victimhood tend not to do as well in life.

I would take nursing advice from a psychologist as readily as I would from an auto mechanic or an accountant.

[Davey Do]

Constantly seeking a new perspective is a major motivating force in my life, for I believe there are always alternative notions to the Mainstream Consensus.

In challenging a belief, a school of thought, or a premise, many will respond defensively as a victim of a personal attack. The victim retaliates by personally attacking the challenger.

The victim needs to be objectively and factually confronted on their inappropriately diversion of the debate subject. However, on these, and many other website forums, the debate usually turns into a brawl or a pecking party.

But sometimes, every now and then, no response is given to the challenger. This lack of response could be for many reasons, suck as lack of interest in the topic, fear of recrimination or the challenger, or maybe just fear of a toppled belief system.

Recently, I challenged the consensus of  the members of a thread and received no response; no reprisal. Now, the reason for no response could be as a result of any of the above listed reasons. My right brain gave this as the reason:

 

[Davey Do]

1 hour ago, TriciaJ said:

I would take nursing advice from a psychologist as readily as I would from an auto mechanic or an accountant.

When I have world and time, I wish to address the other portions of your post, TriciaJ.

But I have to first stop wildly laughing at your closing statement!

[JKL33]

15 hours ago, Davey Do said:

If no endeavor is sought to understand the reasons behind a difficult Patient's behavior on these forums, serious doubts arise that a better tact will be taken in a real life situation.

It is very useful to understand a patient's behavior. I prefer to start from a position as close to neutral as possible. That is to say, I prefer not to start from a position of assuming much of anything, such as assuming that they are having a bad day, assuming exactly why they are seeking services, assuming how they are going to feel about the fact that they are receiving health care services, etc.

I came to this mindset through trial and error and a good deal of angst. The process was related to my reaction to some of the shenanigans that can be readily witnessed in the ED. They were making me bitter and I didn't want to be bitter. So I decided I needed to think about everything MUCH differently. That's when I came up with the idea that I do not have to feel a certain thing about any given patient; neither a positive thing nor a negative thing. And that I could universally proceed in the following way (tailored according to specialty) :

1. Human being

2. What is the situation (note: not to be called the "problem" but simply the situation)

3. How can I best assist in a manner that is therapeutic (I.e. uses prudent nursing actions, does not make things worse, tries to give the patient some kind of resource, etc., etc.)

My experience has been that EVERY patient situation can be approached in this way. It is particularly internally calming especially in shenanigan-type situations.

Example:

Very well-known patient makes 4th ED visit in 3 days for [chest pain, headache, take your pick]. The patient has a strong history of not verbalizing any helpful response to any medication other than dilaudid.

Original internal nurse response to this situation: Anger.

Using neutral steps:

1. Fellow human being

2. Main possibilities: Serious medical condition, benign medical condition, tolerance, addiction, other psychiatric conditions/comorbidities

3. Therapeutic actions:

• Appropriate interactions fit for a fellow human being (tone of voice, body language, basic pleasantries as appropriate).
• Perform usual due diligence in conjunction with medical orders as needed to ensure no serious medical condition
• Provide usual/accepted/appropriate treatments in conjunction with medical orders
• Strictly use therapeutic communication techniques learned in school (these work, plus they keep the nurse focused on the patient rather than on the self). Example: Patient says, "This is BULLS**T, the only thing that is going to make this headache[chest pain] go away is dilaudid. You guys effing KNOW THIS!!" Nurse response: "The physician has ordered [not dilaudid], which is the treatment recommended by xyz society. We are also doing xyz tests to make sure [blah blah blah]. It sounds like you have some concerns about this plan of care." There will likely be lots of other interchanges and fooling around in a situation like this, but at each step you just interact in a professional manner. If the stars are aligned just right you might be able to find out a little bit more about the history of "the situation" and have a mini-therapeutic chat about it.
• At the end of the visit, provide appropriate discharge and follow up information. Give information for relevant resources as appropriate. Give the patient all benefit of the doubt and make sure they have the information they would need to seek a change/seek further help.

There. You have kept your cool and done your job by simply treating someone with basic human dignity, recognized the situation, done due diligence to evaluate/treat the situation appropriately and made a solid ending to it.

[SmilingBluEyes]

Dignity. Respect. Boundaries.

There I summed up how I feel on the subject, as succinctly as I could.

[Daisy4RN]

On 7/13/2021 at 3:42 PM, Davey Do said:

However, many of the responses from some of the members on these forums do not take this approach. Without knowing any more than the poster who minutely describes the behavior of a difficult Patient, the supposedly supporting members will name call and pigeonhole that Patient.

This is true but I tend to think it is just other nurses joining in on the vent probably because of other similar situations.

 

On 7/13/2021 at 3:42 PM, Davey Do said:

It is easier to appear anyway we want to appear on the internet than it is in face to face encounters. So, if an individual is going to respond negatively to an abstract situation on the 'net, chances are that individual will respond negatively in a real life situation.

While this may be true I think that most people would be able to seperate the fact from fiction and realize that it would be highly irresponsible and unprofessional to actually let someone on the internet influence a real life interaction with a pt (or anyone else for that matter). I realize that there are of course some people who are off balance but I hope you are wrong in that " chances are that individual will respond negatively in a real life situation".