Trying to be therapeutic!

[KarenMS]

Im a second semester student having a hard time finding the right words with some patients. For instance, I've had a few patients who fall all over themselves to apologize when I have to clean them up after a BM, or put topicals on private areas. We learned not to say things like "Don't worry about it" "It happens all the time" and "it doesn't bother me at all" and the like, because they could be dismissive. I'm somewhat on the awkward side, and could use a script in this unfamiliar situation!

For what it's worth, body fluids, topicals in remote places, wounds, smells....nothing bothers me. I truly wish patients wouldn't feel so bad because I am beyond happy to help them get more comfortable. I just don't know how to communicate this "correctly."

[cracklingkraken, ASN, RN]

"Don't apologize. I'm here to take care of everything you need. I'd be more worried if you weren't having BMs" or something like that?

I always try to empathize and maintain a light mood. I'm more of a cheerful, sarcastic sorts. I'm not good at scripting because each person is different. But most patients enjoy humor, so I try to go with that.

[NurseGirl525, ASN, RN]

I also explain everything to the patient I am about to do ahead of time. I give them some autonomy also by letting them pick the temp of the water or the thing I am about to do first if possible. But really talking ad explaining what you are about to do ahead of time helps tons. I also then will talk about random things just to get their mind off of it. It's a process to learn. But experience will help over time.

[Lev, MSN, RN, NP]

"I'm happy to help in any way you need."

[konstantine]

I think it's less about being dismissive than about not adapting what you say to what it seems like the patient is actually worried about. "It doesn't bother me at all" is good for a patient cringing at the smell of a BM. The other two are pretty trite, but might have a place somewhere. If the patient seems bothered about taking your time, "This is just part of taking care of all of you. It helps me see what's going on." might work. Since you're a student, it's easy to lay that on thick. "I'm only taking care of you/I only have 2 patients! I'd be bored otherwise!" If I get a vibe that the patient likes helping be a part of teaching, I'll say something like, "Would you like to be my guinea pig so I can learn how to help out a patient without getting all of us and the floor soaking wet?" which usually makes them laugh. Sometimes just validating the patient is helpful for topicals. Just commenting on the breakdown, "Oh man that looks like it hurts, let me put this on, it'll help," takes it from embarrassing to the patient to addressing a valid medical concern, which makes it more medical and keeps the privacy boundary. A lot of the times I find I need to step back and help the patient help themselves or at least make a choice, saying something like, "Would you like me to get you some warm water and a washcloth so you can clean the front, and I'll get the back? That way I can check out the skin on your back and make sure everything looks okay." It sounds like you just need to show that you really don't mind instead of worrying about the "proper" way to say it. I'm sure that attitude will show.

[KarenMS]

Thanks so much for the responses. What you've all said makes a lot of sense; I think I was focusing too much on the actual words rather than the attitude and tone behind the words.

I'm hoping that ease will follow time and experience, and I'll be more natural with patients.

[KarenMS]

I think it's less about being dismissive than about not adapting what you say to what it seems like the patient is actually worried about. "It doesn't bother me at all" is good for a patient cringing at the smell of a BM. The other two are pretty trite, but might have a place somewhere. If the patient seems bothered about taking your time, "This is just part of taking care of all of you. It helps me see what's going on." might work. Since you're a student, it's easy to lay that on thick. "I'm only taking care of you/I only have 2 patients! I'd be bored otherwise!" If I get a vibe that the patient likes helping be a part of teaching, I'll say something like, "Would you like to be my guinea pig so I can learn how to help out a patient without getting all of us and the floor soaking wet?" which usually makes them laugh. Sometimes just validating the patient is helpful for topicals. Just commenting on the breakdown, "Oh man that looks like it hurts, let me put this on, it'll help," takes it from embarrassing to the patient to addressing a valid medical concern, which makes it more medical and keeps the privacy boundary. A lot of the times I find I need to step back and help the patient help themselves or at least make a choice, saying something like, "Would you like me to get you some warm water and a washcloth so you can clean the front, and I'll get the back? That way I can check out the skin on your back and make sure everything looks okay." It sounds like you just need to show that you really don't mind instead of worrying about the "proper" way to say it. I'm sure that attitude will show.

Hi! Just wanted to thank you a year and a half later for this reply! I was just looking through posts I've made on this site and found this one. I've been using your tips in clinical and at work since I read this and they've been so helpful; I had just forgotten where I'd read them!

Thanks again, I'm worlds more comfortable communicating with patients now, partly due to your help!