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Are You Listening to Your Patients?

A nurse learns valuable lessons about paying attention when a patient reports feeling worse than you think they should.

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According to public opinion polls, nurses are the most trusted professionals.  Trust and active listening are integral components of the nurse-patient relationship. 

Most nurses would also probably feel confident in stating that they always trust what a patient tells them is happening at any moment in time.

As a nurse, I also believed that I always took the time to listen to my patients, to be present and to value their input in their treatment. 

However, in the busy, stressful environment in which nurses practice on a daily basis, our patients' concerns or feelings may get lost. 

It took me donning a hospital gown to renew my commitment to actively listen to my patients.

Not Quite Right

A short while ago I was told that I needed surgery. As a nurse I knew that a laparoscopic cholecystectomy was routine, and I felt confident checking in for surgery. 

On the day of my surgery, I changed into my hospital gown and laid down in the hospital bed. 

As I waited for the OR to call for me, I thought about what a strange perspective it was to be on this side of the bed.

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My surgery was uncomplicated but my surgeon wanted me to stay overnight for observation.  Still groggy from anesthesia, I snoozed on and off for a couple of hours, had a dinner consisting of the world's best Jell-O, and visited with family and friends. 

Just as visiting hours were ending I began to feel very ill.  I became diaphoretic, lightheaded, and the room began to spin.  I rang the call bell. 

"Can I help you?" the nameless voice from the wall asked. 

"I need my nurse please" I asked, ashamed that I was being such a difficult patient. 

About 20 minutes later the harried night nurse appeared at the door.  No introductions were offered.

I quietly explained that I did not feel "right."  I explained that I felt clammy, lightheaded, and nauseous after feeling well all afternoon.  "You are probably just tired," she said.  I lay in the bed wondering if maybe I was. 

"Can we at least check my blood pressure, to put my mind at ease? "  I asked.  "I have this bleeding problem, and ." 

"I know, you're the one that's the nurse," she replied. 

The nurse agreed to humor me and walked out of the room.  Five minutes later she reappeared without the blood pressure machine. "The aide says she just checked your blood pressure and it was 136/86," she said.

Lying there, I waited to hear the Twilight Zone theme song play. 

I pled my case, feeling there must be some confusion; no one had taken my blood pressure since my arrival on the unit. The nurse continued to insist that the aide had just taken my blood pressure and that it was fine. 

As I lay there in bed, I had begun to think about the situation. Why was my nurse not listening to me? After all, wouldn't a patient know themself best? 

I wondered if had ever treated a patient this way. I thought through my years of experience and hoped I had never easily dismissed a concern a patient had.

My nurse relented and agreed to take my blood pressure "again." I lay there with the room spinning, waiting for the verdict. The machine beeped and the red numbers appeared on the screen: 90/52. 

The nurse diligently sprang into action hanging IV fluids and checking to be sure my blood pressure responded to the boluses. 

I felt better after some fluid and was able to go home the next day.

 Lingering Questions

After my recovery I returned to those questions that had spun around in my head that night.  I

revisited the events and again felt my nurse initially did not value what I was telling her.  Why would nursing staff not value what their patient was telling them? 

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I explored this thought more and resolved to always "hear" my patients and to trust what they tell me - even on the busiest of days. 

As easy as it is to get busy with patient care and a myriad of tasks to perform, we need to remember that if a patient expresses a concern, we have a duty to investigate it as set out in the ANA Code of Ethics.  In this situation, the moral and ethical compass was clearly broken. 

As professionals, these ethical standards should be paramount to the care we provide.  Healthcare professionals are the experts - that is the purpose of the vigorous nursing school programs that aim to prepare us for any situation. 

However, the truth of the matter is, when it comes to the patient, they are the expert in the field of knowing themselves.  By resolving to take the time to be present and really listen to our patients, we can address their concerns, hopefully offering some comfort along the way. 

By doing this, nurse and patient can form a team of experts, ready to embark on their journey together.

Jennifer Allis Vazquez is Organ Procurement Coordinator, LifeChoice Donor Services, Windsor, CT.


 

I totally agree with Karen's comment. Taking the time to listen or explain things to patient's and families and do the "little things" to make them comfortable has taken a back seat to getting all the computer charting and paperwork done.The people who manage to always get out on time are praised for their ability to "manage time wisely" because that saves the hospital money. I think management should review their priorities.

Mary KellerDecember 03, 2012



Very good points. As a healthcare provider as well, it would be well for ALL of us to listen to this message, MD's included. I have not had a PCP for almost a year because no one wants to take time and listen to the Pt's concern anymore. It's rush them in and rush them out. We have dehumanized the Healthcare profession and made our professionals mere robots to get the most profit for our work.

Paul F,  ParamedicDecember 01, 2012
CT



I am a bedside nurse with 31 years of working. I work long hours ("12 hour") shifts turn into 14 & 15 because I stay at the bedside, listen to my patients, teach, make sure the medical interventions are appropriate and if not get moving to make sure the md has the correct information to make the right choices for my patients. I make sure my patients are toileted safely and have their teeth brushed. To do all that I should only have 4 patients. That makes room for if one goes bad and if I have an admission which is like having two patients the amount of work it takes. My point is that I work "off the clock" to get all this done. My patient care comes first and then comes the computer. There is too much computer time a nurse has to do and it clearly takes up too much valuable time that is needed at the bedside listening to patients and families. I am told by my patients that I am "such a great nurse." No, I am just doing the basics of nursing care. It is virtually impossible to do this and get off the clock. As a nurse you get reprimanded verbally to get off the clock and "it is a 24 hour job, time management" etc. These are just excuses and a knowledge deficit on what it really takes to be at the bedside.

Karen November 30, 2012



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