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Old 05-16-2012, 05:17 PM
 
Location: Love, Epicenter
399 posts, read 493,471 times
Reputation: 385

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I think from paying attention to some of the feedback you all have given and also the information presented at the externship and my inner reaction to it, I realize that one of my biggest issues is probably being more straight forward.

I keep saying I tip toe a lot with patients (people in general) and while it's good to be tactful, I feel I need to get more comfortable sharing what I know without thinking of myself as a "know-it-all" because much of the feedback here seems to be that you all want nurses who are open and willing to educate you and that it's not imposing to do so.

Also, I'm very comfortable (almost too comfortable from the feedback I've gotten from my patients) asking their permission to do x,y,z. I've actually had patients tell me, "Just STOP ASKING!" they wanted me to take more initiative and to just do things, so I think it's a matter of being more assertive for me.
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Old 05-16-2012, 11:18 PM
 
Location: in your dreams
10,892 posts, read 13,019,314 times
Reputation: 15317
I think it's good to explain what's going on. (But not to the point where it's excessively annoying, lol)


I know when I was in the hospital for surgery I was really confused and out of it, a bit scared, and pretty much in shock so it did help when the nurses actually made the effort to communicate with me what was going on and everything.

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Old 05-17-2012, 09:12 AM
 
706 posts, read 1,722,675 times
Reputation: 873
A good nurse would have a sense of which patients can intellectually process medical information, and which ones are better left in the dark. There is no one-size-fits-all.
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Old 05-18-2012, 12:16 AM
 
Location: Bronx, New York
2,141 posts, read 2,454,186 times
Reputation: 3181
Night has a different pace. During the day pts are leaving the floor for tests and procedures. The bulk of meds are given during day shift and. A lot more docs and bosses are around. At night we do a lot more paperwork and have a lot less resources. You have to be a bit more independent. No unit clerks to answer phones. No IV team when you need to start a saline lock. No resource nurse to help with admits and on my unit we do most admits at night etc. The pts also don't sleep as much as you expect they would at night while they are in the hospital. If I have elderly pts with dementia in my block I will be running all night trying to prevent falls. Psych pts take up a lot of time too.

Sometimes I'm having a peaceful night then the lab results we drew at 12am come back and now I have to pick up orders to repleate the pt lytes. I was almost through my shift the other day and tele called. My pt had brady down to a ridiculous heart rate and had a pause too. From calm to trotting briskly down the hall with the EKG machine. Those are the uneventful nights a rapid response or code ( which happens at least once every 3 shifts.) make life really interesting. It's different at night but still busy.

Quote:
Originally Posted by PrinieRN View Post
That's great to hear!

Can I also ask you about the night shift? About how it compares to the day shift? Im doing an externship now but it's all during the day. I kinda want to try that night shift thing.
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Old 05-18-2012, 02:07 AM
 
11,685 posts, read 13,091,702 times
Reputation: 30980
Quote:
Originally Posted by PrinieRN View Post
Hey, I have a question for you guys.

You're in the hospital and the nurse comes to assess you or give you meds, are you okay with him/her teaching about the meds and what she's doing at that moment? Or would you find her teaching you about your health, meds, and wellness as her coming off as a know-it-all?

What would you want?
I don't mind being taught at all, and I very much want the instruction. But I do have two caveats.

I certainly expect the nurse to find out first what my experience with my current meds has been. The fact is I have the experience of the effect of my current meds on my body, and that experience trumps what the textbooks says the effects should be.

I am an intelligent, older adult with a long, complicated medical history. I have survived and expanded my life far beyond what was ever predicted, and I always discuss medicines and medical treatment in depth with a doctor. I am not a passive patient.

Respect my experience with my body and its problems, and I will eagerly listen to you. I feel that I need to learn about my medications and treatment....and in my experience nurses are often as savvy, if not more so than doctors.

Just this past week I had a very unfortunate experience, however, with a hired nurse in my home. She presumed that I was ignorant and that physically I was an infant....she got off on the wrong foot the first day while familiarizing herself with my current medications, trying to explain them to me as if it were day #1 for me too, and as if I had never seen or heard of medications that I have been taking for years, when we had just reviewed my history.

Big mistake.

By the third day her attitude had become so intolerably bossy and presumptuous that I got out of bed, walked to the door and ordered her out, and then called the service that sent her to inform them and tell them why. (I suspect that this woman simply needed to feel she was in absolute control in order to feel secure with a patient.) I refused their offer of a replacement, and hired a retired nurse who lives in the neighborhood.

She has been the exact opposite. Day #1 we reviewed meds and past medical history together - as a team, and then she had a few things she wanted to check with the doctor afterwards, and that was fine with me. This woman respects me and I respect her; I am actually enjoying my days better now because she isn't a control freak and we are helping me together. She has acqainted herself with my limitations, rather than trying to impose her own regimen. She knows that she is a professional nurse, not a boss or a mommy. What a relief!
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Old 05-18-2012, 02:57 AM
 
Location: North Carolina
102 posts, read 271,738 times
Reputation: 221
I'm a third semester nursing student (graduating nursing school May 2013), and that's in our job description. We are to educate the patient about the procedures we are performing, the medications the patient is receiving, any special equipment that is in the room (JP drains, Hemovacs, PCA pumps, chest tubes, NGs, feeding tubes, vents, etc). We are also to provide condition-specific information related to the patient's medical diagnosis. As nurses, we have to formulate nursing diagnoses with interventions, and we usually have to provide teaching regarding this information as well. Discharge instructions are also considered teaching, and that is part of our job as well.

When I go into a patient's room, teaching isn't the first thing on my mind. I make sure the patient is medically stable, pain free, and comfortable. I address immediate physical, physiological, and psychological needs. I think ensure that the family has everything that they need. If all of these criteria have been met, I come back in the room and begin my teaching. I will say things like, "you have a PCA pump, can you describe to me how to use it?" If the patient gives a sufficient explanation, I just back up the important points and move on. If the patient cannot effectively explain the device, then I explain fully.

For other equipment, like drains, I do all the explaining. I ask, "what have you been told about this JP drain?" I then base my teaching on what the patient already knows. If the family is in the room, I also ask them if they have any questions that I can answer.
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Old 05-18-2012, 03:15 AM
 
Location: Bronx, New York
2,141 posts, read 2,454,186 times
Reputation: 3181
Yes...respect is key in the pt/nurse relationship. You have to assess the pts prior knowledge and willingness to learn before the teaching begins. The relationship can be permanently soured by coming off as a know it all or trying to force the teaching when the pt is focused on something else. Strong people skills and high emotional IQ are just as important as knowledge and hands on skills.




Quote:
Originally Posted by kevxu View Post
I don't mind being taught at all, and I very much want the instruction. But I do have two caveats.

I certainly expect the nurse to find out first what my experience with my current meds has been. The fact is I have the experience of the effect of my current meds on my body, and that experience trumps what the textbooks says the effects should be.

I am an intelligent, older adult with a long, complicated medical history. I have survived and expanded my life far beyond what was ever predicted, and I always discuss medicines and medical treatment in depth with a doctor. I am not a passive patient.

Respect my experience with my body and its problems, and I will eagerly listen to you. I feel that I need to learn about my medications and treatment....and in my experience nurses are often as savvy, if not more so than doctors.

Just this past week I had a very unfortunate experience, however, with a hired nurse in my home. She presumed that I was ignorant and that physically I was an infant....she got off on the wrong foot the first day while familiarizing herself with my current medications, trying to explain them to me as if it were day #1 for me too, and as if I had never seen or heard of medications that I have been taking for years, when we had just reviewed my history.

Big mistake.

By the third day her attitude had become so intolerably bossy and presumptuous that I got out of bed, walked to the door and ordered her out, and then called the service that sent her to inform them and tell them why. (I suspect that this woman simply needed to feel she was in absolute control in order to feel secure with a patient.) I refused their offer of a replacement, and hired a retired nurse who lives in the neighborhood.

She has been the exact opposite. Day #1 we reviewed meds and past medical history together - as a team, and then she had a few things she wanted to check with the doctor afterwards, and that was fine with me. This woman respects me and I respect her; I am actually enjoying my days better now because she isn't a control freak and we are helping me together. She has acqainted herself with my limitations, rather than trying to impose her own regimen. She knows that she is a professional nurse, not a boss or a mommy. What a relief!
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Old 05-18-2012, 02:18 PM
 
12,440 posts, read 14,569,865 times
Reputation: 14146
Quote:
Originally Posted by PrinieRN View Post
Hey, I have a question for you guys.

You're in the hospital and the nurse comes to assess you or give you meds, are you okay with him/her teaching about the meds and what she's doing at that moment? Or would you find her teaching you about your health, meds, and wellness as her coming off as a know-it-all?

What would you want?
Absolutely!!..it's exactly what I would hope a good nurse would do....and I appreciate them going through it step by step.
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Old 05-18-2012, 03:47 PM
 
Location: Love, Epicenter
399 posts, read 493,471 times
Reputation: 385
Quote:
Originally Posted by NCRNStudent View Post
I'm a third semester nursing student (graduating nursing school May 2013), and that's in our job description. We are to educate the patient about the procedures we are performing, the medications the patient is receiving, any special equipment that is in the room (JP drains, Hemovacs, PCA pumps, chest tubes, NGs, feeding tubes, vents, etc). We are also to provide condition-specific information related to the patient's medical diagnosis. As nurses, we have to formulate nursing diagnoses with interventions, and we usually have to provide teaching regarding this information as well. Discharge instructions are also considered teaching, and that is part of our job as well.

When I go into a patient's room, teaching isn't the first thing on my mind. I make sure the patient is medically stable, pain free, and comfortable. I address immediate physical, physiological, and psychological needs. I think ensure that the family has everything that they need. If all of these criteria have been met, I come back in the room and begin my teaching. I will say things like, "you have a PCA pump, can you describe to me how to use it?" If the patient gives a sufficient explanation, I just back up the important points and move on. If the patient cannot effectively explain the device, then I explain fully.

For other equipment, like drains, I do all the explaining. I ask, "what have you been told about this JP drain?" I then base my teaching on what the patient already knows. If the family is in the room, I also ask them if they have any questions that I can answer.
Hey fellow class of 2013.

I think you have a good strategy and I'll give it a try to see how it fits with my own style of communication.
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Old 05-18-2012, 03:52 PM
 
Location: Love, Epicenter
399 posts, read 493,471 times
Reputation: 385
Oh my...I'm very glad that you got yourself a a nurse that treated with you with the respect you deserved. I know that sometimes people have a tendency to treat and speak to older people like they're babies which isn't fair . You really do have to work with people where they are and it's frustrating (imagining myself in your situation) having people just coming into your life and deciding that their way is the right way. That was very rude. But I'm glad you got someone who was willing to collaborate with you on your care plan, as it should be.

Quote:
Originally Posted by kevxu View Post
I don't mind being taught at all, and I very much want the instruction. But I do have two caveats.

I certainly expect the nurse to find out first what my experience with my current meds has been. The fact is I have the experience of the effect of my current meds on my body, and that experience trumps what the textbooks says the effects should be.

I am an intelligent, older adult with a long, complicated medical history. I have survived and expanded my life far beyond what was ever predicted, and I always discuss medicines and medical treatment in depth with a doctor. I am not a passive patient.

Respect my experience with my body and its problems, and I will eagerly listen to you. I feel that I need to learn about my medications and treatment....and in my experience nurses are often as savvy, if not more so than doctors.

Just this past week I had a very unfortunate experience, however, with a hired nurse in my home. She presumed that I was ignorant and that physically I was an infant....she got off on the wrong foot the first day while familiarizing herself with my current medications, trying to explain them to me as if it were day #1 for me too, and as if I had never seen or heard of medications that I have been taking for years, when we had just reviewed my history.

Big mistake.

By the third day her attitude had become so intolerably bossy and presumptuous that I got out of bed, walked to the door and ordered her out, and then called the service that sent her to inform them and tell them why. (I suspect that this woman simply needed to feel she was in absolute control in order to feel secure with a patient.) I refused their offer of a replacement, and hired a retired nurse who lives in the neighborhood.

She has been the exact opposite. Day #1 we reviewed meds and past medical history together - as a team, and then she had a few things she wanted to check with the doctor afterwards, and that was fine with me. This woman respects me and I respect her; I am actually enjoying my days better now because she isn't a control freak and we are helping me together. She has acqainted herself with my limitations, rather than trying to impose her own regimen. She knows that she is a professional nurse, not a boss or a mommy. What a relief!
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