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Managing patient expectations: do some patients expect too much?

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While most of the ward staff were busy dealing with an emergency situation, Colin was surprised by another patient’s reaction

Colin Phillips-SNT

Before I started working in a hospital, I didn’t appreciate just how many expectations are placed on you.

I had an abstract universal idea that these expectations would be “generally high”, but hadn’t grasped, until I started on a ward, the concept of patient expectation not being carried over from one patient to the next. I can’t do a good job for one patient and not others, I have to start afresh for each and every patient.

The care you give is not averaged out across all the patients you deal with.

My most stark example of this happened during a night shift. It was the third of three nights in a row and I was just approaching the halfway point when I started to think “I can do this, the end is in sight!”

The hours were dragging as they generally do on nights shifts, when you’re quietly doing your work whilst everyone else is sleeping.

There had been no issues at handover, all the patients had settled well and were now soundly asleep. I’d taken the opportunity to do a little bit of housekeeping, stock up supplies etc, when I heard a gasp.

There are lots of sounds on wards that you get used to, to demote to the usual hum of background noise, but a gasp is one of those unmistakable ones that makes your heart and mind race to quickly focus on the source and any action that you may need to take.

I ran to the patient concerned and identified a potential arrest situation. I escalated it quickly, the ward team and shortly the crash team began working on the patient.

It was a concerted effort that was done well and the patient was stabilised after 45 minutes. I left the room to gather my thoughts.

I have never got used to dealing with a crash situation. The severity and speed of the situation can mean you need at least a few moments to decompress afterwards.

As I walked along the corridor lost in thoughts about what had just happened, my eye was caught by an unusual silhouette in an adjacent bay: a patient was sitting bolt upright. This was unusual for 3 in the morning and I rushed over to see, asking: “Is anything the matter?”

The response: a stark assertion that “the service round here is sloppy”.

I was taken aback by the level of indignation presented at 3am but relieved at the same time as it was not life threatening as I’d first thought. I asked what could be done to help and was promptly told “A cup of tea would be good for a start”. As ever, a cup of tea is a great resource and I was glad I could do something simple and practical, even if this was only “for a start”.

I made off down the corridor to make one and considered the stark differences in the two situations I had just encountered. First, the crash call, and then to be presented a few moments later with an incensed patient criticising the service at 3am.

I couldn’t help feeling annoyed. How could they say this, did they know what had just gone on? Perhaps I should have explained why all the ward staff were busy?

But on reflection I realised it probably wouldn’t have made any difference if I’d told them about the crash call instead of apologising. Far better to make the cup of tea and appreciate this patient’s situation.

After all, expectations vary greatly and it’s up to you to respond as best you can to that particular sitatuation.


Colin Phillips is in his first year studying adult nursing at King’s College, London

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