At a recent meeting of patient safety professionals a small group of nurses huddled around where I was sitting, and one began to share a story about how hard it is to advocate for patients. She explained that a woman who was in labor was in the hospital and one of the nurse’s colleagues was taking care of her. As her advocate, the nurse knew what the patient wanted – a normal delivery. But events moved slowly and as the woman was not yet sufficiently dilated, the resident physician ordered medication to speed up her delivery. The patient’s nurse knew this is not what the patient wanted; but the nurse “needed” to find the nurse manager who then needed to find the attending who would then go to the resident for authority to countermand the medication order. By this time the mother was in labor, and as a result of the effort to hurry things along, was showing signs of complications — hemorrhage.
The nurses listening to the story were sympathetic to the mother as well as to the nurse who was there to advocate for the patient. They expressed frustration about the chain of command they felt they had to follow in order to help this patient. This chain of command, they all agreed, was the problem.
But I disagreed with the nurses. It was not about the resident giving the wrong order. I asked the nurse why the patient wasn’t immediately consulted about speeding up delivery. That’s where the delay was, I told them. If she were truly advocating for the patient, the nurse would have told the resident, in front of the patient, that this is not what the patient had wanted. The nurse said that it would not have been appropriate to speak in front of the patient. “Why,” I asked?
This is the culture change that is needed. The family, I explained to her, would never have followed that procedure. A loved one with this mother-to-be would have said “Stop: this is how we are going to do it, we will respect her wishes for a natural delivery.” If this patient’s family member had trained through the PULSE of NY Family Centered Patient Advocacy program, he or she would not have been intimidated or caught off guard. They would know what patient-centered care is — and realize that this was not very patient-centered.
If you feel that your relative who is a patient is not being consulted, you have a right to stop the process and make sure the patient is in charge. This mother-to-be could have said that she didn’t care, they could do what they want; or she could have said, “I don’t want my labor induced – what are the other options?” At any time the patient can ask a loved one or nurse to be involved, help make decisions… or not. In this case, the nurses truly believed what they did was patient-centered even though the patient had no control of the situation.
That is where the culture of patient care needs to change.
Sign up for the PULSE of NY Family Centered Patient Advocacy Training – 8 hours of patient safety education and learning advocacy skills and communication.
Tuesday evening May 19 and Thursday May 21 from 5:30 PM – 9:30 PM
3601 Hempstead Tpke. Levittown. Registration required by April 25, no walk-ins.
Cost: $125.00 per person or come with a team of three people and pay $75.00 each. That’s a savings of $50.00 per person. (Each participant must register separately.) Visit www.pulseofny.org to register