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Sunday, February 13, 2011

Anticipate and explain

Fear. Confusion. Anxiety. Stress. These are some of the emotions that roll through the minds of patients and their families while their loved one is lying in a hospital bed, perhaps near death, hooked up to an array of machines.

Most people are healthy most of their lives, and have no need to educate themselves on all the various diseases and disease processes that can slow down a life and even grab it and rip it into the other world. They have no need to know about the many devices and techniques used to treat illness either.

So this obliviousness can result in fear, confusion, anxiety and stress at the patient bedside. Why are all those lines in my mom? Why is that mask over her face? What the heck is sepsis? What's an ABG, CBC, PO2, SpO2, CO2 and all those other medical terms we often float around? What are all the bells and whistles for? Should I be concerned when I hear an alarm?

Fear not, because the roll of the respiratory therapist is to clear up the confusion. The proactive RT will introduce himself and explain any equipment he is using even before the person asks, "What is that?"

A good RN, a good RT, will stop for a moment, several moments, several times a day, to explain what is going on, and ask the patient, "Do you have any questions about what is going on here?"

Just asking that simple question shows that you care, and can allay the fears of a concerned family member. They know that it's not your fault their mom or dad is in that bed, and now they are pacified by knowing that you care to. That they are involved in every step of the healing process, or the moving along process.

I personally don't like to go overboard while doing this, and try to play it by ear. I don't want to confuse people more than they already are, and is usually why it's best to start by giving a very brief explanation of what I'm doing and simply asking if they have any further question.

If they don't, I drop the topic. If they do, I give the briefest answer I can.

Likewise, I never involve myself with any decision making, such as, "What should I do? Should I let my mom stay on the vent."

I never give my opinion on these matters. Usually I defer to the doctor or RN. Yet if, for instance, a family member is trying to decide whether or not to let us put their loved one on a ventilator, I'll say something simple like: "A ventilator is only temporary. It allows the patient time to heal. Usually it's only a day or so."

If the patient is a train wreck and has made no prior acknowledgement about end of life care, however, and intubating, putting the patient on a ventilator, and doing CPR will only delay the inevitable, my speech is altered as: "It's never an easy decision. You can always let us do what we're trained to do, and play it by ear. You can always tell us to stop at any time."

And I only say those lines when I'm asked directly, and have no way out of saying something.

Yet during most patient family-RT interactions, it's just me making an equipment check, or giving a breathing treatment. In these instances, I'll usually explain what I'm doing with the first visit, and play it by ear after that.

It's usually not hard to tell if a patient, or his family, has questions. When you get this feeling, you simply ask, "Do you have any questions."

And of course you shouldn't be afraid to say, "I don't know that answer to that, yet I'll find out," or, "How about if I have your nurse come talk to you. That's a question for her."

Sometimes, howver, the best thing to do is simply use common sense, which is why common sense is a good trait for respiratory therapists to have.

Ignorance about the medical community, and fear, can cause anxiety and stress. And that's why I think it's extremely important for

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