By Diana Wilkiemeyer, MSN, RN, PHN
My nursing wisdom comes from a home care perspective, where patients who we might initially think are just being difficult often are sharing information with us in an oblique manner. Their statements might sound humorous or even angry, but they also can help you discover what fears they may have and what they need. It just takes a discerning ear.
For example, a patient once said to me: “Why didn’t you call me earlier? You know I need to plan my day!” My elderly homebound patient was telling me she has a right to plan her day and to not take her for granted.
When I was removing her wound dressing, she complained: “All that slashing and grabbing! Give me a break!” What she meant was, “Take your time and soak it off.”
“That wound has been draining and hissing all night!” Translation: “It hurts and I didn’t sleep very well.”
My mission: Review her pain medication regimen. And when she brings up topics that seem totally unrelated to the purpose of our visit, it is often because she wants me to stay a little longer. I may be the only visitor for that day.
Another difficult client was bent like a hairpin and tough as they come. She was 88 pounds of molton lava. But one day when she was in a placid mood, I remarked how blue her eyes were. “They are green! Could glaucoma have changed their color? I haven’t been able to look in a mirror for years.” My mission:
Forget my plan to teach her to do her own wound care. Her vision is too poor.
Another clue to her poor vision was an unplugged heating pad covering the birdcage, instead of the blanket she usually used. Our visit led to several additions to her nursing care plan, including reviewing home safety, personal hygiene and medication administration.
My patient, Winnie, mused, “I need something to cheer my appetite.” After a little discussion about her food preferences, I reminded her to reorder her medications, since they were all gone. She sighed: “Honey, I was so proud of myself for taking every last one!” My interpretation: More teaching about her medications, not only refilling but also times and dosing, is necessary.
One of my favorite patients told me about her recent visit to the physician. “He said I need chemotherapy and my hair will fall out, and I responded ‘Not this hair,’” she said. My patient described how her physician became serious and wanted to explain why her hair will fall out. She responded again, “‘Not this hair.’ Eventually I admitted that I wear a wig. I just had to pull his leg. He thinks I’m crackers anyway.”
My conclusion: “This lady can cope!”
When we remain sensitive to our patients, we develop insights into lives that can be very different from our own. And that is part of the joy that comes with working in home care, a specialty that calls for sensitivity, but also creativity and a sense of humor. •
Diana Wilkiemeyer, MSN, RN, PHN, is a retired nurse who lives in Berkeley, Calif.
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