Monday, June 14, 2010

Controlling behaviour

In response to StorytellERdoc's blog entry titled "Who am I treating?".


We get such controlling behaviour rather regularly in Singapore. Unfortunately, management and the work culture (it's a private hospital) tends to bow down to patients/NOKs who raise hell, so it becomes a recurring pattern on their future admissions.

I am in the Paediatrics, so parents have an "excuse" to provide information regardless of the child's age. Some parents seem to think that their treatment demands should be met, although our professional assessment of patient may indicate otherwise. It can be an annoying situation. [Edit: Come to think of it, even the consultant doctors face such demands. Although they face it less frequently than the nurses, IMHO, due to parents having more respect for a doctor's assessment.] Then again, IMHO such controlling behaviour often extends beyond just treatment demands (e.g. demand to jump queue for private room).

E.g. Recently there is a case that should rightfully belong to High Dependency Unit (HDU) but is nursed at acute ward levels. Ostensibly it was for the hospital's compassionate image in catering to the parents' budget issue. However, it results in overloading the ward nurses with HDU work in a busy acute ward short on trained staff.

The child was admitted because of infection from a previous ventricular shunt inserted at an overseas hospital. The mother was obsessed with the patient's temperature, because she wanted to keep the child afebrile to have a ventricular shunt inserted sooner and to prevent seizure. The child was still suffering from on-and-off low grade fever, and we followed our nursing protocols.

One day the temperature spiked from afebrile to 38.2 degC (100.8 degF) in-between an hourly temperature monitoring. The patient's mother was verbally nagging and blaming the nursing staff non-stop (especially me since I was in-charge of his medications that shift) for not monitoring him more frequently (on-demand) and not giving him the anti-pyretic while he was afebrile. She was demanding that I give paracetamol STAT via NGT, while I was preparing the patient's STAT IV Albumin drip order at his bedside. [Edit: I told the mother that I will feed the NGT paracetamol after I had set up the very important Albumin treatment. Nevertheless, she went on threatening and complaining of poor nursing care.] I finally told her, "I am handling a very important treatment for your child, please can you give me a few moments of peace to ensure that this goes correctly?"

The mother screamed "You cannot talk to me like this!" and repeated her broken record of why because of our treatment that her son is now having "high" fever. [Note: her son came in due to an infected shunt inserted overseas and had been febrile on-and-off since admission.]

The mother never paused for a moment to let me focus on her son's more important STAT Albumin treatment. I hit my tolerance limit. [Edit: I reiterated to the mother that I will feed the NGT paracetamol after I had set up the very important Albumin treatment.] I told her firmly that we have our protocols for managing a patient's fever, especially in preparation for operation, we don't want to mask any underlying infection and we were handling her child as per protocol. She disregarded my explanation and still raised her voice and continued to blame us. Finally, I told her that if she is not happy she could lodge a complaint. That I was there to help her child get well, if it were for her, I won't care either way. I continued with my work while her husband spoke to her in their language (presumably telling her to tone down), and then she continue running her broken record at a lower volume.

When the patient's consultant PHK came, we informed him of the incident details after he reviewed the patient. Fortunately for me, this consultant was fair to nurses. He returned to the patient's bed and told the mother that we the nursing staff are competent in our work and had been doing her family a huge favour in cost savings by treating her child at the ward. She had been privileged to received such good nursing care at lower cost (and free doctor's consultations). However if she insists on demanding interventions her way, he will re-assign the patient to HDU and she will have to foot the full bill.

That lecture bought us some peace for a while. I was glad the consultant was the one who dealt with the parents. Sadly, I am not confident that my hospital management would have been so supportive of its nursing staff.

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