Nursing Procedures and Skills
WHAT NURSES MUST KNOW BEFORE CALLING DOCTORS AT NIGHT
One of the tasks that a nurse dreads doing is calling up doctors at night. There’s a big fear of being scolded or being thought of as stupid by both the doctor and the rest of the medical team. But it’s actually a very vital part of your duty as the first-line contact with the patient. Here are tips to help you become more confident about picking up that phone in the middle of the night!
KNOW YOUR MEDICAL BASICS
In assessing patient status, you should be able to know the difference between normal and abnormal findings. Constantly reading up and reviewing your theoretical medical knowledge will help you understand if a patient’s behavior is expected in his/her course of treatment. For example, surgical patients fresh from surgery are expected to experience pain and some minor bleeding but they should not be having a fever or passing out whitish stool.
CREATE A SYSTEM
Calling at night should only be reserved for medical emergencies. Unnecessary calls can be limited if you create a system to avoid them. It is a general rule to ask all your concerns or clarifications during work hours. If non-urgent, it is also better to message the doctor first and ask permission if you can call to clarify. It is also good to ask the doctor about what conditions or situations should they be contacted for a specific patient.
ASSESS IF CALLING IS NECESSARY
It’s also important to ask yourself is if you should really contact the doctor. Things such as a request for additional supplies or patient complaints should first be handled by you or your nursing supervisor. You can also ask peers initially about illegible orders. A removed IV line can be reinserted by the nurse, depending on the hospital policy. In general, you should first exhaust all possible and reasonable means to address the situation if it is within your control. Contacting the doctor becomes necessary for cases wherein a decision has to be made, information impacts or may change treatment process, the patient is showing changes in mental status, or when patients are refusing treatment of a doctor’s previous orders.
ASSESS IF THE INFORMATION NEEDS TO BE RELAYED ASAP
The nurse should also assess if the concern is urgent or not. Although a patient transferring rooms is important for the doctor to know, this can be relayed via email or messaging. Relaying slowly decreasing input and output monitoring but with stable vital signs may be delayed and addressed in the morning. Urgent information that should be relayed regardless of the time of day includes sudden patient deterioration, escape, and other medical emergencies that require immediate decisions.
KNOW WHO TO CALL
Once you decide that a call to the doctor really is necessary, you should then determine who you should be calling. It is common for patients to have multiple doctors or to have residents on call to assess the situations first and report directly to the attending physician. If there are residents in the hospital, they should be the first to know about what is happening to the patient. The call should also be directed to the doctor or service who has jurisdiction over the concern. For example, concerns about a sudden spike in blood sugar should be relayed to the endocrinologist while infection of a surgical site should be relayed to the surgeon. General patient concerns such as a request for discharge against medical advice should be relayed to the attending physician.
KNOW ALL THE FACTS
Before making the call, gather all the relevant information you may need to relay. Basic things to have in hand are the vital signs monitoring, the latest laboratory results, the list of medications, the latest changes to treatment, and the doctor’s last orders. Having them with you will help you answer the questions the doctor may have regarding your update. You should also organize all your questions and concerns so that you will only have to call once.
DELIVER THE MESSAGE
It is best to keep your message as short as possible. Be direct to the point and avoid small talk so that you both don’t lose precious time. Of course don’t forget to greet the doctor, introduce yourself (including from what hospital you belong to as some doctors practice in multiple hospitals), and give relevant information on the patient you are referring to (specifically name, age, sex, room number).
A common method for giving updates is the SBAR (situation, background, assessment, recommendation), with 1-2 sentences summarizing each component. In using SBAR, you begin with the situation or the reason you called in the first place. You then give some background through relevant events that led to the situation. You then provide your best assessment of the situation or the patient’s condition, and you give a short recommendation that can be acted upon and ask for the doctor’s orders. An example of an SBAR update is as follows:
“(intro) Good evening Dr. X, this is Nurse Y from Z Hospital.
(situation) I am calling because patient A, 27/F, room 301 had a seizure.
(background) Her vitals were stable the whole afternoon but she became irritable around 1 hour ago and her companion noticed her limbs trembling for about 5 minutes before reporting to me.
(assessment) The seizure has stopped but is still unresponsive. Vital signs remain stable at BP 120/80, HR 90, RR 20.
(recommendation)You should see her as soon as you can.
(request for order)What do you want me to do at this moment?”
DOCUMENT THE ORDER
Oftentimes, doctors will ask more about the patient’s status so you should have that information at hand. You should also always have a pen and paper with you so that you can write down once the doctor starts to give orders. Write them down clearly so that you don’t forget and you don’t have to call again. Also, always read back the order to ensure that you understood it correctly. Don’t forget that verbal orders should be documented in the chart so that other members of the medical team will know what happened and what interventions have been given.
GIVE FEEDBACK ON THE ORDER
If an order was given for you to carry out, report back to the doctor on the order’s completion and presence of any side effects. If non-urgent, this feedback may be given by a message or email for the doctor to see upon waking up.
The doctor, as head of the medical team, is often appreciative of relevant updates of their patient’s status. The most common reason doctors get mad at night calls is if they believe it was not necessary, so make sure you followed our tips in determining the need for making the call.
If they do get mad at you or sound cranky in the middle of the night, don’t take it personally. Most likely they are just tired as doctors often crave rest. Don’t let your fear of confronting a doctor distract you from your duty as a nurse to protect the interest of the patient.
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Nursing Procedures and Skills
Essential Strategies for Dealing with Difficult Patients and Families in Healthcare Settings
As nurses, we sometimes encounter patients and their families who are difficult to work with. These individuals may be demanding, uncooperative, or even hostile. While these situations can be challenging, we must develop strategies to handle them effectively. Here are a few of the approaches to handling difficult patients and relatives:
Understand the Patient’s Background
It is important to understand that difficult behavior may be a result of the patient’s underlying condition, personality, or previous experiences. For example, patients who are in pain, anxious, or feeling vulnerable may be more likely to act out. It is therefore important for the nurse to try to understand the patient’s background and perspective and tailor your approach accordingly.
Be Calm and Stay Objective.
It is essential for the nurse to remain composed and calm when dealing with difficult patients. This will help you maintain control of the situation and prevent it from escalating. It is also important for nurses to remain objective and not take patients’ and relatives’ behavior personally when dealing with their difficult behavior. Try to focus on the patient’s needs and the care that you are providing, rather than getting caught up in their emotional reactions.
Show Empathy
Empathy is one of the essential qualities of a nurse. It is an important skill when dealing with difficult patients and their families. Showing empathy means acknowledging the patient’s feelings and concerns and trying to see the situation from their perspective. The nurse can use phrases like “I understand how you feel” or “I’m sorry you’re going through this” to demonstrate empathy.
Use Effective Communication Techniques
Effective communication is key when dealing with difficult patients and their relatives. Make an effort to listen actively to the patient or family member’s concerns. Use active listening skills, such as repeating back what the patient has said to ensure you have understood their concerns correctly. Using open-ended questions encourages the patient to talk and express their concerns. This will show that you care about their needs and are willing to work with them.
Know When to Seek Help
It’s important to know when to seek help from colleagues or a supervisor. If you are feeling overwhelmed or unable to manage a difficult patient or family member, don’t hesitate to ask for assistance from colleagues or a supervisor.
Involve the Patient in their Care
The patient is at the center of care. Empowering the patient and involving them in their care can help reduce difficult behavior. Encourage the patient to participate in their care plan, and explain the reasoning behind any treatments or interventions. This can help allay the client’s anxiety.
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Lifestyle
HOW TO COMMUNICATE EFFECTIVELY WITH PATIENTS
Effective communication with patients is a crucial aspect of healthcare. It allows healthcare providers to establish trust and rapport with their patients, gather accurate information about their health concerns, and provide effective treatment and follow-up care. In this article, we will discuss some key strategies for effective communication with patients.
First, it is important to establish a warm and welcoming environment for patients. This can be achieved through nonverbal cues such as maintaining eye contact, smiling, and using a friendly tone. It is also important to give patients your undivided attention and to listen actively to what they have to say. This includes using techniques such as rephrasing and clarifying to ensure that you have accurately understood the patient’s concerns.
It is also important to communicate clearly, concisely, and respectfully. This means using simple, easy-to-understand language and avoiding jargon or technical terms that may be confusing to patients. It is also important to be patient and allow the patient to ask questions or express any concerns they may have.
In addition to verbal communication, it is important to consider nonverbal cues as well. This includes maintaining appropriate physical boundaries and using appropriate touch. Nonverbal cues can also be used to show empathy and support, such as by nodding or maintaining a comforting facial expression.
Another important aspect of effective communication with patients is cultural competency. It is important to be sensitive to the cultural and linguistic backgrounds of patients and to take steps to ensure that they feel respected and understood. This may include using interpreters or translation services or simply taking the time to learn about and respect the cultural beliefs and practices of the patient.
Effective communication with patients is not only important for the provision of quality healthcare, but it is also essential for building trust and rapport with patients. By following the strategies outlined above, healthcare providers can improve their communication skills and provide the best possible care for their patients.
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Nursing Procedures and Skills
IMPROVING NURSE-PATIENT RELATIONSHIP
Improving the nurse-patient relationship is essential for providing high-quality healthcare and ensuring positive patient outcomes. A strong nurse-patient relationship can lead to increased trust, improved adherence to treatment plans, and a more positive work environment for nurses. The following are ways for improving the nurse-patient relationship:
Communicate effectively: Effective communication is key to building a strong relationship with patients. This means listening actively to what patients have to say, using clear and straightforward language, and providing information in a way that is easy for patients to understand.
Show empathy: Empathy is the ability to understand and share the feelings of others. By showing empathy, nurses can help patients feel heard and supported, which can improve the relationship and lead to better patient outcomes.
Be respectful: Treating patients respectfully is an important part of building a strong relationship with them. This means showing respect for their autonomy, privacy, and dignity, and treating them as partners in their own care.
Be responsive: Patients may have questions or concerns at any time, and it is important for nurses to be responsive to their needs. This means being available to answer questions and address concerns and making sure patients have the information they need to make informed decisions about their care.
Collaborate with other healthcare providers: Nurses often work with other healthcare providers, such as doctors, therapists, and social workers, to provide comprehensive care for patients. By collaborating with these providers, nurses can ensure that patients receive the best possible care and support.
Involve patients in their care: Involving patients in their own care can help improve the nurse-patient relationship. This means giving patients the opportunity to participate in decision-making and allowing them to express their preferences and concerns.
By implementing these tips, nurses can improve the nurse-patient relationship and provide better care for their patients. A strong nurse-patient relationship can lead to better outcomes and a more positive healthcare experience for everyone involved.
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