Expected Outcome - Not Met

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As I walk down the hall of my long-term care clinical site, I am anxious to begin a day full of learning! I have my group patient care plan in hand, and I'm ready to work on my interventions.

by QuietRN

Expected Outcome - Not Met

I spent a lot of time coming up with interventions that I felt could really help our almost-a-century-old patient. As we pass room 221, I realize that there is a different patient there. Where's our group patient? Oh no. At that moment I know exactly where she is.

She had been on my mind all week, and not just because my homework revolved around her medical history. After only three weeks in this facility, I have really grown attached to the patient in room 221.

Even though I don't speak or understand a word of Spanish - the primary language of the patient - I really felt like we were able to communicate. She wasn't even able to speak Spanish at this point; her sole means of communication was through moaning/yelling.

Even with this barrier, I was starting to recognize certain nonverbal signs: the small raise of her eyebrows, the opening or closing of her mouth, the slight grasping gesture her hands would make. I tried learning a couple words of Spanish so that when I was doing a physical assessment, I could at least try to let her know what I was going to be doing.

The few times she opened her eyes - though just a tiny slit - were so exciting!

We were communicating!

The third day of our clinical had me extremely worried about this patient. We went in to take her vital signs. It didn't take long to realize that she wasn't doing so well. Her respirations were around 35/min and she felt very warm. She was also coughing and choking on thick, greenish sputum. I wished I could sit there for the full 6 hours and hold her hand. I hoped her nurse would take these signs seriously and call the doctor and the patient's family.

On that 4th day of clinical, it was not surprising to learn that she had passed away. I know that death is inevitable, especially at such an advanced age. And while I was disappointed that I couldn't list my expected outcome as having been met, I was really just sad that I wouldn't get to care for this patient again. I sometimes wonder if I am too sensitive to be getting into nursing. I once thought that's what this profession was all about - caring. I see health care professionals all around me who don't even seem to know the meaning of the word. Can I become an expertly skilled nurse and still be a sensitive, caring woman who is truly concerned for the patients she cares for? It is more than just completing the interventions and meeting the expected outcome, right? It should be about making a difference in that patient's life and letting your life be touched by them as well.

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7 Comment(s)

eriksoln, BSN, RN

Specializes in M/S, Travel Nursing, Pulmonary. Has 15 years experience. 2 Articles; 2,636 Posts

As I walk down the hall of my long-term care clinical site, I am anxious to begin a day full of learning! I have my group patient care plan in hand, and I'm ready to work on my interventions. I spent a lot of time coming up with interventions that I felt could really help our almost-a-century-old patient. As we pass room 221, I realize that there is a different patient in there. Where's our group patient? Oh no. At that moment I know exactly where she is.

She had been on my mind all week, and not just because my homework revolved around her medical history. After only three weeks in this facility, I have really grown attached to the patient in room 221. Even though I don't speak or understand a word of Spanish - the primary language of the patient - I really felt like we were able to communicate. She wasn't even able to speak Spanish at this point; her sole means of communication was through moaning/yelling. Even with this barrier, I was starting to recognize certain nonverbal signs: the small raise of her eyebrows, the opening or closing of her mouth, the slight grasping gesture her hands would make. I tried learning a couple words of Spanish so that when I was doing a physical assessment, I could at least try to let her know what I was going to be doing. The few times she opened her eyes - though just a tiny slit - were so exciting! We were communicating!

The third day of our clinical had me extremely worried for this patient. We went in to take her vital signs. It didn't take long to realize that she wasn't doing so well. Her respirations were around 35/min and she felt very warm. She was also coughing and choking on thick, greenish sputum. I wished I could sit there for the full 6 hours and hold her hand. I hoped her nurse would take these signs seriously and call the doctor and the patient's family.

On that 4th day of clinical, it was not surprising to learn that she had passed away. I know that dying is inevitable, especially at such an advanced age. And while I was disappointed that I couldn't list my expected outcome as having been met, I was really just sad that I wouldn't get to care for this patient again. I sometimes wonder if I am too sensitive to be getting into nursing. I once thought that's what this profession was all about - caring. I see health care professionals all around me who don't even seem to know the meaning of the word. Can I become an expertly skilled nurse and still be a sensitive, caring woman who is truly concerned for the patients she cares for? It is more than just completing the interventions and meeting the expected outcome, right? It should be about making a difference in that patient's life, and letting your life be touched by them as well.

When I was a student, I had a patient drill me with something like this. He was loseing his eyesight to diabetes, and couldnt get the operation he needed done to stop the process until other problems were handled. Obviously, this man was stressed out.

When I went in to give him his medications, he stopped me. Said (parapharse here) "Stop, dont just hand me pills to complete your task and move on. Cant you ask me how I am doing or maybe go a step further, ask me what I SAW last night that I appreciated seeing before my sight is completely gone. A man is worth nothing without being able to see. I want to appreciate every minute I have left that I can remember what green looks like, what a sky that looks like rain looks like, what my beautiful wife looks like. I want to relish this time. I dont want to spend it going through the routines and daily processes that you people call a career. Thats nothing to me. WHAT ABOUT ME?"

I try to not be so mechanical with people now. Sometimes ratios and acuity forces it, but when I can, I try to remember this lesson. He did lose his eyesight. From what I understand, he went to a psych. unit because the became depressed in a clinical sense. Dont know what became of him after. I like to think someone who was more experienced did actually treat him more like a person and less like a task so that he was able to have some hope for a life without eyesight.

feliz3

382 Posts

As I walk down the hall of my long-term care clinical site, I am anxious to begin a day full of learning! I have my group patient care plan in hand, and I’m ready to work on my interventions. I spent a lot of time coming up with interventions that I felt could really help our almost-a-century-old patient. As we pass room 221, I realize that there is a different patient in there. Where’s our group patient? Oh no. At that moment I know exactly where she is.

She had been on my mind all week, and not just because my homework revolved around her medical history. After only three weeks in this facility, I have really grown attached to the patient in room 221. Even though I don’t speak or understand a word of Spanish – the primary language of the patient – I really felt like we were able to communicate. She wasn’t even able to speak Spanish at this point; her sole means of communication was through moaning/yelling. Even with this barrier, I was starting to recognize certain nonverbal signs: the small raise of her eyebrows, the opening or closing of her mouth, the slight grasping gesture her hands would make. I tried learning a couple words of Spanish so that when I was doing a physical assessment, I could at least try to let her know what I was going to be doing. The few times she opened her eyes – though just a tiny slit – were so exciting! We were communicating!

The third day of our clinical had me extremely worried for this patient. We went in to take her vital signs. It didn’t take long to realize that she wasn’t doing so well. Her respirations were around 35/min and she felt very warm. She was also coughing and choking on thick, greenish sputum. I wished I could sit there for the full 6 hours and hold her hand. I hoped her nurse would take these signs seriously and call the doctor and the patient’s family.

On that 4th day of clinical, it was not surprising to learn that she had passed away. I know that dying is inevitable, especially at such an advanced age. And while I was disappointed that I couldn’t list my expected outcome as having been met, I was really just sad that I wouldn’t get to care for this patient again. I sometimes wonder if I am too sensitive to be getting into nursing. I once thought that’s what this profession was all about – caring. I see health care professionals all around me who don’t even seem to know the meaning of the word. Can I become an expertly skilled nurse and still be a sensitive, caring woman who is truly concerned for the patients she cares for? It is more than just completing the interventions and meeting the expected outcome, right? It should be about making a difference in that patient's life, and letting your life be touched by them as well.

What made you believe you did not make the difference to her? The fact that your patient was not able to tell you that herself because of the language barrier, does not mean that you did not accomplish your goal. Remember, my friend, your primary objective is to do no harm. It sounds to me by what you told to the readers of your story that you accomplished the most important objective of the nursing profession beyond your own expectations, and I congratulate you for that. Somehow your were able to connect with your client, and that is remarkable for you were dealing with a language barrier ...are you aware that your good will and intentions came across as clearly as day to your client? Congratulations, feliz3

Edited by feliz3
Wrong word, missing a space between words

Mahage, LPN

Specializes in IMCU. Has 1 years experience. 376 Posts

When I was a student, I had a patient drill me with something like this. He was loseing his eyesight to diabetes, and couldnt get the operation he needed done to stop the process until other problems were handled. Obviously, this man was stressed out.

When I went in to give him his medications, he stopped me. Said (parapharse here) "Stop, dont just hand me pills to complete your task and move on. Cant you ask me how I am doing or maybe go a step further, ask me what I SAW last night that I appreciated seeing before my sight is completely gone. A man is worth nothing without being able to see. I want to appreciate every minute I have left that I can remember what green looks like, what a sky that looks like rain looks like, what my beautiful wife looks like. I want to relish this time. I dont want to spend it going through the routines and daily processes that you people call a career. Thats nothing to me. WHAT ABOUT ME?"

I try to not be so mechanical with people now. Sometimes ratios and acuity forces it, but when I can, I try to remember this lesson. He did lose his eyesight. From what I understand, he went to a psych. unit because the became depressed in a clinical sense. Dont know what became of him after. I like to think someone who was more experienced did actually treat him more like a person and less like a task so that he was able to have some hope for a life without eyesight.

As beautiful as the OP's original post was, YOURS sent chills up my spine. Thanks so much for posting it. WOW that is a message you were apparently meant to hear and I do so appreciate you sharing it.

Mahage

Teresag_CNS

Specializes in ICU, trauma, gerontology, wounds. Has 34 years experience. 3 Articles; 194 Posts

Keep your passion to change lives. Do not be discouraged by what you see around you. It will take courage, but nurses have this by the armload.

Caring may not be what your employer values, but why let their values determine your self-image? First, you are a nurse, a member of a profession and a caring human being. You may also be a sister, a mother, a daughter, a wife. Being an employee is WAY far down on that list. Never forget that.

Wishinonastar, BSN

Has 37 years experience. 3 Articles; 1,000 Posts

As many patients as I have had over too many years to count, I never tire of getting to know them and spending time learning about their personal issues. When they die, I always miss them, even if I had only seen them one or two times. I try to notice the uniqueness about all my patients, in every setting. I want them to feel that their concerns are always important to me. I have hurt and cried over patients many, many times, but even though it can be such an emotionally draining job I can't imagine doing anything else.

I think a lot depends on the setting whether nurses resist opening themselves to patients or not. There are a certain percentage of nurses who feel for their patients more deeply in any setting, but those who are this way seem drawn to certain areas, such as hospice and home care, where they are in a more personal relationship with their patients. Not everyone is comfortable opening themselves in this way. I could never be satisfied working in an OR, recovery area, or the ER, because there is not the same opportunity to get to know your patients, which is very important to me. You will find your niche, we all do. Don't worry, you will be fine.

Chaya, ASN, RN

Specializes in Rehab, Med Surg, Home Care. Has 15 years experience. 932 Posts

It would be so reassuring to any patient's family members to be able to believe their loved one had such a caring nurse looking out for their loved one at the times when they could not be present.

Yes, we need to harden ourselves in order to perform some of the duties we do. But we need to remember WHY we are doing what we do and not lose the caring component!

journey_bound

32 Posts

You guys are beautiful! I think this is what nursing is about... It's hard for me right now because I'm so task oriented trying to learn skills and be ready to run the floor (I grad soon). OP, you are going to make a fantastic nurse! eriksoln, thank you for sharing that story... I hope that I carry it with me throughout my career. Patients in the hospital are often dealing with difficult times in their lives and are extremely vulnerable. The idea of someone laying in their bed, scared and feeling alone with the nurse so nearby yet so far away, passing them without notice and fulfilling their "tasks" for their shift is sad. I intend on striving to be a nurse who cares about each patient as an individual.