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As an ED nurse, I often help patients and families ride a roller coaster of emotions. Last week I heard one physician tell a family, "You need to prepare yourselves. It would be a medical miracle if your mother survives this surgery." Well, miracles do happen, and this patient not only survived surgery but recovered well enough to go home. Later her husband came back to the ED to complain. He felt the physician's words took away hope. What should nurses do in a situation like this? -Y.R., TEX.
Prognosis is an inexact science. Health care providers don't want to make promises or give false hope. But patients and their families have a right to information about the full range of possible outcomes, good and bad, even though the focus may change with new information.
Many physicians are wary of medical uncertainties and feel uncomfortable appearing ambivalent as they talk with families. Some feel they should prepare families for the worst-case scenario. But when families hear only the worst-case scenario, they may assume (possibly wrongly) that the physician has already given up on their loved one.
How can you improve communication during a crisis? Help provide balance by anticipating family members' concerns, helping them articulate their fears, and suggesting options. For example, you might ask, "Are you wondering if you should call family members to her bedside to say their good-byes? Or would you prefer to have family members stand by, ready to come to the hospital during her recovery to keep her spirits up?" Encouraging families to discuss their options with the physician can help the physician address practical concerns while the family processes information about the prognosis, and temper uncertainty with hope.
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