CARING for the patient :wub:

[Melclin]

Once or twice in the past I have taken palliative or lonely nursing home patients to their destination via some lovely spot to which they've not been in many years. Once to the lakeside and another to the beach, each time unloading the stretcher to sit in the sun with the patient. I stole the idea from other paramedics in our service and its something that some of us do occasionally.

I'm big on this sort of stuff. Playing music that the patient likes while in the truck, holding nanna's hand on the way to hospital, the occasional hug. I'm an atheist, but I'll happily pray with my patient if it comes up. I consider it to be one of the most rewarding parts of the job. Obviously, this all happens in carefully chosen, clinically and logistically appropriate situations.

I'm posting this mostly because I'm interested in expanding my arsenal. I also recognize that these are sensitive issues and it isn't risk free in some ways, so I'm interested in opinions and discussion on the issue as well. What other pastoral, warm and fuzzy, rapport building, comfort inducing "treatments" do you employ (or wished you could employ if you are restricted from using it for some reason)?

Really, I'm interested in any way you treat fear and misery. Or are you against the idea? Is it inappropriate and should we stick to conventional medical therapies? I'm interested in all opinions and any criticisms.

 

[NomadicMedic]

I'm a big fan of conversation. It's one thing that you just can't teach, unfortunately. Some paramedics are great at making small talk… Others not so much. A few tips and tricks that I try to pass along when I can; take a look around the house before you leave. Make note of pictures of kids or grandkids, hunting trophies, bowling trophies, books that you may have read. Whatever looks interesting. Use these as topics of conversation.

There's a few topics that almost everyone will talk about. Their kids, where they work(ed) and where they're from. I can easily fill a 40 minute transport by asking about what the patient did before they retired, where they grew up or about their kids.

There are other medics that simply can't have a conversation with the patient, aside from "are you allergic to any medications?"

Frankly, if I'm not doing a bunch of interventions, I'm taking my gloves off and sitting back for a conversation and a comfortable ride to the hospital. An extra pillow, an extra blanket, some music on the radio. All of these things help make that time go a lot quicker.

And the other thing, don't be scared to touch your patient when you're not sticking them with an IV or wrapping a blood pressure cuff around an arm. Holding a hand, putting your hand on their shoulder, it's all good medicine. Possibly the best medicine that you have at your disposal.

Start talking to your patients. Chances are, you've got something in common that you can talk about. A place you visited, a place you've always wanted to go, a book you shared, people you know. I believe that there are no strangers, only friends you haven't met yet.

 

[mycrofft]

Like DC said.

Also, even small talk is great because, as I've been told, it can be bi%#h being a full-time terminal patient. How about those Sox? Supposed to rain today. How's your giraffe doing?

https://www.youtube.com/watch?v=-Fo9C8WVNuI

 

[Kevinf]

My patient lamented that he was not longer able to go to the store and get snickers bars anymore, so my partner and I went to the vending area and got him a pair of snickers. He was very appreciative of that.

 

[NomadicMedic]

When I was doing BLS IFT I had a daily patient that was going to UW radiation from a near by nursing home. He had testicular cancer and had a poor prognosis. One sunny day he asked if I could stop at Jack in the Box and get him some tacos. Of course we did, and we went to Golden Gardens, a park in Seattle, to eat our tacos and sit in the sun. I just told the dispatcher what I was doing. He was fine with it. (It pays to stay on the good side of the 'spatch)

He died a few days later. He was a hell of a good guy. One patient I actually became friends with.

 

[The S man]

Reading this has been most inspiring. I'm just beginning my career, and It is one of my goals, perhaps one of the most important, to connect with and comfort patients in the ways described. I'm not particularly charismatic, so it may be something that I have to work on, but I'll get it. Props to you guys. You're truly heroes of the community.

 

[Summit]

Sometimes a stable long stay icu patient gets to go outside

 

[broken stretcher]

few years back had a long haul peds psych trip about 4-5 hours away and the kid had to go to the bathroom real bad. Kid kept complaining to my partner and i was driving. Instead of making him be uncomfortable and pee in the container, my partner told me to pull off at the rest stop. I thought my partner was nuts but i did it and he told the kid he was to remain between both of us and not a step ahead or behind, and if he ran he was going to have a problem. Kid didn't deviate a single step the entire time we let him out of the truck and he even got a mcdonalds ice cream from us out of it.

 

[Household6]

I saw a video once on music therapy of dementia patients.. I have a Pandora station that I play to see if I can get a reaction..

I've gotten a response when I've played old gospel hymns.. It cracks me up. They don't remember much, but when you play Love Lifted Me, they sing along.

https://www.youtube.com/watch?v=QG7X-cy9iqA

 

[TheLocalMedic]

Sometimes what patients need most is just someone to talk to. I often have great conversations with people on the way to the hospital, and letting them talk takes their mind off of whatever is wrong with them.

Occasionally on interfacility trips I'll even take little detours if there's somewhere they want to go. Had one woman who wanted desperately to see her terminally ill son who hadn't been able to see her in the hospital. It didn't take long, and I could see how much it meant to both of them when we stopped by his house with her.

 

[Restless]

I only hope....

....that if I EVER need an ambulance again.........that it's one of YOU that respond. Remember too, even a "simple" ambulance ride for "you" can be terrifying and frightening to us (the patient)

Y'all do a Momma's heart proud!!!

 

[Melclin]

Sometimes a stable long stay icu patient gets to go outside

I've heard this. I don't think I read it anywhere authoritative but its pretty effective isn't it? Assists sleep/wake cycles and what not?

...I'm not particularly charismatic, so it may be something that I have to work on, but I'll get it..

I had to work on it too. I'm an esoteric, nerdy kinda guy and it didn't come naturally to talk to truck drivers or farmers etc. I had to pick up many colloquialisms that I'd never heard before and there are one liners you pick up from other providers. I think a good place to start is to be open and genuine in your intention to be nice. Offer that extra pillow..a drink of water whatever, explain as much as you can to people; they're scared and don't know whats coming next. You'll get the hang of it. Just don't take the opposite, cold route because small talk doesn't come naturally.

Start talking to your patients. Chances are, you've got something in common that you can talk about. A place you visited, a place you've always wanted to go, a book you shared, people you know. I believe that there are no strangers, only friends you haven't met yet.

Common ground is a big one for me. I think if you're actually enjoying the conversation about a topic you like, then that comes across in your demeanor.

My patient lamented that he was not longer able to go to the store and get snickers bars anymore, so my partner and I went to the vending area and got him a pair of snickers. He was very appreciative of that.

Snickers...dementia playlists..terminally ill kid visits...tacos. Loving it guys

 

[Mjolnir]

I will always attempt to chat with a patient (given they're not raging EDPs, out for blood). My rule is, I try once. If a conversation develops, I'll talk all the way to the ER. If they're not interested, I just do my best to get them as comfortable as possible, and politely keep my mouth shut.

There is definitely something to be said for going beyond what "the book says", and interacting with your patients. I have friends that took the course together with me, and they never get to know the patient beyond what's needed on the PCR.

 

[mycrofft]

There is rendering care, and caring. This is the second and it supports the first.
Compassion it not taught, but learned.

 

[Asclepius92]

Reading this has been most inspiring. I'm just beginning my career, and It is one of my goals, perhaps one of the most important, to connect with and comfort patients in the ways described. I'm not particularly charismatic, so it may be something that I have to work on, but I'll get it. Props to you guys. You're truly heroes of the community.

^This.

I, too, am just getting into the field and am not a "social butterfly" for lack of a better term so the bed side manner is something I'll need to develop but reading the things you guys have done with some of your patients has given me some great ideas to sit on.

 

[PrincessAnika]

I joined a transport company. seriously - I get to spend way more time with my pts and get to know them.
we did take one pt who is bed bound to visit her father in the hospital after one of her appts.

 

[captinfocker]

Also listen to the little things the pt's say, for example we were loading a regular dialysis pt who told us the sun felt good and she hadent felt it in months. When we dropped her off I parked farther away from the door so we could take a slow walk in the sun to the door. Always remember we do this pretty much every day so we get used to being in the back of an ambulance, most people do not and it can be scary for the first time.

 

[exodus]

To be honest, as much as I would love to, I wouldn't do 90% of what you guys are doing in fear or being fired or written up. It's just not worth the risk for me.

 

[PrincessAnika]

guess I should add we had the chief of operations with us on our detour - nothing we do for our pts is done without approval.

 

[PrincessAnika]

also, the more I think about this the more it should be noted, esp for the newbies, but also for those of us who forget -- it doesn't have to be stopping at the beach or getting a food or whatever. the other day we had a pt going from ECF to drs office to his residence, and while we were waiting at the drs office he was getting a little worked up because he was worried about who would be home when we got him there. my partner pulled out his cell phone, dialed the guys house number for him and gave him the phone so he could talk to his wife. when he was done talking he just erased the number from his phone. pt felt better, and calmed way down. <3