What do I say?

They want to know
What do I say?
Maryse Godin, N. M.Sc.(A)
Clinical Nurse Specialist
Emergency Department
Montreal General Hospital – MUHC
September 2012
8:00 on Monday morning
z
You hear a car crash occurred in the Ville
Marie tunnel and Urgences Santé just arrived
with the driver, a 32 year old man. Rumor on
the floor is that he is in bad shape and the
team is proceeding to intubate as the Code
Trauma is called.
8:30
z
z
You have not seen the trauma patient but,
come face to face with a young woman in
tears accompanied by 2 men and a security
guard. She says the police told her that her
husband was in a car crash and brought here
She wants to see him right now, and talk to
the doctor right now. She is extremelly
distraught
What do you say?
z
z
z
z
z
Tell the security guard to kick her out and keep her
out until she is calm?
Tell her you don’t know anything and keep walking?
Ask her for her husband’s name and tell her you’ll
get back to her?
Ask for her husband’s name and tell her he is here
and in bad shape?
Other suggestions?
9:00
z
Two more traumas have come in, the doctor
says he has no time to speak to anyone.
Patient is going for scan but unstable so
accompanied by nurse and resident.
z
Patient is back from scan. Team has not
decided if it will be OR or ICU from here.
Why say anything?
z
Family needs in the ED
z
z
z
z
z
Information
Assurance
Proximity
Support
Family needs in critical care (CCFNI)
z
z
z
z
Assurance (questions answered honestly)
Information
Proximity
Support
Why say anything?
z
Meeting family needs leads to better patient
outcomes
z
Family anxiety may lead to negative
physiological and behavioural outcomes for
the family, for the patient and for the staff
What are you allowed to say?
Guiding principles
True or false?
z
z
z
Only a physician can give information about
the diagnosis
The patient’s life is in jeopardy so I have the
right to tell the next of kin everything
The best approach is to give vague
statements such as “we’re doing the best we
can” and “for now, he’s stable”
Disclosure principles
z
Professional obligations
z
Professional boundaries
z
Code of Ethics
z
Institutional rules and regulations
Professional obligations
© Éditeur officiel du Québec
À jour au 1er septembre 2012
Ce document a valeur officielle.
L.R.Q., chapitre C-26
Code des professions
¾
39.4. L'information, la promotion de la santé et la prévention de la maladie,
des accidents et des problèmes sociaux auprès des individus, des
familles et des collectivités sont comprises dans le champ d'exercice du
membre d'un ordre dans la mesure où elles sont reliées à ses activités
professionnelles.
Professional boundaries
z
Who is your team?
z
What is your role within that team?
z
Communicate, communicate,
communicate………
Code of Ethics
Code de déontologie des infirmières et infirmiers
(L.R.Q., c. I-8, a. 3)
¾
15. L'infirmière ou l'infirmier doit s'abstenir
d'exprimer des avis ou de donner des conseils
contradictoires, incomplets ou non fondés. À cette
fin, il doit chercher à avoir une connaissance
complète des faits avant de donner un avis ou un
conseil.
Code of Ethics
¾
17. L'infirmière ou l'infirmier doit agir avec compétence dans
l'accomplissement de ses obligations professionnelles. À cette
fin, l'infirmière ou l'infirmier doit notamment tenir compte des
limites de ses habiletés et connaissances.
¾
19. L'infirmière ou l'infirmier doit, si l'état du client l'exige,
consulter une autre infirmière ou un autre infirmier, un autre
professionnel du domaine de la santé ou toute autre personne
compétente, ou le diriger vers l'une de ces personnes.
Code of Ethics
z
Le client peut renoncer, en tout ou en partie, à son droit au
secret professionnel. Sa renonciation peut être expresse ou
tacite. Elle est expresse lorsqu'elle autorise explicitement ou
formellement le professionnel à divulguer à un tiers tout ou une
partie des renseignements et le professionnel doit se conformer
à cette demande, selon les conditions définies par le client.
z
Le client peut aussi y renoncer implicitement. Par exemple, une
personne vous consulte accompagnée d'un proche; elle
renonce ainsi implicitement à son droit au secret professionnel
à l'égard de ce proche
Code of Ethics
z
…..il incombe à l'infirmière d'exercer son jugement
clinique afin de déterminer si elle peut ou non
communiquer des renseignements confidentiels
dans cette situation….
(lorsqu'il a un motif raisonnable de croire qu'un danger
imminent de mort ou de blessures graves menace
une personne)
Institutional rules and regulations
z
Find out what they are
z
Role of the nurse to advocate
z
When in doubt …… What is reasonable?
Process of breaking bad news
z
Notion of a process, as opposed to a point in time
z
The interactions that take place before, during and
after the moment that bad news is delivered
(Warmock C, Tod A, Foster J, Soreny C, 2010)
Process of breaking bad news
z
Process related activities include:
– Assessing need for information
– Identifying and clarifying misunderstandings
– Initiating discussion
– Obtaining and explaining complex medical
information
– Helping people cope with their emotional reaction
(Warmock C, Tod A, Foster J, Soreny C, 2010)
Next morning
z
z
z
z
Patient went to the OR
Information given overnight with list of
injuries and explanation regarding the
worrisome pelvic injury
Wife wants to know about transfusion
overnight and trend in haemoglobin
What do you say?
Keep in mind
z
z
z
z
z
z
Saying nothing is not an option
Say what you know
Keep it simple
Enlist the team
Meet the need for assurance without giving false
hope
Avoid empty sentences.
–
–
Everything will be alright
He’s stable