Signs vs Symptoms

After my last post about pulse oximeters and oxygen saturations some of the comments were interesting and not surprising.

One of the most common things you hear when having an asthma attack is “your sats are fine your ok”.

As a nurse your trained to look at signs first and then symptoms but often we look at the signs and judge a patient by them rather than the whole picture. Which as a patient I know is so frustrating. Especially with asthma you feel so awful as not only you cannot breathe but you are scared and tired and often being told your fine is really hard to hear and can make you feel worse as you have altered judgement due to the situation so it will often make you think they won’t do anything to help your breathing.

I wonder if there is a way we can communicate with nurses and doctors to say that we know our sats may be fine but that doesn’t mean I don’t feel absolutely awful, scared and would like something to help alleviate that. I am wondering about using a cue card type of thing which we could show to the nurses and Drs when they are telling us that our oxygen sats are fine and we are ok. During this time speaking is very difficult so a cue card might be easier to communicate our feelings just so they can understand. I have found that once nurses and Drs understand how I feel they are more sensitive about what they say to you. There are many more ways in which you can be told your sats are fine and are ok without the patient ending up feeling terrified or over reacting afterwards.

Some examples might be:

I know you are really struggling but a good thing is that your oxygen levels are good just now but we will keep an eye on them.

or

We will give you some medication to help with your breathing and make it easier. Your observations look ok just now but we will keep an eye on them while your chest settles and breathing becomes a bit easier.

This is just an example of what I thought could be said but I am sure there are many more ways it could be said.

As a nurse looking after patients and trying to get help from them I have found it hard to get them help when you can tell by looking at them something is not right but their clinical signs are all ok. When you call for help from a Dr you will go through a series of questions many of which are about signs a patient is displaying not what your gut feeling is and that they just don’t look right. Often by the time their signs match your gut feeling the patient is much sicker than before.

It is a real balance between not over reacting and acting as needed. In a way I am privileged as I have seen it from both ways. I am both a patient and a nurse and hope that my experiences as a patient reflect how I conduct myself as a nurse.

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