Are We Hearing the Questions that Patients and Their Families Don’t Ask?

“The spoken and unspoken messages we give patients and families are powerful.”

Viewpoint author Juanita Reigle

As a ‘frequent flyer’ of late, accompanying a family member on the long trek through cancer treatment, I’m acutely aware of the ways in which doctors and nurses communicate with us. Some have never mastered the art of interacting with people in stressful conditions. Others have remarkable radar and a special ability to “read between the lines,” identifying concerns that he and I haven’t yet voiced.

In ‘She’s Fine,’ the Viewpoint essay in AJN’s October issue, Juanita Reigle reflects upon how we respond to the questions patients and family members don’t raise. Some are left unasked because people are too overwhelmed to formulate a question. Some people aren’t ready to hear the answers. And sometimes, sadly, families sense that this doctor or nurse really doesn’t want to engage with them.

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Student Errors in the Clinical Setting: Time for Transparency

Mistakes happen.

When I was working as an ED nurse, we often had nursing students assigned to the area. One day we had an elderly man with asthma in one of the treatment rooms. The physician ordered aminophylline suppositories. After reviewing the “5 rights”—right patient, right medication, right dose, right time, right route—I directed the student to administer the suppositories. All seemed well.

Imagine my surprise when the student proceeded to insert the suppository into the man’s nose! She explained that since it was a breathing problem, she naturally thought they would be inserted nasally. It never occurred to her that these were rectal suppositories and it never occurred to me to ask if she knew what to do with them. We all had a good laugh and that was that.

Undocumented errors.

Another day, another patient, another faux pas: a physician said to “cut the IV,” which everyone knew (that is, we assumed everyone knew) meant to discontinue the patient’s IV. One of my colleagues intervened when she saw a determined-looking student, with bandage scissors in hand, approach the patient’s room, ready to “cut the IV.” We again marveled at the student’s interpretation of the phrasing, and that was that.

And that’s the problem—that was that. There was no documentation of these as “near-miss” errors, and while some of […]

The Words We Use to Talk About the Act of Suicide

    marie + alistair knock/flickr creative commons

Suicide. A dear friend of mine died this way almost 40 years ago, leaving behind a beautiful six-month-old boy and a beloved and loving husband. I have never given any thought to the way we friends and family refer to her death. Then last week, I came across a 2015 blog post by the sister of a man who died in the same way.

In the post on a website that shares experiences of disability and mental illness, former hospice social worker Kyle Freeman argues that this term suggests criminality. She points to laws in the U.S. that, until a little more than 50 years ago, defined suicide as a criminal act. Kyle feels this history has perpetuated a sense of shame and embarrassment in survivors.

“…the residue of shame associated with the committal of a genuine crime remains attached to suicide. My brother did not commit a crime. He resorted to suicide, which he perceived, in his unwell mind, to be the only possible solution to his tremendous suffering.”

Kyle believes that the common use of the phrase “committed suicide” is not only inaccurate but can add to the suffering of those who have lost friends or family in this way. She prefers the term dying by suicide. […]

Please Nurse: Needing to Feel Human Again in the ICU  

Ruby Vogel circa 1970. Courtesy of Shannon Perry.

The patient perspective below was written by Ruby Vogel in 1976, shortly after she was discharged from the hospital following a cholecystectomy and colon surgery. Her daughter Shannon Perry, PhD, RN, FAAN, professor emerita at San Francisco State University, recently received the document from her sister, also a nurse and former nursing educator, to whom their mother had originally given it.

According to Perry’s sister, who found the document while cleaning out some files, Vogel had thought her daughter could use the information to help her students understand the experiences of patients in the ICU. Some things were different back then—for example, says Perry, a cholecystectomy and colon surgery were major surgeries with several days in the hospital for recovery. But some things stay the same, and this vivid account highlights how patient-centered care—a touch, a hand on the brow—can make the difference. Ruby Vogel died in 1985.

Intensive care put me in a different world—of noises, silly ideas, and feelings. I seemed apart from people. They came and went but I wasn’t people, just that big sore place. I could hear and I could see. People didn’t seem to speak to me nor stay around long enough for my eyes to focus or my lips to form words. In and out. Checking! Checking! Checking! I could see and hear. Family, nurses came in, took a look and left. I was still there.

That awful machine next […]

2017-09-11T10:45:55+00:00 September 11th, 2017|patient experience, Patients|0 Comments

How Long Should Routine Health Screening Continue in Older Adults?

Photo by Johner Images / Alamy Stock Photo

Communicating to older patients that routine screening tests are no longer recommended can prove difficult. Recent research, however, offers guidance on how nurses and other clinicians should approach such conversations.

As we report in a September news article, a study focused on cancer screening found that older adults unlikely to benefit from certain tests were receptive to recommendations to stop screening, with a caveat: they preferred that life expectancy not be a part of the conversation.

The study’s accompanying editorial notes that broaching the topic of life expectancy can turn a discussion about maintaining health into an unexpected discussion about the end of life, which “may be a shock in the primary care setting at a routine visit.” The authors of the study recommend changing the language used in these conversations—for example, saying “This test would not help you live longer” instead of referring to “life expectancy.” […]

2017-09-06T09:21:09+00:00 September 6th, 2017|Nursing, patient engagement|1 Comment