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It would be good of the nurse to ask Mr. A more questions about his complaint, and maybe even ask if there is something specific that she did that offended him. That way he would feel like his concerns were being heard and that he was valued.

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I think it would be a good idea to maybe ask why the patient felt like his needs are not being met and why he felt as though the nurses were not paying attention to him. It would allow the nurse to better address the issue and encourage the patient to keep talking.

I think it was a great effort made by the nurse to offer to get him into contact with someone and also get him the contact information to allow him to make a complaint, this let the patient know that the nurse cares and wants to address the problem at hand.

Lastly I feel like it was a great touch for the nurse to apologize for the problems that occurred at the end, this allows things to end on a better note by reminding the patient that we have taken his problems into mind and are empathetic for what he has experienced.

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I agree with you Kylar! I think by doing that it shows the nurse is interested in his concerns. I think it could help the patient become less frustrated and make him feel like he is being listened to.

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I would hope that a nurse would be aware of this hospital resources, but I guess that anything is possible!

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I agree with Braden! I think that having the patient clarify would be very helpful. Or at least asking him to clarify!

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Thats a good point Kylar and Braden. It would be a great idea to ask for clarification of what exactly upset him so that they can both be on the same page.

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I think that this just sounds so much more professional in comparison to the original dialogue! Meghan, I actually guess I felt that the checking on who to contact seemed pretty realistic... and I like that the response from the nurse was honest.  If you all would rather get rid of that part, I think it would be appropriate too. Just whatever makes you all happy makes me happy! I thought it was best for the nurse to apologize for his past experiences, so i'm glad that was incorporated into the new dialogue. Along with Braden's and Kylar's response to this, I think it could also be improved if you all agreed that the nurse ask a little more in detail about his negative experience(s) during his stay, but totally up to you guys!

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Do you think that changing the part about not knowing who to contact would be too much? I just feel like a nurse should know that and we could eliminate the "I'm not sure" part?

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I think that it might be a good idea to explain why the nurses were looking at the computer screen so much during his previous encounters :) Otherwise it's great!

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Maybe we can add in there the nurse asking about his experience? Have him explain why he is frustrated with nurses so the RN can understand what he is upset about and could maybe explain to him why some nurses are doing what they are doing.

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I felt that this would have been a much better and more appropriate way to deal with the situation at hand. His quality of care should not be compromised just because he does not see eye to eye with the nurses in the facility. The nurse in this scenario is much more attentive and understanding of her patient's concerns, and this is how we should react in the real world setting.

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Philip Alonzo is a 42-year-old CEO who is recovering from an appendectomy. He is in his hospital bed on the surgical floor when the RN stops by to check on his readiness for discharge.

RN: Hi, Mr. Alonzo, how are you feeling since your surgery today?

Mr. A.: I feel fine. I am more than ready to get out of this place. What do I have to do to make that happen?

RN: We want to make sure than your body is recovering well from the surgery first. I am going to check your vital signs and take a look at your wound to make sure there are no complications. Then I will look at lab results in the computer. If there is nothing of concern, you should be ready for discharge soon.

Mr. A.: Don’t remind me of that computer. I have never been so disappointed in a place in all my life. The nurses paid more attention to the computer than to me.

RN: I apologize for your frustrations. I can assure you that the nurses are trying to do everything they can to help you feel better. May I ask what happened that made you feel as though you were not being paid attention to?

Mr: Anytime I would ask the nurse a question their answer would be delayed because they were too busy typing. And when I would tell them how I was feeling they would still be staring at the computer and just nodding their head, I could tell they weren't listening.

Mr. A.: Who’s in charge of the nurses around here?

RN: We have a director of nursing and a nursing supervisor. Is there someone you would like me to contact for you?

Mr. A.: No, but who would I talk to in order to register a complaint about the nurses?

RN: I am not certain on that question. I believe the director of nursing or hospital relations would be good resources. Their offices are located on the first floor. If you would like I can get that information for you.

Mr. A.: That would be great. I would like to have a word with someone about the nurses here.

RN: I will ask resources where you can talk to someone and get that information for you.

Mr. A.: That would be great. Finally someone paying attention to me and not a computer screen.

RN:  Before I go, I have a few instructions from the doctor regarding your surgery. It will take about 6 weeks for your abdominal wall to fully heal. In that time you should refrain from lifting over 5 pounds or participating in any straining activity. The doctor would like to see you back in 2 weeks to check on your progress, and we can set up an appointment here before you leave. While you are healing you should try to get as much rest as you can. It is best if you limit your driving, and do not operate a vehicle if you take the narcotics. I understand your schedule may be busy, but the doctor recommends that you do not go back to work until after your check-up in 2 weeks. If you don’t have any further questions, I will work on your discharge papers and get you the information on who to contact regarding your experiences here. Once again, I apologize for any miscommunication and frustrations.

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The nurses role should've been to care for the patient and his needs. She needed to work with the patient and not against him. She needed to give him the best quality care she could, and this includes listening to him and his needs as well as educating and helping him recover. This doesn't only apply to this nurse, but to all nurses.

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I am trying to read everyone's comments but between the posts moving and getting added, I don't think I got the read every single one just yet. I just wanted to say that I think we are doing a great job, guys! We all are very insightful and am glad to see that we will not make such a careless decision in our future career. :)
PS. Thank you to whoever organizes these Q's and A's.

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Like Megan stated I believe the nurse is supposed to serve as the patient's advocate in situations like this. She is supposed to address his needs and talk to him about the problems he had experienced. Maybe is she would of handled the situation effectively he wouldn't of felt the need to talk to someone higher than her. After addressing his needs, then he probably would of been more likely to listen to what she had to say. Then she could of properly informed him of what he had to do to take care of himself and measures to take within his healing process.

I like the note that Kelsey made when she stated that a nurse is not only a care giver but an educator and communicator. She has many roles, and I strongly believe that if she would of properly balanced her roles than this could of been a much more effective patient-RN relationship.

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The role for any RN is to care for the patient, make sure his/her needs are met, and to make sure he leaves with a good understanding of his condition and what he needs to do to care for himself. If she hasn't met his needs and answered his questions, he will not be able to focus on what she is trying to teach him. Then without the proper understanding of how to care for himself when he gets home, his health won't improve.

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I think the patient-RN relationship seems very distant. They were both engaging in one-sided conversations, neither taking into consideration what the other was saying. The patient was not focused on listening to what the nurse had to say, he was only focused on talking to someone to complain about his experience. On the other hand the nurse barely addressed the patient's needs and was focused on getting her point across, telling the patient what he needed to do, and getting her checklist completed like Ashton mentioned earlier.

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Nurses have very important roles in regard to the care of their patients. As Meghan stated, the RN needs to be the advocate for her patient. She should have spoke up when the patient expressed his negative experiences. The Nurse is not only a caregiver, but she communicates with so many others to help get the job done. The nurse is also an educator. The nurse in the interaction I think kind of attempted to educate the patient on his discharge instructions, it just wasn't appropriate given the circumstances, as well as how it was carried out. She made no step to make sure the patient understood anything she had been addressing.

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I would describe their relationship as careless. I say this because the nurse wasn't caring about the patient. She wasn't expressing concern for the patient at all. The patient also didn't care for the nurse and the rest of the staff. He had problems with them which led him to not being interested in what the nurse was instructing him to do.

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The RN's role in helping the client with his nursing problems was telling him a few minor details and brief answers to the questions he asked. The reason she did this instead of stopping her schedule and seriously taking into account his concerns was because she was too busy and wanted to get him discharged. The nurse gave no indication that she wanted to learn more about his concerns and gave the shortest answers she could.

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It seems like the nurse is not respecting the patient or making time to hear his concerns; he is just another person she needs to check off her list. He doesn't seem to have a lot of respect or much good to say about her or the entire experience, which results in tension on both ends.

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The nurse should have been on the patient's side. It is her job to give him the best quality of care that she can and that entailed addressing any and all of his concerns. She needed to make to apologize and attempt to explain why the nurses have to use the computer and assure him that they were all on his team throughout his care. It is also her role to make sure that he fully understood his medical instructions before he was discharge which is not something she was focused on.

Thats a great point to make Kelsey. She should be well-rounded and educate just as much as she offers care. And I agree Kylar, if she would have listened intently to what he was saying and helped him through the situation, he may not have wanted to have spoken to authority.

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The nurse should've addressed the patient's questions first. She needed to answer his questions with respect and maybe inquire about his experience so she could get an understanding of what was wrong. If she answered his questions first it would've prevented the situation from getting worse.

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The relationship between the RN and the patient was very superficial. They were both on different pages in the conversation and not paying much attention to what each other were saying. The nurse seem uninterested and in a hurry to get through with the exam, and the patient was not listening to what she had to say, but instead focusing on his complaints about the staff.

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I think that it is appropriate to describe this relationship as insecure. It is evident that the RN was not too worried about acknowledging any of Mr. A's concerns, and that is very out of line and unprofessional. There is not one thing the nurse said or did in the interaction to make me think that she was sincere and or compassionate.

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I think one of the most important things to remember as a nurse is to actively listen to the patient. Engaging with them, asking them questions and letting them talk gives the nurse a chance not only to see where the patient is at in their understanding, but also to make sure they are on the same page.

By stopping and actively listening to the patient and making sure she answered his questions, the nurse would have saved so much time instead of trying to talk over him and just get the job done.

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1.     What was the RN's role in helping the patient with his nursing problem? Why?

The RN should have been an advocate for her patient, and she should have helped him to understand what was going on when previous nurses were working on the computer. Her role in helping her patient was to help him also understand what he needed to do to prevent himself from further injury or pain after leaving the hospital, as she was the nurse in charge of his discharge. Another role that should have fallen under her is that she should have been able to point the patient in the correct direction of the individual in charge of the nurses and should know how to file a complaint. 4

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There was very little relationship to describe in this interaction. The nurse seemed uninterested in the patient’s concerns, and the patient did not seem interested in learning about what was required of him after discharge. The relationship seemed strained at best, and very much not on the same page.

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I would describe the Patient-RN relationship as very superficial. From the way that the nurse was not concerned with the feelings of the patient, I can tell that there is not a very personal relationship between them. However, because of the slang and relaxed way of speaking to each other in the beginning of the conversation, it is possible that the nurse is too comfortable with the client. She could she his concerns as a low priority because she thinks that he is overreacting.

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When speaking with the patient, the RN should have stopped her assessment when he started voicing his frustrations. She should have apologized for the actions and offered him any assistance that he may have needed. She should have dedicated her time to him and answered his questions thoroughly.

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I do not think the patient assimilated the information at all. He wanted to address his nursing care before learning how to take care of his wound. He wasn't listening to the nurse when she was giving him instructions. You can tell this because he wasn't reiterating anything or responding to what the nurse was telling him.

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I doubt that the patient really heard any of the information; he was too concerned with his own pressing issues to be able to focus on what she was teaching him. If he had been listening, there would probably be more signs of him agreeing with her, and asking more questions in response to her instructions instead of trying to go back to his concerns.

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The RN should of apologized for the problems the patient had experienced with other nurses, allowed him to fully explain what happened, and then if he was very adamant about wanting to see someone she should of directly brought that person to him, scheduled them for a meeting together, or taken the man to see him. By ignoring his questions not only did she not address his negative feelings about the experience and prove his point, but also caused a rift between them which prevented him from getting the information about the care he needed and measures to take for his own health.

Megan, I also agree with your statement that she needed to explain why it is important to document, while also being empathetic to the problems he had experienced.

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As a nurse she should have expressed her care for the patient. She should have done this by asking the patient more questions when he initially said he was irritated with the computer. By investigating why he had these feelings she might have been able to explain why the nurses had to pay so much attention to the computer. This could have prevented the client from wanting to talk to whomever was in charge of the nurses.

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The RN in this situation should have taken the time to address and answer any of the questions that the patient had instead of just putting in a filler for the question before she continued talking about the instructions. Overall, I think she could have just asked some more questions regarding what was so dissatisfying during his stay, as well as trying her best to stop thinking about what needed to be said next in order to answer the patient's questions. If she did not know the information, she maybe could have made an effort to at least figure it out.

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I do not think the patient assimilated any of the information that the RN was trying to communicate. He was focused on the subject of the quality of his care while she was focused on the medical situation at hand. They were not on the same page and not understanding what each other were trying to say.

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I agree with everyone; the nurse was not listening to the patient's words at all, or even the meaning behind them. He was clearly upset about his experience in the hospital, and she didn't stop what she was doing to meet his concerns. It seems like he wasn't concerned with her suggestions because he was to preoccupied by his issues with the treatment, and the nurse was not doing anything to help him.

Also, when she did answer his questions she was unprofessional and abrasive.

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1.     How should the RN have handled the patient's questions?

The nurse should have stopped he evaluation of the patient and taken time to address the patient’s concerns with the care he had received. She should have asked him what instances had occurred and how the nurses could have changed or better explained what they were doing so that the patient would not feel neglected the next time. Also, the nurse should have explained to the patient, in a way that made it easy for him to understand, what the nurse was doing on the computer and why it was crucial for them to document so much on the surgical floor.

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Well all I can tell you that is if I were that patient, I definitely would not have been taking in any of the information that the nurse was trying to provide me with, especially because I would have been aggravated, if not furious! I think that it just made things worse to have another nurse dissatisfy you when you're trying to have your needs met when you are unable to figure out things yourself. It appears the individual in this situation was not taking in any of the information that was provided because he did not mention anything other than how dissatisfied he was with his care.

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2. Do you think the patient assimilated the information the R was trying to communicate? Why or Why not?

I do not think the patient took in any of the information the nurse was saying. First and foremost he did not reiterate or address any of the comments she was making about treatment methods and what he should be doing in the future to prevent problems. He was very head strong about wanting to talk to a person in higher management about the nursing staff and the fact that his needs and questions were being ignored, and she was redirecting the conversation, further proved his point about the nurses not paying attention to him and seemed to make him more adamant about wanting to talk to someone else.

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I do not believe that the patient assimilated what the nurse was trying to tell him. The reason why is because he was concerned with how he was being treated. He never showed signs of listening to her instructions. He repeatedly expressed that his focus was on how the nurses were treating him. She was giving many instructions and he did not make any confirmation that he was listening to her.

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1.     Do you think the patient assimilated the information the RN was trying to communicate? Why or why not?

I do not think that the patient took the information that the RN was conveying in, nor do I think that he actually assimilated it to his current understanding. The nurse did not try to help the patient understand why the use of the computer had been so important, so this man could not assimilate this knowledge into his understanding of what a post-surgical hospital stay might be like. I also don’t think that he really registered any of the instructions that the RN was giving, because the patient and the nurse were not conversing about the same topic – the patient was focused on reporting the nurses and the nurse was focused on relaying the discharge information.

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The nurse is definitely not focusing on what the patient is stating at all,. She is not being an active listener, instead she is just making sure she gets out what she has to say next. She is being a prime example of the horrible nursing care the patient is talking about. His issues and problems should have been addressed, not ignored.

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I also agree with you guys. The RN wasn't addressing the need of the patient at the moment. He was more concerned with the type of care he was receiving and not about his wound. the nurse needed to assess his concern before moving on.

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I also agree with what was said. The nurse treated the patient as though he was just another check off on her list.

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Meghan and Haley, I agree with you both 100%. I think that the nurse in this example is just too focused on the things she knows she needs to do, which results in ignoring the patient and his needs. He really is not receiving the kind of care I imagine we would all want for our loved ones and friends so it's a shame if this were a real experience. No matter how busy we think we are, it will always be important to actively listen to our patients because some things can be handled at a later time!, such as the instructions she needed to give Mr. A.
-Kelsey Stewart

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I agree with what you said Meghan. The nurse seemed to half heartedly 
respond to her patient's concerns about his care. She should have 
stopped her assessment and took the time to talk about Mr. A's concerns 
before proceeded. By ignoring his frustrations, she was contributing to 
the problem that he was angry about. Also, she didn't speak in a very 
professional manner when it came to his medical instructions. The 
directions were somewhat unclear and poorly worded. 

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I agree with what you said Meghan. The nurse seemed to half heartedly 
respond to her patient's concerns about his care. She should have 
stopped her assessment and took the time to talk about Mr. A's concerns 
before proceeded. By ignoring his frustrations, she was contributing to 
the problem that he was angry about. Also, she didn't speak in a very 
professional manner when it came to his medical instructions. The 
directions were somewhat unclear and poorly worded. 

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1. What are a few of the communication problems raised in this scenario?

The nurse did not address the concerns of the patient, she did not seem to be interested in actually communicating with him but rather she seemed like she was just trying to get him to stop asking questions. Based on the transcription of the conversation, it does not sound like the nurse even stopped what she was doing when the patient was talking. She should have stopped assessing his wound so that she would be able to communicate with him. By not focusing her undivided attention on the patient’s concerns, the nurse did not convey any interest in the situation.