Dialysis Patients’ Very Different Life or Death Choices

Illustration by Barbara Hranilovich. All rights reserved. Illustration by Barbara Hranilovich. All rights reserved.

This month’s Reflections essay is called “Sitting with Death.” The subtitle provides a little context: A social worker on a dialysis unit bears witness to patients’ life or death choices. Despite the sad stories the author tells, this remembrance doesn’t leave a reader feeling disheartened.

Retired social worker Linda Converse writes that starting work at a dialysis center was at first daunting. How could she talk to patients about such an ultimate choice as whether or not to give up dialysis?

But over time she began to understand that there was usually no right answer. For each person, there was a different personal algorithm that guided the choice, one based on such factors as quality of life, obligations to loved ones, values, and much else. Writes Converse:

I’ll never forget some of the patients who chose to stop dialysis, nor will I forget those who chose to hold on for as long as possible. There was no consistent logic when it came to an individual’s choice. What one person considered an impossible quality of life, another wouldn’t.

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December 5th, 2016|patient engagement, patient experience|0 Comments

The Primary Care Confessions of Traumatized Patients

drawing of patient in waiting room Illustration by Hana Cisarova. All rights reserved.

In this month’s Reflections essay, “The Traumatized Patient,” family nurse practitioner Margaret Adams delves with sympathy into what she calls the “primary care confessions” of a challenging subset of patients. Writes Adams:

I’ve come to recognize patients like you—sometimes by your disturbingly long and detailed allergy lists, but more often by the frequency with which you come in for the same constellation of symptoms: fatigue, headaches, dizziness, general malaise. Something happened to you— maybe years ago, maybe recently—and it left its mark on you in irredeemable ways, . . .

While symptoms often do have underlying physiological causes, Adams is likewise attuned to the emotional subtext behind certain seemingly fruitless patient encounters. And with many specific examples, she makes the case here that the life of trauma plays itself out over time in the body and mind. […]

October 18th, 2016|Nursing, nursing stories, patient engagement, Patients|0 Comments

What Patients Told

By Marti Trudeau, RN, CPHQ, MPA, director, University City State Programs Office, BAYADA Home Health Care, Philadelphia

ky olsen/via Flickr ky olsen/via Flickr

I was anxious as I arrived at Mr. Johnson’s house. He was my first centenarian patient. He lived alone, taught Sunday school, and had no ailments. He didn’t need help, but his family thought he should occasionally have a nurse visit. After assessing this healthy man, I asked him, “What has helped you live so long?”

Surely he’d been asked this question many times, yet he thoughtfully answered, “Every morning I wake up, drink a large glass of water, then look in the mirror and smile.”

“You drink a glass of water?” I responded.

Listen to what I said, sweetie,” he answered.

I recall this because when patients called me “sweetie,” I would say, “Please do not call me sweetie, and feel free to call me Marti.” But I didn’t say anything to Mr. Johnson. I figured that at 101 years of age he could call me anything.

Weaving through my mind as I left were the words, “Every morning . . . water . . . ” Thus began my habit of drinking a large glass of water each morning—not exactly what he recommended, but what I heard at the time.

Through the years, patients told me many things.

Sometimes my effort to comprehend […]

All Unhappy Patients Are Not Alike

illustration by the author illustration by the author

The first sentence from Leo Tolstoy’s novel Anna Karenina is one of the most famous in literature:

All happy families are alike; each unhappy family is unhappy in its own way.”

It can easily be applied to patients. Happy patients tend to love their doctors, feel they received the best possible care, and consider their nurses invaluable.

Unhappy patients are unhappy in their own way. The challenge for busy nurses is resisting the temptation to turn a deaf ear or feign listening, in effect reducing patients’ concerns to “waa, waa, waa.”

A common thread among unhappy patients is unmet expectations.

Sometimes the patient’s expectations are unrealistic because they’re based on incorrect assumptions—but they do not know this. Responding requires a willingness to listen and the patience to tease out why a patient is unhappy with their care. Let patients tell their stories. Most bedside nurses have limited time; it’s okay to enlist help from a case manager, social worker, or nurse navigator if necessary. However, investing time up front to improve communication with a patient may pay off in dividends by smoothing the rest of your shift.

Begin by listening. Sometimes, I’ll take a seat, and write what the patient says while they talk. This simple act conveys their complaint is taken seriously, and helps […]

Daniel

jen promesJennifer L. Promes is a gerontological clinical nurse specialist and Magnet Program director in Omaha, Nebraska. In this post, she describes an experience she had early in her career while working as a certified nursing assistant in a nursing home’s memory support unit.

Daniel had a kind, mild-mannered disposition, but because of his advanced dementia he would sometimes become agitated and belligerent, especially at night. Most of the staff didn’t want to help him prepare for bed. I knew Daniel was much more cooperative if you distracted him by talking about his past, so one night I volunteered to help him with his personal care.

All of the residents had just finished their evening meal and were waiting patiently at their tables to be assisted back to their rooms for the night. As I approached Daniel–a short, stocky bald man in his late 80’s with thick-rimmed glasses, always dressed in a button-up flannel shirt, polyester slacks, and square-toed, diabetic shoes—I could tell he was “working on something.” He had a table knife in his hand and was prying at the seam between the two leaves of the table. He was quietly muttering something under his breath as he worked, his head nodding as he grew more tired.

Daniel would “fix” anything he could get his hands on. A farmer […]