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What should have been said? Did i do the right thing?

Posted

We all have stories of "funny things" and not so funny things patients say....

i had one about a week ago, that my heart goes out to....i had NO idea how to handle this situation. The general med/surg floor was full so we got this young woman (36 years old) who came to our unit from a vaginal hysterectomy. We are a med/surg specializing in cardaic and pulmonary, but she was young/healthy and was doing fine. We knew how to do the monitoring for bleeding etc. SUPER nice woman, husband was super sweet/supportive. You could tell they were not of higher education, lower income etc. Keep in mind she is HYSTERECTOMY (Fibroids i believe). Left her ovaries.

Anyway...she asks me the question "How long does this usually take to heal before i can be come sexually active again?" Ok, I feel comfortable discussing this with patients. No big deal, common question we get.

i went over her patient education on sex with her, addressed her sexual concerns etc.

then she says to me "Good. I think we want to start trying for children soon."

I said to her...."Do you mean your own children or adoption?" (i wanted to make sure i was hearing her right) she went on to say "We would like our own." At this point she knew something was wrong as i had NO IDEA what to say. She said "Is there something wrong with that?" i asked her what education she had prior to the removal of her uterus, she told me they went over everything with her. I said "Were you made aware that without the uterus you will be unable to have children?"

Okay i thought it was like hospital policy to over something like that with a woman!!! i mean i know she is 36, so they cant just assume she doesnt want children....just because she is 36? I dont know call me crazy. I know this was TOTALLY wrong and i reported it to my manager because i felt this was kind of a big issue that i wasnt sure how to handle. She looked into it further, i don't really know what came if it yet but i do know that their ARE hospital policies regarding this discussion no matter patients age. Either noone did it or she didnt understand it.....

my heart goes out to this patient,they were the sweetest couple and i can't help but get it off my mind. Did i say the right thing?? Could i have said it better? What should i have done?

How would you have handled the situation?

I do want to add, i honestly think this was aged bias. I cannot fatham a nurse or a doctor who would not have this discussion with a woman of someone who is lets say my age (22 yrs old). I mean really...? Even if the patient is aware you need a uterus to concieve, they need to made aware without it they cannot have children. Is it not our job to make sure patients know what they are signing for and going into surgery for?

*Jayda*

noahsmama

Specializes in pediatrics, public health.

The other possibility besides age bias is that perhaps the doctor who went over the risks/benefits of the surgery with her just assumed that anyone would know that without a uterus it is impossible to conceive. I think most people know this, so this would not seem like an unreasonable assumption to me, even though in this case it was, sadly, wrong. I guess the lesson one can learn from this is not to make any assumptions that one's patients will necessarily know even such basic facts about biology. It is very sad for this couple though -- and it sounds like you handled it as well as anyone could have.

canesdukegirl, BSN, RN

Specializes in Trauma Surgery, Nursing Management. Has 14 years experience.

Oh honey, that is an awful predicament for you to be in. She MUST have had some pre-operative teaching prior to going to surgery. I guess her doc either did not explain it well enough (which I find hard to believe) or she was simply in denial,or she honestly had no idea what the surgery really entailed. This is a horrible situation for you and for them. I feel as badly as you do...that is tough.

You were put squarely into a situation that you should not have had to be in. With that said, I think that you did the right thing by re-stating what the expectations were for her and her husband post op. It was a good thing that you brought it to the attention of your manager. I fear that the surgeon did not do ENOUGH teaching for this couple. There is no way that the surgeon could not have addressed this with them....it is a HUGE surgery with many considerations.

You should not feel badly about how you handled it. I think you did well. There is nothing else that you could have done...you were quite blindsided. Please do not own this, as it is not your doing. Rest assured that you had no way of knowing that the education of this couple was obviously not comprehended. I know that it still breaks your heart for them, but you did the right thing. Sadly, it is the downside of what we experience as nurses. *HUGS*

The worst part of it was, after i talked with this family i went to the charge nurse and discussed it with her (im VERY VERY new). And this other young nurse hears me asking the charge nurse and starts LAUGHING!!! and was like "Oh, my god. are you serious?." i just looked at her and said "Yea"

I kind of just ignored what that nurse siad... im a very quiet and passive person with a big heart, and i really wanted to say something to her. Because to me it was not funny at all.

Feels better knowing someone else would have done or said the same thing. i actually got teary eyed telling my manager! (not full out crying haha) but i was mostly upset about the whole situation and how my coworkers handled it when i asked them.

Miss Mab

Specializes in mostly in the basement.

Braniacs--

She still has her ovaries----therefore ---they can still have ' their own'.

Granted, via in vitro though...w/blessed surragate.

Maybe you mistook her sex question for more than she meant. She wanted to know when she could get going again. Maybe her mind just clicked over to the baby issue. Maybe SHE was testing YOUR higher education?

I pray for a troll

sorry---i should have said caring braniacs at least. My bad.

You asked what could you have said or done better? Just not phrase an answer like this---

"""Even if the patient is aware you need a uterus to concieve, they need to made aware without it they cannot have children"""

You could talk about it being tougher and offer education and referral info options but maybe not so much the false stuff...

Edited by Miss Mab
left out the surrugate part--wrong to assume and all that

Boog'sCRRN246, RN

Specializes in Utilization Management. Has 10 years experience.

Braniacs--

She still has her ovaries----therefore ---they can still have ' their own'.

Granted, via in vitro though.

Maybe you mistook her sex question for more than she meant. She wanted to know when she could get going again. Maybe her mind just clicked over to the baby issue. Maybe SHE was testing YOUR higher education?

I pray for a troll

sorry---i should have said caring braniacs at least. My bad

In vitro still requires a uterus...and in this case, it would also require a surrogate.

Miss Mab

Specializes in mostly in the basement.

wow

just

wow

Miss Mab

Specializes in mostly in the basement.

In vitro still requires a uterus...and in this case' date=' it would also require a surrogate.[/quote']

I already edited in about the surrogate before your post as I realized that need might not be an obvious leap for all.

So no, doing in vitro(the donor egg w/ a functioning ovary) does not require one to have a uterus at all.

Sorry guys/gals. Didn't intend to be snippy. I can see how a few of us might not get this. Heck, I ony do ED/Psych so trust me, it's not exactly my area either and it's certainly okay to have questions......

but 4 posters agreeing w/OP? Isn't this that critical thinking piece they're always yammering about?

And the charge nurse/admin?

Fingers crossed--troll?

Good luck all. :crying2:

noahsmama

Specializes in pediatrics, public health.

Miss Mab,

The OP's post makes it clear that the patient thought that she and her husband could still conceive a child through sexual intercourse, even though she had had a hysterectomy. It is amazing that the patient could think that, and disturbing that information to the contrary was either not conveyed to her, or conveyed and not understood.

Yes, she and her husband could potentially still have a biological child via IVF and a surrogate IF their personal religious beliefs and finances allow this (IVF and surrogacy are both enormously expensive and not consistent with everyone's religious beliefs), but that in no way changes the fact that there was somehow a major breakdown in conveying necessary information for informed decision-making prior to surgery. Maybe the OP should have been more specific and should have said "you can't have children by sexual intercourse, you will need to either use a surrogate or adopt", but I kind of think you're missing the main point, which is that they didn't know they would not be able to have children "the old-fashioned way", and somehow this info was not conveyed to them prior to surgery.

And I think that the sarcastic use of the term "brainiac" was rather uncalled for, even if we are missing something that seems obvious to you.

Miss Mab

Specializes in mostly in the basement.

I apologized for the tone and I won’t belabor the issue more by continuing this thread.

Yes, I agree there was a communication breakdown somewhere along that chain. Whether the pt. didn’t understand her options at this point, or the surgeon didn’t get a good consent or the actual conversation between OP and her PT as none of us were there and clearly we see it differently.

Yet, I think you’re also assuming facts we don’t really know and I do, though regrettably harsh, stand by my response to the facts that I have been told.

When the pt stated they wished to have their ’own’ the Op responded--- "Were you made aware that without the uterus you will be unable to have children?"

You’re right, I wasn’t there, but in asking for opinions I thought it was both a rather poor, not to mention inaccurate, reply to a patient clearly expressing fear.

But, that’s not even the issue that troubled me. Between that conversation and then one had with supervisors and from there to multiple replies here on AN, the general attitude of acceptance and agreement to those words--- Were you made aware that without the uterus you will be unable to have children---just seemed so incredibly dated. Maybe that’s all.

Hey, to each their own. I’m bowing out of the thread as I’m sure it could/will go on for days. IMO, no mention of other options between four or five discussion points in this whole saga to me did show a need for more education. Others are free to feel differently.

Again, the issue isn’t really about potential costs of IVF or possible religious opposition---it was that at least 8 nurses in this vignette all seemed to believe that without a uterus you CANT have children. And that concerned me. Nobody mentioned personal wants/$$$/tactical issues.

I’m comfortable w/my understanding.

nursel56

Specializes in Peds/outpatient FP,derm,allergy/private duty. Has 34 years experience.

This woman's doctor needs to have a long sit-down with the couple as it appears there was a failure of informed consent somewhere along the line, and I can see why you would be surprised - OP and you handled it just fine! :)

Edited by nursel56

merlee

Has 36 years experience.

You did the right thing. Sometimes 'informed consent' doesn't mean they truly understand. Many years ago, I had a patient ask me 'after they take my bladder out, how will I pee?' She was having GALL bladder surgery, and had no idea that there were 2 bladders. She signed for the surgery without asking the doctor this incredibly crucial question.

Many people are still intimidated by docs, and do not even know they can ask questions, or don't know what to ask.

Apparently there were assumptions made here, and possibly the doc simply assumed that most people know what a hysterectomy ultimately means.

Tait, MSN, RN

Specializes in Acute Care Cardiac, Education, Prof Practice. Has 14 years experience.

I would have been shocked as well, and probably would have just stood there dumbfounded, and I am rarely caught off guard by patients.

Tait

ebear, BSN, RN

Specializes in Med-Surg/Peds/O.R./Legal/cardiology. Has 37 years experience.

Guess we "brainiacs" just don't understand Miss Mab. :lol2: She bowed out before I could reply. Oh, well...she would have continued to be head-strong anyway. :cheers: A real peach she is....

nurse2033, MSN, RN

Specializes in ER, ICU.

Sounds like you did as good as any of us could have. One thing I have learned is that you can never be ready for every situation. You were right to alert your manager. There is a huge potential for that patient to get very upset. Holy cow! Good example that you can never make assumptions. Good job.

Hey guys, Miss Mab apologized for her abrupt presentation. Can we let it go now? Please?

*********

"In vitro" is a term with more than one implication. It can mean fertilization using the couple's eggs and sperm with incubation inside a surrogate. It could also mean (and this is a more common usage) external fertilization and implantation into the egg source's uterus.

In this case, the first possibility is still an option, but the second is most definitely ruled out.

I work postpartum and when we take care of babies conceived through in vitro fertilization, it's almost always the case that the fertile eggs were returned to the mom they came from.

So to say that in vitro is not possible is largely true. In vitro via a surrogate would still be a choice, but not a likely one for a couple of limited means.

It's also possible that the physician did go over everything with the client prior to the surgery, but she heard what she wanted to hear (or didn't hear what she didn't want to hear) -- I've been in a number of situations over my career where I was present in the room and heard what the physician told the client, and, later, the client seemed to believe s/he had been told something entirely different from what I heard the physician say. People who are anxious often hear only a fraction of what we think we're telling them, or misunderstand but are too intimidated by the Great Almighty Physician to ask the questions necessary to get things straight (like the bladder/gall bladder example earlier), or they just tune out the stuff that they don't like. I don't meant that as a criticism of anyone -- it's just a coping mechanism, and human nature to some extent.