Nursing school 1983 - the nursing students are being taught how to deal with the difficult patient - the patient is difficult because they have lost their autonomy, help them cope by giving them choices to make, for instance "do you want your bath now or in an hour?"
Present day ER - The seasoned ER RN is attempting to triage a medical clearance patient brought in hog-tied by the police. The patient has refused to speak to the police or the jail personnel so apparently that makes him 'medically unstable' and in need of clearance so he can be booked. The nurse is attempting to get a temperature and the patient is pretending she isn't there. The nurse realizes that the patient is being difficult because he has lost his autonomy so to help him she gives him choices.
"Do you want to open your mouth so I can take your temperature or do you want me to take it in your butt? I don't care either way but I am busy and we ARE going to get this done."
The patient opened his mouth.
It may be not so much about giving choices but in how you present them.
Wednesday, December 3, 2008
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19 comments:
Awesome
A drug-seeker who was rambling off partial med names/phonetics/made-up-shit once told me I needed to learn to write faster b/c I was having a hard time keeping track of his disjointed med list.
My response slipped out before I had a chance to think about what I was going to say.
"I write fast enough. Maybe you should remember to write down your medications like a big boy"
His wife (and the entire ER staff) just about died laughing.
*snort* They told us that in nursing school 3 years ago. Perhaps one of the reasons I dropped out.
Ya'll have all kinds of respect from me. I couldn't do it (and I knew it). I'll take my ambulance any day of the week over patients in the ER. At least I can get rid of them faster....
Perfect.
I do the same thing when patients are being difficult in the rooms, too. As in "do you want to get into a gown so I can examine you or should I go get the trauma shears?"
LOL. Sometimes you just have to make the choices crystal clear.
Very good - I have just woken up after my night shift in ED - always check in daily.
Back tonight for more.
"Do you want to take this risperdal by mouth or do you want to be tied down and get a shot in the butt?"
Heh. That was this semester for me. My professor thought it was funny that MY idea of giving a patient a "choice" was "You are GETTING a bath. Would you like to use THIS shower, or THAT shower". Then I turned and said "see??? It's a CHOICE!"
LOL! I'd open my mouth, too. Also, Risperdal PO, any shower is fine, and I'll just change into this little gown thingy, thanks.
Whatever happened to those tympatic thermometers, tho? Have they gone out of fashion already?
I'm a big fan of the, "Listen up, motherfucker. We're doing this my way, or I will pound a cubic meter of sand up your ass with my foot!" approach.
Hello ERNursey,
Excellent approach. I've heard of it before and I know it works.
CrankyLitProf, you're tenured right?
Cheers,
Jeff Deutsch
That is what we're taught to used when de-escalating situations in psych. Generally tends to work. Generally... :)
I love it!
I have found as a rehab nurse, if you really want to scare the cr*p out of some uncooperative people tell them what you'll put up their arse if they don't cooperate.
Works every time. But the docs who order rectal temps for adults really scare me.
I always let the patient know that the doc did it when they're ordered, so they can chew them out when they see them.
That is so true, sometimes thats the only way to get things done.
Yep, had one last night. Didn't want to give us his pee for tox. "Okay, I need you to pee in this bottle. If you still can't, then I have to put this-hold up for effect-catheter in to get some." "Oh, why didn't you say so? Sure, I'll pee in the bottle."
Got a half-dull urinal bottle from the guy.
Works every time. ;-)
I'm a nursing student. I am by no means timid and I feel fairly confident about a lot things. I really like my current idealistic attitude if only because I know one day it will evolve into something else and I kinda like seeing the world with "new eyes". That being said, I am actually looking forward to the day when I can feel confident enough to take some of the filter off of things I say to patients. I know it's something I need to work on as I've been had a couple of times even when I knew the wool was being pulled over my eyes. In my school words like "assault" and phrases like "don't lose your license before you get it" have been tossed around frequently and so I haven't quite gained the guts to give...um...*FIRM* choices LOL What a great post!!!
Eck....brings back memories of my years in the ER. My last night in the ER was spent trying to get an IV into a 4-year old with status epilepticus---while his mother was ordering pizza on the phone next to his seizing body. (So I left the ER to the younger, more "energetic" crowd...)
Anon,
Your stage of it is appropriate. I still say 'err on the side of respect for your patient.'
In the above cases, all you're really doing is handing the patient a menu and waiting to take their order.
Column A or Column B? Oral temp or rectal? Pee bottle or cath? PO med or suppository?
See, we're really just playing waiter/waitress. The only problem is that sometimes we get just a little pleasure from outsmarting them.
;-)
Would you like your bloodtests here on a trolley, or in the police station pinned down?
lol...I loved this post! It's so true that choices like these do work!
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