Difficult patients and their family
While working with my patient one night I knew before I walked into the room that it would trust my abilities to be patient (something I am not known for) and ignore insults. Before I walked into the room I could hear muffling crying sounds and “kvetching” as us Jews call it. I opened their door, let’s call this pt Mrs. B., and found her shaking while holding the hospital phone, a distinct odor (most likely passing gas from having surgery), and her with this look on her face. Her face was scrunched in disgust, wet cheeks from crying and her hands trembling from stressing herself out. I introduced myself, with a smile on my face, asked her what I could do for her. First response I get out of my patient, whom I have never met before, was “Who the fuck are you? Can’t you see what’s wrong? This place is so full of confused people who don’t know anything.”
As someone who has been cursed out for no reason, by my patients, this wasn’t a big deal and didn’t get to me. During this time I had 3 other patients who were needing much more attention at this time. Spending more time a healthy patients room tends to happen more than we wish. Usually these patients take our attention because of the fact that they can speak, walk and complain. I had 3 others who either couldn’t communicate, needed total care assistance and giving their medications can take a long time.
This wonderful lady Mrs. B had me in there while she vented about many things. As she listed these issues I thought a few things in my head. 1) Why is she blaming me for something I wouldn’t know since I just met this woman. 2) None of this information is true, 3) Let me explain the correct information so the family doesn’t get conflicting information.
I attempted to calm her down however at certain times, there is nothing you can do. She wouldn’t get off of the phone and I wanted to prevent a conversation on both sides of her head. As someone who is already overwhelmed, I didn’t want to add to this distress. The moment she hit the red “hang up” button on the hospital phone she turned to me. Before I could even consider saying something she yelled at me again. I calmly spoke to her and offered my knowledge and resources to the doctor’s notes in the computer. She agreed, to my surprise.
I then read her the notes explaining why to her questions: Why this medicine? Why am I on contact precautions? Why am I quarantined? Why do I need these blood tests? Why do you need to test my urine? Why am I still here? Etc.
These questions I could answer with ease, as all answers are in the chart. After each answer I gave, I was met with more resistance from the patient. It seemed as though anything I could say, wouldn’t get what she wanted; something magical to get her pain free and less frustrated with the past experience in her current hospital stay. It had been a good amount of time after I left. After wearing the contact gown and gloves my body was sweaty, my hair stuck to my skin and I had my other patients to see, nurses needing a witness for insulin, nerve blocks and more that required my full attention.
As my hands were being dried with paper towels my hospital phone range with an outside number. As I threw the paper towel in the trash I knew what was coming. I was right, the patient’s family was calling to chew someone out and I was the person to chew out. It didn’t matter that I had only spoken to the patient once so far and that I didn’t give her the information that had upset her.
First words I hear on the phone “Hi, this is Mrs. B’s sister, is this her nurse for the night”? I immediately wanted to say no, but instead I said “Yes, my name is ********, what can I do for you?” they immediately went to their strong voices and accusations and confusion about the conversation. I then calmly had told them that this information was simply just a misunderstanding without setting blame on anybody. I decided education is the best way to prevent further issues. By the end of the conversation the family members on the phone were relaxed, relieved and no longer shouting. They thanked me for spending time with me on the phone and I said I was happy to clear up any confusion and fears they had.
When I went back to the door of the patient’ room I could hear her crying and calling her family once again. The same information she relayed the first time. Education is important for patients in the hospital, but you cannot control how much they absorb and understand, or want to understand.
Fast forward to the early morning hours of my shift and then comes the can of worms. I don’t mean a can that can be held in one hand, it’s more like a tub or massive tank of worms.
Sitting outside of the room charting away I could hear coughing and something that sounded like crying. She hit the call bell and my PCT when to go check on her. I can hear louder coughing, crying, whimpering and the words “trouble breathing”. These words mean a lot to a nurse, doctor etc. I jumped up from my chair, put my gown on and then went into the room.
I ask her to hear it in her own words. As she is coughing I hear “I can’t stop coughing and am having trouble breathing”. I grab the pulse ox near our vitals machine and turn towards Mrs. B. Immediately she gives me a look of hate and confusion, did not know anybody could feel both things at the same time or even show it on their face. She turns her head towards me a bit more and says “what the fuck do you think you’re doing with that?”. I try to explain to her that this will help us to see the oxygen in her blood, to make sure she’s getting enough air. I then tell her it will help us to know if she needs oxygen during this breathing trouble and coughing issue. Before I can even bring my hand closer to her finger she yells at me “This hospital doesn’t know what they are doing. I tell you I’m having trouble breathing and you don’t know what to do. I’m in pain and you do nothing!”. It doesn’t matter what I say or do, but her mind is made up. She will no longer listen to my advice or explanations. As a nurse I can tell when my words will reach a patient or not.
She then continued on swearing, shouting and insulting me, the hospital, doctors etc. Within minutes she called again with her call bell and started asking for pain medications.
