Nurses are expected to ask questions and engage our curiosity to combine with our sharp assessment skills to help treat patients. Sometimes, curiosity is out of place. When does it help, and when does it hurt? When is it appropriate, and when is it not?
As with most nursing questions, a gray area exists. Maybe in this case, asking questions was appropriate or accepted, whereas in this other similar case, it wasn’t. Perhaps the nurse asking the questions is a variable. Perhaps the patient’s mood is a variable. Almost always, whether you need the information for the patient’s medical care is relevant. Sometimes you don’t know whether it is or not until you ask (“did you consent to have this object inserted into your rectum?”); more often, you can tell your own intentions before you open your mouth (“this looks good. I just have to get the story on this!”).
It would be easy to establish a rule of thumb such as “never ask patients questions that are not specifically related to their care,” but that isn’t good nursing practice either. We still need to chat with our patients, ask how they are, and sometimes engage them in actual conversations to take their minds off other less pleasant things going on. Most people like to talk about themselves, and that does not change when they become our patients. We do have to think of their psychosocial needs.
This issue is tricky and requires a gut sense of what the patient will like or tolerate. For example, I have asked half a dozen well-seasoned patients about their memories of the Spanish flu, the Dust Bowl, and other historical areas of interest, and most have enjoyed reminiscing. The rest were frosty. It’s hard to tell. Conversely, I have failed to investigate stories behind injuries thoroughly enough and thereby have missed the other injury the patient didn’t want to tell me about and was hoping I would be curious enough to ask about.
What if you are a nurse practicing in psych, corrections, or a geographical location that invites curiosity because of the clientele? If George Clooney rolls in with a pitchfork in his throat, will you ask more questions than if Mr. Jones does? If your patient butchered her entire family, do you really want the details? Do you need them?
Ah, then, what about our own safety? Shouldn’t we know why the prisoner is shackled to the hospital bed? Shouldn’t we know why all of our inmate patients are in jail? At first blush most would say absolutely yes, but consider this: if you know that inmate A has killed four people and inmate B is in prison for writing hot checks, you’re probably going to pay more attention to inmate A.
That allows inmate B to sneak up on you and choke you with your stethoscope.
NOT getting all the information forces you to pay the same attention to everyone. Don’t be caught off guard!
What’s the answer to how much information we need? It lies somewhere between our comfort zone and the patient’s. With every patient we encounter, we have to listen to our guts and decide how to proceed, what questions to ask, and what assessments to perform. It never hurts to consider what we are deliberately not going to approach. Know your intentions, know your boundaries, and stay alert.