This month, I am sharing some personal observations that span the course of my career involving a particular patient profile. Nurses will no doubt recognize him.
The archetype is a middle-aged to older male who has serious health issues, but avoids or denies the care he so desperately needs. Typically, he is or was in a high-powered role, like a corporate executive or business leader, in a field unrelated to healthcare. He projects being successful, strong, and in full control of everything. Showing signs of personal vulnerability or weakness is simply not acceptable.
He views illness and physical limitations as evidence of weakness. He might refuse to use a cane or assistive device when needed, despite the injury risk, because he does not like the image. When his need for medical care becomes obvious, concerned relatives, friends, or co-workers are left to compel him to seek care, often emergently. Upon being confronted, his characteristic response is, "I'm fine. I'm fine. Nothing is wrong." Penetrating this armor is tough.
After his arrival in a healthcare setting, perhaps by coercion, getting accurate information is extremely difficult due to his level of denial and aggravation. Because the history he offers likely contains intentional gaps, a deeper dive into what is really going on becomes essential. However, convincing him that he needs to undergo a full evaluation with diagnostic testing and possible intervention requires a Herculean effort. Preventing him from signing out against medical advice might be even harder. The response is one of fight or flight.
As I write this editorial, I am navigating this situation. I have seen it many times as a nurse and as a friend and relative. With someone close, the experience can be especially trying and even exasperating.
I offer this advice to nurses: Remember that underlying this very difficult behavior are feelings of being overwhelmed and fears of losing control, of the unknown, and of admitting a lack of knowledge. This person needs information in layman's terms and small, digestible bites until he can come to terms with what is happening. He needs to preserve his dignity and feel respect from the healthcare team. Building trust is critical. Emergency situations are particularly tough when urgent action is essential, but I have found that the same concepts apply in a much tighter time frame. It is all about the approach. Effective communication can indeed be life-saving.
Until next time,
LINDA LASKOWSKI-JONES, MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN
EDITOR-IN-CHIEF, NURSING2022