How to Make Your Patient Happy

 

I’ve been a people pleaser for a long time now. I’m not entirely sure when it all started. I distinctly remember being an annoying, pain in butt kid and teenager.

Whenever it began, it is a large part of the adult me. In my yearbook I was noted at “best known” for my “perkiness”. Without analyzing why I feel the need to make people happy ( I will do that in a later post) I have to admit that I really, really enjoy it.

I currently work in home care. My patients range from basically healthy in need of companionship to end of life hospice. I feel responsible for the happiness of my patients and their families. I accept this responsibility with…

…happiness (of course).

  1. Call ahead- I always give a one hour window for my visit. I always call if I’m running early or late. I also ask if there is anything they need while I’m “out”. The patient often asks me to stop and pick something up for them. I’m happy to help.
  2. Arrive on time-See above.I am very careful about predicting the time of my arrival. Even if they patient is a little old lady who sits in her chair all day, she appreciates knowing what time to expect me.
  3. Listen-For real. I can’t just pretend to listen. When they talk about their hobbies or their kids or whatever, I listen. The next time I speak to them I will reference our previous conversation. They love that. They know I was really listening.
  4. Smile-A genuine smile can be hard if I’m not really happy. That’s ok. I’m practically always happy.
  5. Laugh-When I laugh with my patient, or make them laugh, its like a gold star that I earned.
  6. Ask good questions-It is so important to ask the right questions. I have learned to stop asking “How are you?” because I have received the response “How do you think I am?” one too many times. now I ask, “What’s new?”. To gather accurate information about the patients health and state of mind I have to ask smart questions. “Are you having any pain?” is just not enough. I also ask about discomfort and weakness. Then I ALSO ask about specific types of pain; back, knee, joint, etc. I know that a lot of patients don’t want to “complain” but I beg them to be honest with me.
  7. Give good answers-The answers are as important as the questions. The most important is when I don’t have the answer. If I really don’t have an immediate solution I promise to follow up, and then I do.
  8. Follow up-See above. Follow up is annoying for me, but I know how important it is for my patients. They are so happy when I get results and report back to them. Almost like they’re surprised that I actually did what I said I would do.
  9. Anticipate outcomes-This is where we use our crystal ball that is really our clinical experience, to predict the future. That is what I have to do every day, every minute.
  10. Remember the childrens’ names
  11. Remember the grandchildrens’ names
  12. Remember the pets’ names-I write them down in the patient’s paperwork. Yes, it is that important.
  13. Notice what is hanging on the walls-So much of what I want to know is hanging on my the walls. Are they a veteran? Are they married? Do they have children? Are the paintings on the wall all painted by the same artist? This is something that I actually look for. If so, I ask about the artist, which is usually the patient themself, or a family member.
  14. Do the laundry-How difficult is it to throw in a load of laundry? Even offering is a truly appreciated gesture.
  15. Wash the dishes-See above.
  16. Ask about hobbies and interests-My patients tell me about the most interesting hobbies; breeding horses (see previous post), keeping bees (stay tuned for this post), needlepoint, painting, gardening… 
  17. Take good notes-I take notes about everything. Sometimes the minute details are necessary to reference later. A seemingly unimportant statement or issue can become significant later.
  18. Bring gloves-You can never have too many boxes of gloves. This makes the patient and the caregiver very happy.
  19. Respect them-I am an invited guest in the patients home. I offer to take off my shoes, I ask permission before I sit. My patient is the boss. They deserve respect.
  20. Don’t argue-There is no situation I can think of where this would be appropriate or acceptable. Just don’t do it.

 

Lessons I’ve Learned:

  1. Its the details that count.
  2. Never underestimate your ability to change someone’s day. 
  3. Be present-whatever is going on in your life doesn’t matter when you’re with a patient. 

Family Ties

Family.

It’s a funny thing when someone in your family is sick.

There are many different types of reactions that the family members typically have.

I had a patient who lived alone in a senior building on the beach. When Hurricane Irene was predicted we called all of our patients and their family members who were being evacuated. My patient’s daughter did not want to talk to me and did not care to discuss her mother’s evacuation. I explained that according to the documents that the daughter signed when care began, she is responsible for her mother if the home health aide cannot make it to her mother’s home due to illness, weather or “acts of G-d”. This patient’s daughter made it very clear that this was my problem, not her problem.

Once I saw a patient for monthly visits who had recently moved in with her son and daughter in law. The patient was near the end of her life and her son felt they should spend this time together. The son spent all day, every day with his mom. He planned activities, took her to get her nails and hair done and to visit her friends. The funny thing was his mother couldn’t really appreciate the outings. She was just too sick and too weak to appreciate or understand what was going on in her surroundings. The nurse I work with joked that the son is busy with his mother’s schedule and his mother is “asleep in her soup”. Maybe this patient’s son was “over doing it”.

One patient I saw was home after a recent hospitalization for a fracture as the result of a fall. She was fine before the fall so she wasn’t receiving any help from family. After she came home she needed some help. I talked to her son about setting up services for his mother. He didn’t know anything about her. He didn’t know where she got her medications or how she usually shopped for food. I was a little surprised that he wasn’t more “on board” and didn’t seem particularly concerned.  Over the next several days and weeks I encouraged the son to be more involved and educated him regarding his mother’s needs. The son “stepped up” and began to worry that his mother was not improving like she should. He took her to see a specialist and she was diagnosed with a terminal illness. The patient died soon after with her son by her side.

I used to see a patient for wound care who had arterial disease (i.e black toes). The patient had a stroke years earlier and her daughter took care of her full time. The patient was bedbound and required complete care, which the daughter lovingly provided. I advised the daughter that her mother’s wounds would not heal and her blackened toes would likely self amputate. The daughter insisted on trying multiple different wound care options and even insisted on a certain type of gauze. I showed the daughter how to wrap the patient’s feet but the daughter insisted on wrapping each individual toe. When I was nine months pregnant this patient’s daughter requested that I be removed from the case. Why? Because she was afraid that it wasn’t safe for me on her stairs. She had four stairs.

I saw a patient recently who had recently had her second stroke. This stroke left her unable to speak and paralyzed on her left side. The patient lived with her daughter and her daughter’s family in a small apartment. The daughter cared for her mother full time including changing her diapers and transferring her with a hoyer lift. This patient required total care and her daughter was happily providing it. I complimented the daughter on what a great job she was doing with her mother, she thanked me with tears in her eyes.

I received a complaint from a home health aide that a patient was developing skin breakdown in her diaper area. I called her husband to ask how often he was changing her diaper. As it turns out, he wasn’t changing her diaper at all. The home health aide was changing it in the morning and the evening and the husband wasn’t changing any diapers in addition to those. I (patiently) explained the importance of keeping the patient’s diaper dry and the husband (claimed) to understand. I followed up with one of their adult children just to be sure that they were aware of the situation.

I want to understand why some families are so attentive to their elderly and sick loved ones and some are so absent. Maybe there’s nothing I can do about it, but I really want to get it. I want to understand so I can help everyone take care of their loved ones so everyone can live (and die) happily ever after. I am aware that this is unrealistic but it is my heartfelt desire. I may have to accept that there is no rhyme or reason to this.

I have worked with a wide spectrum of patients. The majority of my nursing experience is with low income, underserved and poorly educated population. I found that most of my patients felt a strong responsibility to take care of their loved ones. They often didn’t understand their illness or their treatments but they truly seemed to care.  I recently started working with more wealthy and highly educated patients. I was sure I would see a difference, some type of benefit to all of their money and education. It’s been almost a year and I now see there is no difference. The families are the same. Some are hardly involved, some much more so.

I guess its as simple as that. Most people take care of their family because that’s what they are-family.

Lessons I learned:

  1. Always compliment the caregiver
  2. Never assume the family is aware of the client’s needs.
  3. Treat everyone the same regardless of financial and educational status.