I’ve been meaning to write something like this for a long time. Even though I haven’t been working as a nurse for the past two years, I am still an RN, and have plenty experience in hospitals to write something didactic. Between 2001 and 2009 I had experience working in eleven different hospitals and over thirty different hospital units. My field was medical surgical nursing and my specialities were medicine, GI, Women’s Health, L&D, Mother/Baby, Ortho/Neuro, total joint, rehabilitation, cardiac/telemetry, renal/transplant, bariatrics, burns, trauma, and transplant. I did a little bit of everything… except OR, ICU, PACU, and ER. If you are visiting a sick person in the ICU or ER, parts of this primer won’t apply.
How to visit a sick person. I feel like this is a long lost etiquette. In simpler times and in many other countries but our own, family would assume a huge role in tending to the patient’s basic needs. In our culture, this entire duty has been relegated to nurses and nurses aids for the duration of hospitalization. In my opinion it is sad and unrealistic. It is especially unfortunate when family members get angry at nurses when chores haven’t been done, yet it doesn’t occur to them to do it themselves.
This is what I am talking about. These are the things you can do for your loved ones, a sick friend, when he/she is in the hospital. Not only will he/she love you for it, but the nursing staff will love you for it as well. And you will go to Heaven.
Food is the first thing most people turn to when they are nervous and uncertain. Issues regarding food come up frequently when it comes to patient visitors. Here are some things to think about:
- Find out what the patient’s diet is. There are many types of diets. “General” diet means the person can eat most anything, ad lib. There are diet adjustments having to do with texture, such as a soft diet, a puree diet, and a liquid diet. There are low protein and/or low potassium diets for renal patients and low salt/low fat diets for cardiac patients. A clear liquid diet means the patient can drink anything transparent (coffee usually does NOT count, and soda is not a great idea anyway). There are low residue diets for people with diverticulitis. A patient on suicide watch will be served a meal on a paper tray with plastic utensils. Why do you want to know what their diet is? So that you don’t waste your time bringing them food they shouldn’t eat! Take this seriously. Some foods, no matter how much they are craved, can really aggravate an illness. In fact, many, if not most, illnesses are caused by nasty food. Don’t bring nasty food. Call the nurses station ahead of your visit to ascertain what diet is ordered.
- Eat before you come. Do NOT eat or drink in front of your loved one unless they are allowed to eat as well. Think about it. It’s just cruel. Plus, there are medical reasons for not bringing food, or the scent of food into some people’s rooms.
- Nurses are not waitresses. Hospital food is for patients, not family. Don’t try to make exceptions. Walk to the cafeteria.
- The quickest way to a nurses heart is food. But by food I mean food. Candy works as well, especially chocolate, but points are always given when a considerate gift of something healthy and portionable is brought in, such as a vegetable or frut platter, or casserole. What you might not realize is that nurses often do not get breaks and get most their energy during the day by snacking on the run. If you bring in something that ends up on the break room table, every nurse will ask “Who brought this in?” and soon everyone will know that patient-so-and-so’s family brought in a treat. You can get creative and become notorious, like as did the family who brought in a floral-style arrangement of condoms and personal lubricants. Hm.
- Sanitizing foam does not “sterilize” your hands. NOTHING sterilizes your hands. If you don’t believe me, take college Microbiology. You will never see surfaces the same way, ever again. Sanitizing foam not only doesn’t sterilize, it also doesn’t even clean your hands. It just kills the bacteria on the surface of your hands. All the dead bacteria, food particles, dust, and dead skin will stay on your hands. Wash your hands with soap and water. A lot. The germs floating around hospitals are literally deadly. You don’t even want to know. If there are rubber/nitrile gloves available in the patient’s room, feel free to use them — the nurses will think it’s cute.
- Stay home if you have anything contagious. Sometimes you must come in, so be nice and request a face mask at the hospital front desk.
- Do not bring perfume. Do not wear excessive perfume. The nurses will secretly hate you, forever.
- When in doubt, offer a washcloth. A nice little thing to do at any moment is to wet a washcloth (warm, cool if fever is present) and hand it to the patient. If they can’t do it themselves, wipe their forehead, then their cheeks (and their neck and upper chest, if appropriate. Then wipe their hands. The attention is so appreciated. Laying in bed, people get sweaty and greasy, and they feel terrible about it. Help them out! In that vein, if you feel up to it and are familiar enough with the patient, participate in bathing the patient with the nurse. There is nothing “wrong” with doing this; it is a loving gesture and you are learning to do it in case one day the nurses can’t get around to it.
- If you expect the nurse to do a bath, and the nurse makes a gesture of having time and wanting to do it, either offer to help or get out of her way. Jump to it! If you continue with a visit instead of accepting the bath, you might have missed the chance of the patient getting one. In reality, the nurse can probably not do it later.
- A shower is not taken for granted in the hospital. Many units or particular nurses will try whenever possible to get patients into the shower, most do not. So many patients go without showers for days or weeks, and that first shower feels like heaven and really cheers them up! If the patient can be disconnected from IV lines, NG tubes, and can have any other tubes (except the urinary catheter and NG) covered with some sort of waterproof drape setup (think: Saran wrap and/or tegaderm, paper or silk tape), they can probably go in the shower (keep it brief ~10 minutes). Sometimes it’s a total bear getting them in and out with all the tubes and mobility issues, but it is always worth it. Pro tip: make the bed while they are in the shower, and offer a warm blanket when they get back to the bed. Doesn’t that sound nice?
- If the patient can’t eat because of planned surgery, a stroke, or impending death, and you are attending them, please please please attend to their mouth. It will become very dry and/or stinky in there, like a bat cave. Ask for some “oral swabs” from the nurses and swab the mouth out frequently. Some swabs are glycerin-coated and intended to moisturize the mouth. Bring some lip balm or request Vasoline or Chapstick from the nurses, then help keep his/her lips moisturized. Imagine putting nothing in your mouth for days, and laying in bed mouth-breathing, and what hell that must be. Have mercy.
- There is no such thing as dental floss in a hospital. This puzzles me. Toothpaste, a cheap toothbrush, but no floss. Bring floss and/or toothpicks and you’ll be a hero.
- There are no hairbrushes. Just cheap combs. I can’t tell you how many times I had to cut off someone’s hair because other nurses never got around to brushing a bed-ridden patient’s hair. It’s the saddest thing. I call it ICU-head, and it involves dreadlocks most dreadlock-coveting white people would kill for. If your loved one is bedridden and has hair, one of the nicest, sweetest things you could possibly do is learn how to wash a patient’s hair in bed (yes, it can be done) and then comb it. You may have to get the scissors out. Consider yourself warned.
- Nurses are not allowed to cut fingernails. We can file them, but not cut them. Bring fingernail cutters, and heck! bring nail polish, and give your buddy a manicure!
- There is shampoo, but no conditioner. It is that way in almost every hospital.
- There are no Q-tips in the hospital. Enough said.
HYGIENE MATTERS FOR MEN
- Bring an electric razor, not the other type. Especially if the patient is on blood thinners, there is no way they’re gonna let him shave with that. And many, many, many patients end up on blood thinners. The next list item is very, very personal. If you’re squeamish or prudish, skip it.
- If he has a foreskin and cannot or will not reach it to clean it himself, make sure someone is doing it, and doing it correctly. I know of nurses who don’t know the difference between circumcised and uncircumcised and I have seen patients require circumcisions due to neglect of certain “issues.”
HYGEINE MATTERS FOR WOMEN
- Vanity goes out the window. A nice thing to do for a lady is to cream her feet, paint her nails, help her put on makeup for the day, or even shave her legs for her. This type of gesture goes a very long way towards cheering her up.
- She still has her period, period. It’s amazing to me that even nurses were oblivious to the fact that even though a patient was sick or injured, she still had her monthly visitor. As if that was just too much to imagine! Hospital maxi pads SUCK, so a nice thing to do would be to find out what she likes and buy her a box, then bring them to her (perhaps concealed in a makeup bag, for modesty).
- Music is magical medicine. Especially if the patient is bedridden, and even more so if the patient is dying, a very nice thing to do is to set up a small, cheap plug-in stereo at bedside, and quietly play his/her favorite music. I found it very calming and soothing to patients suffering dementia, especially when family could bring in the patient’s very old favorites. Fun for me, because I got to listen to big band, klezmer, Beethoven, Sinatra and the like! A walkman or iPod is another nice idea
- Diversionary pastimes are good, too. Portable DVD Players, handheld video games, video card games, a stack of books or fun magazines…
- More and more hospitals are setting up WIFI, but don’t expect it.
- Take them for a walk. If they are in any shape to get up and walk (ask the nurse if it is allowed, really), or be transferred to a wheelchair or Stryker chair, get them out of that room! Can you imagine spending weeks in the same room? Ugh. You would be amazed how much you take for granted when you see the look on the face of a patient exiting their room for the first time in a while. They look like they’re exploring a new planet. It’s a great diversion, and great exercise. Walking is particularly helpful for many patients who are waiting to pass gas (yes, a lot of patients are waiting to fart!), and is obviously good to help maintain some muscle tone. Some nice places to walk are the hospital garden, the baby nursery, the chapel. Avoid the cafeteria.
- Bring some art to hang on the walls. A kid’s drawing, some photos, or maybe even just a game of hangman you played on the dry-erase board. These will all be things the patient will have to look at after you’re gone. Also, pictures of the patient before an appearance-altering accident or surgery help the nurses establish background on the patient and treat him/her how she should be treated. If this has happened in your case, keep in mind the patient is still the same person inside and probably doesn’t feel much different, and certainly doesn’t like being treated different.
- If the patient has a loud roommate, or is in a loud area of the hospital unit, ask to be moved. You may have to ask repeatedly for days before it can happen. But if it needs to happen, it needs to happen. Do not be afraid to ask, but do not be angry with the nurses if they give you sound reasons why it cannot happen yet. Bed-planning on a hospital unit is a terrible task, and I wouldn’t wish it on anyone. Once you ask, a note is usually made, and bed-planners will try to make it happen. In this same vein, if your loved one has a roommate, be considerate of the roommate while visiting. It’s not unusual to befriend the roommate and become more casual with them, but still respect their need for privacy and sleep.
- There are no rules against laying in the patient’s bed, not ones that I’ve ever heard of. If it is possible to make a spot for yourself, and you are sure you are not dislodging or kinking any tubes, go ahead and lay down next to your loved one. I saw this just as much between couples as I did between parents and children, and I always thought it was the sweetest thing.
- Let them rest. One would think it’s ironic, but patients in hospitals get very little rest and sleep, actually. Keep this in mind if your visit is extending over several hours. Be kind and take leave. Ask other visitors not to come. Encourage the person to sleep. Turn down the lights, tell the nurse he/she is going to try to sleep, put a sign on the door, or even better, stand guard outside the door. There is probably nothing more than sleep (except maybe good food) that a person gets less of in the hospital. If you can ensure even a nap, you are a god.
- A nurse is not a waitress. No insult to waitresses, but nurses study nursing for at least two (and usually four) solid years in school, and are sometimes even more educated than you yourself. Not only that, but they are some of the kindest souls you will meet. I have worked in lowly medical units with nurses who not only have Ph.Ds, but who have been practicing over thirty years. That’s amazing! Imagine what they’ve seen and how many people they have helped! Respect their experience and their knowledge and treat them as peers, not inferiors, to the doctors and yourself. I understand why patients treat nurses badly, but consider it unforgivable (and pretty idiotic) when families and friends of patients do. The bottom line is this: the better you treat the nurses, the better care you get. It’s sad to reduce it to that, and it’s gauche to say it, but it’s true.
- When you ask to see the doctor, don’t expect it to happen right now. By law, a doctor (note the word “a”) must step in on a patient once daily. You might have already missed rounds, which means either the doctor now must see dozens of other patients in fairness before redoubling back to see your loved one (unless it is an emergency), or it might even mean the doctor has left the building and probably won’t be coming back unless there is an emergency. The very best thing you can do is ask the nurse if she will have the doctor call you. Provide a cell phone number, and turn your ringer on. It is an excellent way to get in touch with the doctor, and works best for everyone involved.
- If you are very close to the patient and know which medications he/she takes, but the staff doesn’t yet know, that’s a problem! Bring a list of all the patient’s medications, their doses, and how they are taken. Better yet, bring all the bottles with you in case there is a question. I don’t know how many times a problem was solved simply by getting a patient back on medications they’d been missing. Also, if they ask you what the patient takes, they mean everything. Prescription, over-the-counter, herbal, vitamin, and illicit drugs — list them all.
- Bring the patient’s legal papers. If you are a spouse, parent, guardian, or legal representative of the patient and have access to his/her living will, DNR, POLST (a lot of names for essentially the same form) and/or advance directive, bring it and have it put in the patient’s chart. If the patient has special arrangements and requests such as DNR, make sure the medical team is made aware!
- The Health Insurance Portability and Accountability Act of 1996. There’s a law for everything! Keep in mind that the nurses aren’t allowed to tell you a lot of things unless it is obvious you are recognized by the patient as a confidant (i.e. parent or spouse). Even so, there may be times when you, say, call on the phone and people won’t tell you anything. They may even make fools of themselves trying not to tell you anything. Technically, if you are not a known contact of the patient, all the nurse can tell you is what the patient’s general status is (stable, fair, good, etc) and the patient’s room number. However, some patients choose to remain unlisted so that if you ask after them, the staff is required to lie and tell you they don’t have that patient in the system. Don’t get mad at the staff if you hit a dead end. Get crafty. A little charm and good conversation might get you far!
- A hospital discharge can take many, many hours to process. If your loved one calls you to tell you “They’re sending me home today!” don’t jump in the car. I recommend calling the nurse’s station and requesting an estimate on how long the discharge will take. Sometimes, you may find your loved one is simply hallucinating.
What do you think? Anything to add? Anything you disagree with?