1. What Nurses Want You to Know
Dear Patient:
What Nurses Want You to Know
Liza Wisman
James Madison University

2. Purpose of the Project
As nurses our goal is to improve the health of our patients. Trying to provide care to a reluctant or non-compliant patient makes it more challenging to do our jobs. It can be very frustrating when trying to provide care for a patient who doesn’t realize that we are helping them. The purpose of the exercise was a way for nurses to (indirectly) vent or confront our patients about why we do what we do.
That nurses make fun and/or complain about certain patient behavior doesn’t stop us from delivering excellent care, but rather makes it possible. There will always be things that annoy, anger, or frustrate us about patients and sharing those feelings with fellow nurses means that we don’t share them with the patient.

3. The Prompt: “Dear Patient,”
I asked several nurses to recall times when patients were being non-compliant, behaving in ways that were negatively affecting their health, or simply not recognizing or understanding the efforts we are making to help them get well.
Note: This was an exercise for nurses to vent their frustrations to other nurses and they (in most of the examples) did not actually say these things to the patient.
Here are their stories…

4. Background: Dear patient,
Patient whose PEG fell out over 48 hours ago and finally came in for a replacement despite the tract already being closed and healed because he waited two days to be seen.
Patient: “How much longer y'all going to take because I got things to do"
Dear patient,
I'm sorry it is taking us a long time but we have already bent over backwards to add you into an already overfilled schedule, and waiting 2 days after your G-tube fell out was really not a smart thing to do, on top of drinking an entire Pepsi right before arriving so we can't sedate you to replace the tube. You also took your eliquis two hours prior to arriving so it wouldn't even be safe to place a new tube, but despite your rude comments we are trying our best to find the best plan B so you can continue to receive nutrition.

5. Dear Patient, Background:
1) You haven't addressed to me all day any concerns about your foley catheter, nor have you told me personally that you wanted it out by midnight. 2) Last night you nodded your head and even smiled while agreeing with the NP to have a foley catheter placed. 3) These are all concerns you could have addressed to the NP every time she came in to see you today. 4) You have to understand that everything that everyone in this hospital is doing is for YOUR health and for YOUR benefit right? We really want you to get healthy enough to not have to be in this hospital, but right now that may mean doing some things that are out of your comfort zone or a little uncomfortable right now but will all hopefully lead to a better outcome ultimately.
Background:
A patient who had agreed to foley placement the night prior for prevention of backup into her bladder-drained pancreas transplant:
"Why hasn't anyone done anything about the foley I've had in for a whole day now. I told y'all it was coming out at midnight whether you like it or not."

6. Dear Patient, Background:
I am very sorry that your sleep was interrupted last night. It seems really silly to come here to rest when you do anything but, huh? I can assure you the reason you were disturbed was for the best outcome possible of your care. We wanted to monitor your vital signs. That temperature you had yesterday afternoon, well it may have come back after the Tylenol we gave you wore off. We wanted to be sure you weren’t going septic from the perforated appendix you had repaired two days ago. We also wanted to peek on you to ensure that you were alive and breathing while you slept. And yes, it’s an inconvenience to have a roommate, especially one that’s confused and loud. So, sir with all do respect, we are only ‘bothering’ you throughout the night for your well-being. I can assure you that it’s within my goal each shift to keep you all alive. And if that means disturbing you for vitals, blood draws and to ensure the rise and fall of your chest every hour, then so be it.
Background:
I ask my patient in morning handoff how they slept last night. “Terrible. You cannot get any sleep around here. I must have gotten woken up 5 times last night. Y’all were sticking me and taking my blood, getting my blood pressure and stuff, AGAIN and my daggone neighbor wouldn’t stop hollering out all night!”

7. "I didn't want to bother you."
Dear Patient,
It is not a bother. I understand that you want to be independent, but you're in the hospital for a reason. Let me help you. I realize that your pride is wounded, and that at home you "never pee on myself." I know. I'm sorry. But here we are, in the hospital together. Let me help you get back home. We can't get there if you are letting pride get in the way of asking for help, or not telling me when it hurts. Let me help you. I will not judge you. I don't look at you with pity or think that you are weak. I look at you and see someone who wants to get out of here. I've done this before, I know what to do, trust me.
Background:
As my patient is lying on the floor after falling when attempting to ambulate to the bathroom unassisted...
"I didn't want to bother you."

8. Dear patient,
Not telling me the truth hinders our nurse-patient relationship and creates mistrust. I plan to tell you the truth about your care and I will appreciate it if you do likewise. It will make for a productive 12 hours. Next time you want to go out and smoke, please tell me that is what you want to do versus lying about visiting a friend on another floor who is also a patient.

9. Reflection & Questions to Ponder…
What ways can nurses break through these barriers to care?
How can we communicate to our patients in an effective way so that they are more understanding and active participants in their health?
I shared this presentation with all the nurses who participated in my project. The goal was to discuss and reflect on ways we can adopt a therapeutic relationship with our patients and identify ways to help them see the purpose of our care.