What is Wrong With Me?
Sweat beads on my forehead, my heart is racing, all ready for the next round of EMS patients that are soon to arrive to my trauma bay. It has been a long night so far and we are tired, I have not eaten or peed in 8 hours, but a family has been involved in a crash on the interstate and their van was fully engulfed in flames. I hate crispy critters, the smell of burning flesh stays on your mind for days. The call bell is ringing again.....ding....ding....ding....ding, that "crazy nut job lady" in room 13 wants a snack.......again. She is waiting on psychiatric placement due to depression and suicidal ideations and I can so totally relate to her, since I have depression myself, I could be her, she is somebody's mom.
Adults, children, infants no matter, their faces don't really matter, we call them by their condition,complaint or problem, we give them funny code names and laugh at each one: The "gunshot wound guy" in T1, "the skull fracture kid" in T2, "Code Tooth" dental pain chick in room 4, the confused mamaw UTI in room 1, " the nut job in room 13"...........wait, what is wrong with me?
I could be anyone of these people, my family has been these people, these people are human beings!!
These people have names, they are someones father, mother, child and grandmother. I am a mother, a daughter and a wife to someone. I am a human being too, would I like to be called "the nut job lady" in room 13.....NO!
Patient and Family Centered Care
In the world of healthcare speak we talk about patient centered care, many methods, models and hours of research have been spent on this topic.
Patient-centered care supports active involvement of patients and their families in the design of new care models and in decision-making about individual options for treatment. The IOM (Institute of Medicine) defines patient-centered care as: "Providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions." (from Wikipedia)
In the emergency department our focus has to be centered around the patient, they are our focus, but that patient is also a person, with a family, a life outside, a job, pets, children etc. Focusing on the person as a whole is imperative to complete care. Patient and family centered care is a better approach to healthcare that integrates all the players in the game. It encourages a collaboration of healthcare with patient and family as a whole.
Leaning The Hard Way
I have learned the hard way that listening to the patient and their family will not only save you as the nurse time, it will save you embarrassment in front of the family when they are right and you are ultimately wrong because you did not listen. I have been the family member sitting at the bedside myself, my husband has multiple health issues so we have been in and out of many doctors offices, emergency departments, clinics, intensive cares etc. Feeling scared and alone with a 4 month old infant in a baby carrier , we found ourselves 3 hours away from home at a huge teaching hospital, our world turned upside down when a post-op infection took over my husband's (of less than a year)
body. I learned very quickly that there was no patient-family centered care there, nobody seemed to listen to me until I grew a set of brass "kaunas" and let them know that I was a nurse, this was my husband and I demanded something be done NOW! I hated to act like a totally B@$%, but he was dying in front of my eyes.
Learning from others mistakes has made me a much better nurse today, I listen to the person and his/her family now, even if they just want to tell me about their children, pets or where the best place to draw blood might be.
Setting The Bar- Leading By Example
It is so easy to fall into the norm of everyday work and act just like your co-workers, I am just as guilty I admit. Nurses in the ER develop a different style of coping mechanism I think, I use humor to help me get thru my shift and just get home. It in no way is a personal attack on anyone, our humor is not very respectful at times, I will admit. When faced with such horrific realities of death, destruction and violence we want a way to turn off the negative and be positive. It is hard to just keep smiling when your patient just called you names or cursed you because they have to wait to long or did not get the narcotics they desired.
Hard as it might be to focus on each patient as an individual person, worthy of your time and care, they all deserve care that is respectful. Communication is a key tool, involving the family and patient in what is going on helps to relieve stress and decrease anxiety.
You can set the bar high and lead by example, other nurses watch how you interact with your patients, families and other healthcare team members. Even well seasoned nurses like myself can learn valued lessons that lets us focus on our "human" patients, not the "nut job lady in room 13".
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