Nursing Voices

Wednesday, June 13, 2007

Go Ask Mother

It's beautiful outside today and I have the day off. Maybe I'll go to the beach. I wish I looked like this girl. She looks cute in her bathing suit. I'm getting old. That means that I don't look cute in a bathing suit. I go to the beach wearing shorts and an oversized T-shirt that says, "Nurses Call the Shots." My darling husband says that I haven't changed, and that I still look like a blushing new bride. Love is blind.

I’ve been collecting some questions in the old mailbag, so it’s time for another edition of Go Ask Mother.

Here's a question from a mental health care consumer. She writes:

Dear Mother Jones, RN--Something that I noticed throughout my treatment, good or bad, inpatient or out, was that the mental health professionals were always withholding information from patients. Why is so much information withheld from patients?

I understand that some information is withheld from patients for therapeutic purposes (like not telling anorexic patients their weights); I understand that personal information about staff is withheld for their safety and because it really just isn't relevant. I'm asking about the other things.

Some things that are withheld are piddly, like why we are woke up at 5am when we must get our blood drawn. Why does information like that get withheld at all? I'm sure that for simple things like this there are generally reasonable, if mundane, answers. If I'm told that mundane answer, I might still not like it, but I'll be much more willing to deal with it. If the nurse rather deflects or ignores my question, I'll be frustrated and might make a fuss. Why is info about petty issues withheld?

If a patient asks about their rights, and the question isn't answered, what do you expect us to make of that? I know that it makes me think that you don't want me to know my rights so that you can violate them without my making a fuss. This is probably a big reason for why psych units have such a bad reputation, at least with people who aren't so impaired so as not to notice this. We know that in a psych unit our rights are limited, but we know that we still do have rights, and if you don't tell us what they are, we will be suspicious (as we should be, this is not paranoia). Why is information about our rights withheld?

Why is information about the therapy withheld? I've often asked, as a patient, how a particular type of therapy was supposed to be helping me, and been deflected or ignored. As an insatiably curious person, this is infinitely frustrating. I cannot even fathom why this sort of information would be withheld.

These are the largest areas of information withholding that I can think of at the moment. I would love any insight you have on why you withhold these or other types of information from patients, or why you think your colleagues might (though I certainly don't expect you to be psychic).

Dear Mental Health Care Consumer:

You ask some very interesting questions, and I don’t know if I have the answers that you are looking for, but let’s give it a try.

As you mentioned in your letter, sometimes it’s therapeutic to withhold information. You are right when you said that it’s not therapeutic to focus on someone’s weight when they are suffering from anorexia. Staff also will withhold personal information about themselves in an attempt to maintain personal boundaries, and as a way of assisting a patient to focus on their own issues.

Patients do have the right to know about their treatment. I tell patients why I’m taking their blood pressure, and I’ll explain why the doctor wants to run a blood test. It’s courteous to let people know what is happening to them. However, I have had patients who focus too much on what’s going on around them, and not enough on what brought them into the hospital. Patients who are brought to the hospital against their will are usually angry and challenging, and it’s my job to tell them things that they don’t necessarily want to hear. Sometimes I must deflect questions and comments as a way of leading patients back into a therapeutic conversation.

I’m not sure why information about therapy was withheld from you. Every case is different, but I can tell some reasons that I have noted in the past. I was taught that therapy is a voyage of self-discovery, and that we do a disservice to our patients if we tell them what we think about their situation, or what to do next. If a patient says, “I feel really mixed up. What do you think I should do,” I was taught to answer, “That’s not up to me. What’s important is what you think you should do.” I know it sounds like double-speak, but it’s important that patients make their own decisions about how to live their lives. Maybe that’s why information about your therapy was withheld. I’m not saying that I’m giving you the right answer, I’m just saying that I’m giving you my best guess.

I hope I’ve been able to answer some of your questions.

If you have a question, please send it to me at nurseratchedsplace AT yahoo DOT com.


Blogger Amrita said...

Mother Jones, the girl in the painting looks very much your profile photo. infact i thought it was a painting of you.

12:51 PM  
Blogger Jean-Luc Picard said...

The woman in the bathing suit looks very...errr..healthy.

3:05 PM  
Blogger Mother Jones RN said...

Oh shucks, amrita, thanks for the kind words. I may have looked that way in my youth, but those days are long gone.


4:02 PM  
Blogger TC said...

Her bathing suit looks a little, um, transparent.

8:13 AM  

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