What makes a "good patient"?

[moriahcat]

I have seen venting (normal and appropriate) about problem patients, and sometimes it's enough to make me wonder how anyone can go into the profession. Yes, it's part of what made me decide to focus on my technical skills when I was considering going into nursing... I've known a lot of nurses, at all levels. It's a hard job. I'm also prone to understatement.

I'm relatively young, but in the last year I've had two admissions to the medical/surgery unit due to respiratory issues (pneumonia both times, but the asthma exacerbation portion was what I think made them admit me). I was laid off shortly after being discharged from the first admission, and wasn't able to maintain my COBRA coverage, so last week when I was there for two nights, I didn't have insurance. The hospital is being really, really good to me, and they even filled my antibiotic prescription for free (that was the one I was really worried about in regards to cost, it wasn't cheap).

But I know I'm not at my best when I'm sick -- I don't think anyone is. The fact that I'm a charity case right now makes me feel even worse if I annoy the nurses. Both times I've been in, I've been put pretty close to the nurses station, so I heard enough both times to know they were extremely busy with patients with a much higher acuity than mine.

So... I really tried not to hit the call button. I mean, they checked on me enough that, for example, this last time I only had to twice... once when they'd wanted me to save a urine specimen and there wasn't a hat or a cup or something in the bathroom, and I needed to go. The other time was the one I feel really badly about because they were slammed and I could hear it both in the lady's voice who answered the button, and just the noise of the ward in general.... they'd had a hard time sticking me, so when they moved my IV site to my left side, they left the IV port in the right hand that the ER had put in. My fever had broken and I sweated through the tape, and the IV port came out. I had pressure on it by the time they were able to get to me, but I'd managed to bleed all over.

They did have me on oral pain medicine to help with the pain of coughing, but I knew that was the absolute lowest priority in comparison to keeping me breathing, and keeping other patients who were likely post-surgical comfortable. During morning shift change the second morning, I'd asked for my pain meds, but I knew they'd come when the rest of my meds did. They'd worn off overnight and when the RT came in a little over an hour later, he could tell I was extremely uncomfortable when coughing for him, and hit the call button and asked for the pain meds then. Without me asking. I felt badly because I knew I hadn't been forgotten about, just that it was busy, and it could have seemed like I had complained when I hadn't.

I also *always* said please and thank you. I mean, that's just manners.

But are there any other tips that you guys would have for patients who really don't want to be pains in the tookus?

[imintrouble, BSN, RN]

I've given your question some thought. It's not so much what the pt says, although please and thank yous are rare, and appreciated.

For me it's not the words, it's behavior.

The pt gets off the phone when I come to the room.

Mutes the TV when I'm assessing breath sounds. Looks at me when I'm speaking, instead of at the TV. If they can stand, get out of the bed/sit in a chair when their linens need changed. Help clear their table when meal trays arrive. Use their IS even when I'm not in the room. I can hear them from the doorway when I'm walking down the hall. Walk to the BR instead of asking for a BSC/bepan when there are no physical limitations.

I guess it boils down to assisting in their own care, as much as they are able.

Respect, for themselves and for me.

[Nurse_]

A good patient, at least for me, is someone who takes control of his/her medical illness. They are involved with every process and eager to learn about their condition. Those patients are the ones who will probably maintain their health regimen outside the hospital and hopefully, stay away from hospitals.

[Sfrazilus]

In school we're trained that a "bad patient" is one who prevents you from dealing with their problem. Someone who doesn't complain of pain or new symptoms prevents you from helping them. It may not add to the nurse's daily aggravation, but it makes the job harder.

It seems like the do-gooder thing to say, but after working in rehab a few months, I've seen people hurt themselves because they didn't want to be a bother. The end result is an incident report and crap from a manager.

Even if it doesn't get to that extreme, I'd rather have a needy whiner than someone who says nothing to me and complains to their family/friends or our supervisor that we're not doing anything for them.

[uRNmyway, ASN, RN]

A good patient, at least for me, is someone who takes control of his/her medical illness. They are involved with every process and eager to learn about their condition. Those patients are the ones who will probably maintain their health regimen outside the hospital and hopefully, stay away from hospitals.

The exception to that rule are the Web-MD licensed doctors lol. Its great to want to know more about your health issues, but making yourself a hypochondriac with Web-MD is no better than knowing nothing at all!

[uRNmyway, ASN, RN]

Hmm, good patient...

-Polite (as others said, please and thank you, pay attention to you when you are talking to them)

-Involved (ask questions when the doctor is there, know their medications and health problems)

-WANT to get better, and do what is required for that to happen.

-Do what you can for yourself. If you can use the bathroom, do it. If there is nothing physically keeping you in bed, I would rather push you to the bathroom on a commode chair than have you use the bedpan. And for Gods sake, wipe your own butt!!

-Don't make me chase you for treatments and medication. If you have IV meds due at a certain time, try to be at your bedside 15-20 minutes early, just in case I can get there earlier.

-Be reasonable. That goes both directions. If you want something that is not a priority ie. an extra pillow when there is no respiratory issue, then expect that you might have to wait while I deal with more urgent problems. I will get to it, but not before someone who can't breathe or is actively crumping. Then if you have an actual problem or issue, ASK ME! They don't give us a crystal ball when we pass NCLEX. I can't read your mind. If I could, I probably wouldn't be where I am today. You are my patient, and I want to help you, but I can't do it if I don't know what is wrong.

[applewhitern, BSN, RN]

I agree with "imintrouble" about getting off the cell phone. Don't lunge and grab the phone just because it rings while I have a stethoscope to your chest. Please turn down the TV when I (or a doctor) come into the room. Don't cough directly into my face, esp. without covering your mouth.

[BSNbeauty, BSN, RN]

R-E-S-P-E-C-T. That is all.

[wooh, BSN, RN]

Polite and reasonable.

That's all we really want.

If you need something, call.

[Sugarcoma, RN]

What is a good patient? Vented, sedated, orphaned! lol, just kidding.

For me a good patient is one who is polite and actively participates in their plan of care and really seems to want to get better. One who does not fight me tooth and nail for every intervention. Example: Come back later to assess me, I am too tired to try to walk, I am not using that IS, I need you to wipe my butt even though I have always done that myself.

I don't mind if you are a little talky, a little needy, a little anxious. I expect that from people who are scared. I do mind if you try to monopolize my time, constantly use your call light to call me in for multiple ridiculous little things which is obviously just a ploy for you to get someone in the room so you can continue to be the center of attention. I also hate the malingerers and the invent a scenario (Chest pain) to try to score more pain meds. Also, if you ever utter the words "I am the sickest person here" You will annoy me and I will reply with: I am sorry did you just say something? I am just not used to having a patient who is well enough to actually talk here in the ICU.

[Sugarcoma, RN]

OP I think it is sweet that you were concerned with making more work for your nurses. Low sats and trouble breathing sounds pretty darn sick to me and I would have expected you to be extremely anxious as anyone who feels they cannot breath will be. I also think that over an hour for pain meds is not acceptable. I would have called and asked again. Pain medication should be a priority barring an emergency with another patient.

I think most nurses would agree with me that they do not get annoyed with legitimate needs even if it is for water, extra blanket, snack etc. It is the abusive, manipulative patients (and their families!) who annoy us.