'We all make assumptions about our patients and their relationships'

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26 June, 2012

Many years ago I nursed a man, Jim (not his real name) who was a widower.

He had a few visitors, a couple who lived next door, an old friend called Pete (not his real name) who came every day and his daughter visited at the weekend.

Jim had a series of complications following an MI and his condition suddenly deteriorated one evening. His daughter was called and over the next few days it became clear that he was going to die.

The day after he collapsed his old friend popped in. Pete was in fact his partner and they had been in a relationship for many years but had kept it a secret from their families for fear of their reaction.

What followed was a very difficult situation. As Jim deteriorated his daughter sat with him and Pete continued to play the role of concerned friend. He told the nurses how they had been part of each others lives for 20 years but at the end he was not able to sit and be with Jim or take any part in his funeral arrangements.

The nursing team found it difficult to balance the need for secrecy with the need for Jim and Pete to spend time together. We did our best but we knew that when Pete left the ward he would grieve on his own.

Last week the National End of Life Care Programme published guidance on care for lesbian, gay, bisexual and transgender people at the end of their lives.

While guidance cannot change societal attitudes it can help healthcare staff understand and respond to the challenges faced by a person has not previously “come out” or those isolated from their families because of their sexuality.

We all make assumptions and judgments about people and their relationships: the family who never visit, the wife who bullies her husband and stays too long, or the person who has no one who cares about them. These guidelines challenge us to examine our attitudes to relationships and what we understand by the term “next of kin”.

Sam Turner, director of public engagement at the National Council for Palliative Care, sums up the consequences of failing to do this. She says: “We only have one chance to get end of life care right for people who are dying”.

For Pete and Jim the fear of being “found out” and of rejection surpassed their wish to spend their last days together and that is profoundly sad. We couldn’t fix their problem but perhaps with guidance we may have had more understanding and the confidence to support Jim and Pete and ultimately make their lives easier.

Readers' comments (16)

Anonymous | 27-Jun-2012 5:41 pm
I imagine the majorit of nurses don't judge people, don't have the time or the interest to worry about who is visiting who or what their relationship is.

It is sad though that a partner doesn't feel able to sit with someone when they are dying.
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Kadiyali Srivatsa | 28-Jun-2012 9:40 am
The duty of a nurse is to provide emotional and physical support to patients and their families, this is EXTREMELY important as the patients are in a very vulnerable state, scared and the families are not too far behind them with being very fearful of how things will turn out.

Its sad to read comment "nurse don't have the time or interest to get involved with the patients and their family". So we must ask, why do we need nurses in the hospital? What is their role in healthcare?
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Ellen Watters | 28-Jun-2012 10:41 am
Anonymous | 27-Jun-2012 5:41 pm

What a dreadful admission to make. How can you give the patient the emotional and physical care they need if you are not interested or don't make time to know more about them.

Very sad indeed..
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Anonymous | 28-Jun-2012 12:19 pm
Where does is say 'nurse don't have the time or interest to get involved with the patients and their family'?

The article states that 'we all make judgements about people and their relationships'. The point I was making is that we don't all make judgements and we don't all know or think it our concern to know who is visiting each patient, how long they stay or what their relationship is with the patient.

I don't judge or make assumptions about the family who never visits or the patient who has no-one who cares about them. There may be very good reasons families don't visit.

Surely the next of kin is the person the patient wishes is to be, it may not be family and if that upsets the family then we can help bring everyone together if that's what a patient wants but sometimes we have to accept that patients don't want us to get involved and we must respect their decision. There are going to be times when a patient is not able to tell us who their NOK is, what should we do then? usually we go through any old notes we have or contact the GP.

I wish that everyone who is affected by a patient who is extremely sick and dying could be offered bereavement counselling and support, this is something that I feel is under-used in hospitals.
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Anonymous | 28-Jun-2012 2:57 pm
As Jim knew his family the best, he made his own decision not to inform them of his homosexual relationship. Even if nurses think it best that this should be in the open, they cannot see much beneath the surface, therefore the patients secrecy should be respected as they know what is best for their own families whom they want to protect for whatever reason.
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tinkerbell | 28-Jun-2012 3:35 pm
Anonymous | 28-Jun-2012 12:19 pm
Anonymous | 28-Jun-2012 2:57 pm

Well said.

We shouldn't really assume anything nor judge a book by its cover.

As someone once said when we assume something we make an ASS of U and ME.

Obviously we get to know our patients and help wherever we can but we should not invade their personal space or privacy.

Family dynamics are best left to trained psychotherapists if they want one.
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Anonymous | 28-Jun-2012 4:44 pm

Eileen,

Can you remember what support was made available to Pete and Jim, knowing that when Pete left he would grieve on his own. Do you know why he wasn't able to sit with Jim at the end. Was it their choice, did the daughter not want him there or did the nurses feel it inappropriate?

Next of kin - that's a tricky one and something patients and rellies often misunderstand. I have had numerous requests for information from ' i am the n.o.k' when they may be the next blood-line relative or the wife/husband/child but the patient does not want them as n.o.k or any information given to them.

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Anonymous | 29-Jun-2012 5:57 pm
'we all make assumptions about our patients and their relationships'

........err, no we don't............
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Anonymous | 29-Jun-2012 8:05 pm
it is interesting how others make assumptions about the assumptions nurses make. when I trained, and I make the assumption that many nurses agree with me, that we were trained not to make assumptions about our patients, nor should we make assumptions about our colleagues or anybody else as they can often bias our opinions of them, prove to be false, and do more harm than good!
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Anonymous | 30-Jun-2012 10:11 am
anon 8.05 -

we were alway asked not to be judgemental towards anyone we work with or look after. I am not in a position to assume anything about anybody any more than they are about me.
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Anonymous | 1-Jul-2012 5:45 pm
Of course, we all make assumptions and judgements!! We are human beings.

At times this can indeed be be a negative thing; particularly, if we jump to the wrong conclusion. However, doesn't anyone ever use good judgement, based on assumptions from knowledge and experience?

We are logical beings, ergo, we all make assumptions and we are all judgemental.
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Anonymous | 1-Jul-2012 5:57 pm
Anonymous | 1-Jul-2012 5:45 pm

the art is to carefully check the assumptions we make about patients in our care and others as well and try to avoid basing our judgements on those which could be false. there are also certain assumptions which we should never allow ourselves to make as this can influence our attitudes towards others and how we treat them.
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Anonymous | 1-Jul-2012 10:48 pm
Anonymous | 1-Jul-2012 5:57 pm

I have problems with anyone telling me, "...there are also certain assumptions which we should never allow ourselves to make...."

My comment challenged the persistence of those who say that we should not make assumptions, when we do; and those who claim not to be judgemental, when they are.

It is about how we behave as nurses towards our patients, and caring for them in the best way we can. I have nursed some of the worst characters you can imagine (which is no different from most nurses). Have I made assumptions about them? Have I made judgements about them? Yes. Have I ensured that they have the best care available? Absolutely. It's my job as a nurse and I take it very seriously.

When will we accept that as free thinking human beings, we will form an opinion about just about everything and everyone we encounter every day? There is nothing wrong with that. It is our attitude to patients and relatives that is important.
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Anonymous | 1-Jul-2012 11:50 pm

Anonymous | 1-Jul-2012 10:48 pm
from Anonymous | 1-Jul-2012 5:57 pm

are you making an assumption that I do not know that? From your comment it would appear to be the case!
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raggedtrouseredphilanthropist | 2-Jul-2012 9:07 pm
Having recently been on the receiving end it is unfair to nursing staff to generalise on how they respond to their patients/families. I found every nurse and doctor responded to our distress, grief and concern for our relative in very different ways. I don't know how you can standardise human beings responses when they make their judgements and assessments based upon their individual life and work experiences. This is not the place to expand upon our experiences of secondary care and the lack of compassion and empathy we encountered except to say take care not to congratulate yourselves on your approach to patients and families without validation from the recipient of your care!!
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Anonymous | 3-Jul-2012 5:48 pm
Anonymous | 1-Jul-2012 11:50 pm
from
Anonymous | 1-Jul-2012 10:48 pm

"are you making an assumption that I do not know that?"

To which particular "that" (i.e. point made.....for there are several) are you referring? From your comment, it is unclear.
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