Speak ou+

What are you saying!

For days my patient seemed unaware of what was going on around her. She was very ill after radical surgery. In this time before intensive care units, very ill patients always had private duty nurses.

This was her first really comfortable night. t knew her expenses were going to be high and I understood why she wanted to get along without special nurses as soon as she could manage by herself. Just before I finished my shift, the patient said she did not need a night nurse any more. I under- stood, but I was not sure why she wanted me to take the day nurse’s place. If she wanted to get along without a night nurse, I should have been the one to leave the case.

I tactfully tried to make her aware of this. She reached for my haind and said, “Whether you take care of me in the day- ~~~~ ~ ~~~

Lillian H Davis, RN, MS, is operating room super- visor a t the White Memorial Medical Center in Lor Angeles. A graduate of the New England Memorial Hospital in Stoneham, Mass, she has a BS in nursing education from Columbia Union College in Washington, DC, and an MS in medical- surgical nursing from Loma Linda University, Loma Linda, Calif.

time or not, I don’t want the day nurse back after today. I’ve been so sick I didn’t have enough energy to move or talk. She took good care of me but one day I heard her talking to some other nurses outside my door. I’m sure she thought I could not hear her, but I did. She was telling them all the transfusions and intravenouses the doctors were giving me were senseless when they knew I wasn‘t going to get better. She thought it was a waste of time and my money. Right then I decided that as saon as I could say so, I was going to send her on her way. I intended to get better and I didn‘t want anyone with that attitude taking care of me. So after today, she goes.“

What are you saying? Where are you saying it?

A nurse is taught and reminded many times that hearing is the last sense to be- come insensitive to stimuli. Even though your patient is apporently too ill to respond to your questions, he may hear. What does he hear?

Do you talk to other nurses, the patient‘s relatives, or the physician just outside the patient‘s room? Do you talk to family and

June 1973 45

friends by the bedside, telling them that everything possible is being done but the patient doesn't seem to be improving?

Are you helping family and friends to say the best words for the patient to hear? When a wife stands by her husband's bed, can you manage conversation 50 she will not hare the opportunity to remark, "I hope I'm not the one who has to tell him he has cancer." He seems asleep and she thinks he doesn't hear, but he might.

Do you sometimes wonder how patients know so much about other patients and what is happening on the unit? All they need to do is listen. Nurses say it all in talking to each other and to the physicians in the hall or the nurse's station.

I was once anesthetized before surgery. I could no longer make a sound or move a finger. However, I recall how upset m e - one sounded because the oxygen tank on

- the anesthetk machine ran empty and they quickly had to put on another one.

The physician asked from the scrub room, "Are you ready?" I wondered "Ready for what? Hope they know when I am asleep and don't start on me while I still know what i s going on." I couldn't move even a toe to let them know I wa5 still conscious of what they were saying.

If the sense of hearing is the last sense lost when a patient is anesthetized, it is also the first sense which returns when he i s recovering. This emphusizes the im- portance of what is said in the operating room when the patient is being put to sleep ond when he is waking up, One patient told his nurse in the intensive care unit that he was conxious enough before he left the operating room to hear the doctor say, "I don't think he is going to make it.'' It i s what he heard all right, but she tried to convince him he was dreaming.

In the post-anesthesia room a patient doesn't often raise his head from the bed

and say, "Cut it-I can't get any sleep with you gals yakking. Besides, who is looking after me?"

Many people do not recall the experi- ences of the day of surgery, but some do. Often nurses cannot defend or justify the conversations patients hear when going to sleep or waking up.

Tommie, six years old, was riding his bi- cycle when he was hit by a car. In the in- tensive care unit his head was bandaged after a craniotomy, one leg and one arm were in casts, his body was badly bruised and scratched. As in all such patients, a craniotomy check is important each hour.

The nurses and doctors were delighted at his first response to "squeeze my hand." Somehow no one seemed to think he could hear or understand anything but "squeeze my hand" or "wiggle your toes."

If Tommie was able to respond to these commands, then he war also a frightened little boy who was not hearing words his mother would say to him when he was hurt and needed comfort. All the sounds of the busy unit must have been very strange. He must have wondered where he was and where his mother was. He must have felt very alone.

When you are caring for such a person, do you talk to him; do you hold him close to you and tell him what a brave boy he is, and that his mother will be coming to see him? When his mother does come, do you allow her to be close to him and tell her to talk to him, even though he doesn't re- spond? If he hears "squeeze my hand," he can hear other words said near his bed. Are you concerned about all that i s said or do you think he can only hear, "squeeze my hand" or "move your toes"?

Shouldn't all nurses be more concerned with what we say and where we are saying

it? 'U Lillian H Davis, RN

46 AORN Journal