A nurse at an acute care hospital is caring for a patient who is not doing well. The patient is a 65 year
old male who was originally admitted four months ago following a late diagnosis of lung cancer. The
patient underwent a thoracotomy and surgical removal of the left lower lobe. On this admission, the
patient is diagnosed with metastasis to the bone and liver and unrelieved pain in both the left side of
the chest and back. Using concepts from the readings in the assigned chapters and ISMP articles, as
well as the critical elements from the AACN Health Work Environment standards and “Skilled
Communication” article, answer the following question.
- Collaboration is going to be needed to address this patient’s problems. What are the important
concepts related to collaboration and skilled communication that this nurse needs to understand?
Identify and briefly discuss 2 – 3 important concepts: Focus on the “need for”, “barriers to” and
negative outcomes that are possible.
Part II
The nurse calls the physician to discuss the patient’s current situation; pain of a 7 on a scale a (0 –
10) scale despite multiple doses of the ordered Percocet. The nurse suggests changing the patient’s
current pain management to a Morphine infusion or patient controlled analgesia (PCA) pump. The
physician is hurried on the phone and tells the nurse that he doesn’t really think the patient’s pain is
that bad and that he is doesn’t want to cause an addiction to the opiates. When the nurse
reemphasizes the patient’s pain experience and unlikely outcome of addiction in this type of patient,
the physician becomes aggravated and tells the nurse “not to try and practice medicine”. Use the
concepts from the information contained in the two ISMP newsletters, the chapter readings and the
required articles to answer the following questions.
- Identify how this comment is a type of disrespectful behavior that will have negative
consequences on the patient’s care and why the negative outcomes occur.
- Identify important steps for the nurse to consider in responding to the physician’s comment and
write out your actual response to the comment – not what you think, but you would actually
say
Full Answer Section
- Active Listening and Respect:Both parties need to actively listen to each other's concerns and expertise. The nurse should acknowledge the physician's perspective on potential addiction but advocate for the patient's need for effective pain control.
- Barriers:Interruptions, dismissive attitudes, or a lack of trust can hinder active listening.
- Negative Outcomes:Miscommunication, missed information, strained working relationship, and ultimately, compromised patient care.
- Assertiveness and Advocacy:The nurse needs to be assertive in advocating for the patient's needs while remaining professional. This might involve suggesting alternative pain management options, documenting the discussion, and potentially involving other healthcare professionals.
- Barriers:Fear of confrontation or lack of confidence in their assessment.
- Negative Outcomes:Unchecked pain, suboptimal treatment, and potential patient harm.
Part II: Disrespectful Physician Comment and Nurse Response
- Disrespectful Behavior and Negative Consequences:
The physician's comment is disrespectful on several levels:
- Dismissive of Expertise:It undermines the nurse's assessment and experience in caring for the patient.
- Patient-Centered Care:It prioritizes the physician's concerns about addiction over the patient's right to pain relief.
- Power Imbalance:It attempts to silence the nurse's voice in advocating for the patient.
These factors can lead to:
- Delayed Pain Management:The patient continues to suffer unnecessarily.
- Nurse Dissatisfaction and Burnout:Creates a hostile work environment, potentially impacting other patients.
- Erosion of Trust:Patients may lose confidence in the healthcare system if their concerns aren't addressed.
- Safety Concerns:A strained relationship can hinder communication, leading to medication errors or missed interventions.
- Nurse's Response: (Focus on assertive communication and escalation if needed)
"Dr. [Physician's name], I understand your concerns about addiction. However, Mr. [Patient's name] continues to report a significant pain level of 7 despite multiple doses of Percocet. As per the AACN standards for pain management, we are obligated to address his pain. Perhaps we can discuss alternative options, such as a morphine infusion or a PCA pump. Additionally, given his advanced stage of cancer, the risk of addiction is minimal. If you'd feel comfortable, I can reach out to Dr. [Palliative care physician's name] to discuss pain management strategies for this specific situation."
This response demonstrates:
- Respect:Acknowledges the physician's perspective.
- Advocacy:Reiterates the patient's pain experience and highlights the nurse's professional obligation.
- Collaboration:Seeks a joint solution through suggesting alternative options and potentially involving a specialist.
Escalation: If the physician remains dismissive, the nurse should document the entire interaction, including the patient's pain score and discussion with the physician. They can then consider involving the charge nurse or patient advocate for further support in advocating for the patient's needs.