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Include caregivers in healthcare process for greater experience

October 9th, 2014

by Darlene A. Cunha

Recently, I attended an interdisciplinary team meeting. There was a knock on the door to the conference room. Before I could rise to open the door, it swung open and one of our attending physicians scanned the room, made eye contact with me and beckoned me to step outside.

The two of us made our way to my office, where this physician, visibly upset, explained to me her interaction with the wife of one of her patients. She described the spouse (whom I'll call as Mrs. Jones), as aggressive, unrelenting, and dare I say, hostile. I was taken aback, as the patient was admitted the day before. What could possibly have gone so wrong in such a short period of time?

The physician asked me to accompany her to the patient's room, as she wanted me to witness the interaction between the patient, Mrs. Jones and the staff. After quickly reviewing the patient's admission notes, I accompanied the physician to the patient care unit, where we came upon Mrs. Jones standing at the nurses station. She was visibly upset, evidenced by her raised voice and demand to see someone in charge. As I approached the desk, I reach out my hand to introduce myself with a calm, low voice. The staff stood wide-eyed waiting to see what would happen next. The physician gave me the, I told you so look, but I stayed focused on the family member.

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Mrs. Jones shook my hand, and as she did, I gently steered her away from the nurses station and towards her husband's room. The attending physician followed. Once inside her husband's room, she began to raise her voice and insisted on driving the patient's plan of care. She stated she was unhappy with the attending physician's orders and wanted her husband transferred immediately. Any attempt to interject was met with resistance and anger. At this point, I stayed silent while Mrs. Jones voiced her concerns. As she spoke, her voice quivered and she began to cry while she held her husbands hand. It was at that moment, I stepped forward and embraced her. I assured her we were all here to help both of them get through this difficult time.

Over the next hour, the attending physician and I learned Mrs. Jones was recently discharged from the hospital herself, and her husband was recently diagnosed with a terminal illness which prompted his readmission. Since we were not the hospital that initially diagnosed and treated Mr. Jones, Mrs. Jones was upset with the plan of care established by his new attending physician. It was different from the one initially established. The more she resisted the treatment plan for her husband, the more frustrated the attending physician became, until finally Mrs. Jones demanded her husband be transferred.

After several minutes passed, Mrs. Jones calmed down. It was at that moment I asked if we could calmly discuss her husbands care, in the presence of her husband. Although he was ill, he had full capacity to make his own healthcare decisions. Over the next 30 minutes, Mrs. Jones explained her husband's current treatment plan, and that she was afraid any change would set him back. She said she tried to explain this to the staff and his attending physician, but no one would listen to her, as her husband was in charge of his own care. She said she got off on the wrong foot with the attending physician and didn't think she would be able to repair the relationship, and therefore didn't want her husband to remain at this hospital. It was at this point, the attending physician stepped forward, apologized to Mrs. Jones and as the two of them shook hands, the attending physician said, "Going forward, we are a team."

What we learned from this encounter was invaluable to the entire healthcare team. Yes, it's true patients of sound mind drive their plan of care with their physician, but we cannot, and should not, discount the importance of family. While patients drive their plan of care, families participate in the plan of care. Disruption in care caused by poor communication causes a ripple effect across the entire care team.

Mrs. Jones truly wasn't angry with us, she was angry at the circumstances that led her and her husband to this point in their lives. She was scared of the uncertainty of her husband's future and was holding on to the one thing that she felt was stable--the plan of care that had already been in place. It was our job to educate and re-educate on the changes to that plan, while incorporating her concerns and alleviating her fears. Making up isn't that hard to do--you just need to extend your hand.

Darlene A. Cunha, R.N., is senior healthcare executive who focuses on population health management and the patient caregiver experience.

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