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

[Jay2daq]

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 lady partsl 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?

[Been there,done that, ASN, RN]

I wouldn't have touched that one with a ten foot pole! The surgeon removed her uterus,,, let the doctor explain!

Call the resident, or whoever is available ,let them handle this situation.

We need to start making these doctors accountable, not making their excuses.

[rn/writer, RN]

I wouldn't have touched that one with a ten foot pole! The surgeon removed her uterus,,, let the doctor explain!

Call the resident, or whoever is available ,let them handle this situation.

We need to start making these doctors accountable, not making their excuses.

The doc may well need to step up and make certain the patient understands the consequences of the surgery, even if only after the fact.

But the nurse is the one who is going to have to help her deal with the emotional fallout. And maybe ask for a social service consult in the event something more is needed.

I would like to see pre-surgical counseling offered (and strongly encouraged) any time a woman of childbearing age loses her reproductive capacity in this way. Even women who have severe bleeding or other issues for whom the surgery will be a relief may find themselves grieving the closing of this door.

Counseling could help to address any ambivalence and assist the patient in knowing what's ahead. It would also help to identify patients, like this one, who don't have a realistic picture of the consequences of their surgery.

The OP handled a dicey situation well. I'm glad the patient had a capable and compassionate nurse to help her cope.

[vapn]

I say you handled it well, but in most states, before performing such a surgery, you must have signed the consent...the one that says that you understand that you will be sterile 30 days before the procedure or surgery is performed unless it is an emergency.

[PostOpPrincess, BSN, RN]

Holey Moley...RISK MANAGEMENT STAT.

Yikes. I feel bad for you--you are in the middle of something you didn't ask for. BE CAREFUL.

[OttawaRPN]

When I am assessing a patient pre-op, there are some questions I defer to the surgeon. Sometimes, the patient has had this conversation with the surgeon umpteen times and thinks that if they ask me they can change the outcome. Other times the patient is simply uninformed.

Legally, it is the doctor's responsibility, not the nurse's to explain the procedure and implications.

Even though this conversation took place post-op, I would have paged the doctor to come up and have this conversation with the patient. I tell the patient, "that is a question that your doctor can answer much better than I can, let me go get him/her for you."

In my practice, it is not the nurse's responsibility to obtain consent, it's the physician's/surgeon's responsibility. The nurse can witness the consent and ensure consent is signed prior to the procedure.

It is the nurse's responsibility to reinforce any teaching required and contact the md if patient seems unclear about any aspect of the proposed treatment, including risks/benefits, prior to having the procedure done. Kudos to the above poster for laying blame where blame is due. In the scenario the OP described, it should have been the surgeon who delivered the inevitable bad news to the patient and her husband, and the nurse to deal with the emotional fallout and provide the needed support and empathy.

[ebear, BSN, RN]

vapn and Ottawa are exactly right. There is a separate consent for sterilization and if pt is married, often requires signature of spouse (may vary from state to state RE: spouse). Physician is totally responsible for INFORMED consent. You can bet that a lawyer would be very interested in this case. Surgeon also should document "procedure explained at length, all risks reviewed, as well as expected course of post-op care. Patient and husband voiced good understanding. Consents for surgery and sterilization obtained." In most states, there is a 3 yr. statute of limitation for medical malpractice.

ebear (CNOR/certified legal nurse consultant)

[HoneyDew70]

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

(I wondered what a "braniac" was ... why would someone's rabid love of bran be cause for insult? And then it hit me ...

Sorry, didn't mean to hijack the thread.)

Wanted to add that I was devastated when my ob repeatedly told me I need an hysterectomy. And she was so casual about it. My world was falling apart and she was smiling? Then days later when I actually read the paperwork it was a "hysteroscopy."

It can be surprising the things we mishear and misunderstand.

[Been there,done that, ASN, RN]

I certainly did not mean to leave out the need for emotional support. That is a given in any situation.

The physiology of the procedure needed to be re-inforced BY medicine, as this problem originates with a mis-communication between physician and patient

[Anna Flaxis, BSN, RN]

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.

I agree wholeheartedly with this. I would not assume that the physician failed to communicate the consequences of the surgery to the patient. I have cared for many patients for whom the teaching seemed, for whatever reason, to have flown right over their heads. I have witnessed patients verbalize their understanding of the teaching, then have a question (or several) that were covered in the same teaching that they previously said they understood.