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Monday, November 19, 2018  

Healing with hearts and hurting with wordsPublished 10/6/2003

When nurses get together in the workplace it only takes a minute to tell each other what their patient load is like. I work in CCU and it goes a little like this "I have a two day post CABG and a patient with new onset renal failure." We understand immediately what is meant by this description.

From our point of view a two day post CABG is ready to transfer out of the CCU. New onset renal failure will be there a couple of days to determine if it is renal failure long-term requiring dialysis or a renal insufficiency that the patient may rebound from.

There is no loss of patient confidentiality in this conversation and no disrespect from a nursing point of view.

We as nurses have learned to protect personal identities by referring to our patients by their diagnosis. This may not be a wonderful concept but it does make life much easier and protect confidentiality.

Nurses have to give this type of quick and complete information quite often. If you are sending your patient to CT, dialysis, ultrasound, or any diagnostic testing you may need to give a quick brief assessment. When having a fellow nurse watch your patients while you go to lunch you must make sure they know what is going on with your patients. Before transfer to the general floor you must give a complete report to the nurse that will take the patient there.

We need to be thorough and maintain confidentiality and create an accurate picture. Must we use disparaging comments?

I often hear things that are not completely relevant to patient care but that may or may not be appropriate. There is sometimes a fine line between pertinent information and gossip.

For example, when receiving report on a new arrival I have heard some comments that are possibly relevant but less than professional. You may be getting report on a patient that is referred to as a "frequent flyer" a term stolen from the travel industry but with a whole new meaning. The frequent flyer here is a patient that is seen often. Sometimes these are people that come in with the same problems over and over and sometimes they are patients with diseases like diabetes, which cause multi-system problems that necessitate return.

The term while not exactly disrespectful is not at all flattering. We also see a lot of return visits from "huffers." This is the label we have given to patients that inhale paint, paint thinner, gasoline or any manner of things. This one is somewhat disrespectful, but they are doing this to themselves so how much respect have they earned?

Is that the issue, do our patients have to earn our respect? This is an illness if not an epidemic. There are thousands of people in major cities taken to hospitals every day for overdose from inhaling toxic fumes. These are at best borderline names and labels. Occasionally things get a little nasty such as referring to very heavy patients as "jumbo" or "wide load."

Often, confused patients are given old cliches to describe them such as "the lights are on but nobody’s home." Are these little quips necessary? No. Are they disrespectful? I would have to say that they are.

I admit being guilty of these very things. It is commonly accepted to use these little remarks and phrases to explain certain behaviors and diagnoses. The nurses I work with are all very good and professional. How do these little things get started? I am not sure but I do wonder if they should continue.

I had occasion recently to have a very large patient. While attempting to recruit assistance in moving this patient to a specialty bed a family member heard some of the remarks that the nurses I was recruiting used to describe the patient. There was no formal complaint but there was hurt and sadness in the eyes of the family member that I will not soon forget.

We should be more aware of how the things we say can be interpreted by those around us. As nurses we are the closest link to patients and families receiving care and we should be accessible and reliable. We need to be aware that we set the example that will be remembered after the hospitalization and sometimes loss of a loved one.

Don’t heal with your heart and hurt with your words.

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