Compelling stories due to great therapeutic communication.

[frail316]

The value of good communication with my patients could possibly draw the line between life and death and, at the least, dramatically improve building rapport. Gaining trust, Erikson's first stage, is so vital to our work as nurses that it disappoints me how much it is not emphasized in nursing program curricula, as I think it should.

I encourage you to post any stories (short, long, inspirational, or tragic, etc) that were affected directly by communication skills, or even lack thereof.

[Dolce, RN]

I spent my last semester of nursing school doing an internship in the ICU. My no-nonsense preceptor told me she would not be placating our drug overdose patient. The patient was in her 40s and had denied purposefully overdosing on her tricyclics and ibuprofen but she had clearly taken way too many to be confused as an accident. My preceptor walked right into her room to do AM rounds and demanded of her, "So, why did you try to kill yourself?" I was shocked and humiliated at her abrupt style of communication with the patient and noticed that the patient instantly became defensive and again stated that the whole incident was an accident.

Later that morning, after I had established a good therapeutic relationship with the patient, I went into the patient's room alone. I asked her how she was doing, we talked a little. Then I said to her, with a compassionate look on my face, "Tell me what happened." She began sobbing and the whole story came out about her fight with her boyfriend and how she had gone into the bathroom and downed the 30 tricyclics and various other medications. I was able to discuss the situation in an objective way with the patient but still had compassion and empathy for her. I learned from that experience that it is so important to develop that good therapeutic relationship with the patient prior to delving into personal issues or challenging them to make life changes.

[sharona97, BSN, RN]

I had to transport a patient to the cath lab one morning. He was our first case. So as usual I wheeled him by the windows facing Corpus Christi Bay to see the sun rising over the water.

This patient was scard to death of the L-Sided Heart Cath and was not afraid to tell me so. He even asked for a washcloth to be placed over his eyes before enterig the lab. So I promptly retreived one for him and gently placed it to cover his eyes.

Upon entering the lab, the staff looked at me curiously and I introduced each and every member of the team as they came over to the patient and compassionately told him their name and function for this test. We all had a sick feeling in ourselves.......

He made it through the cath wothout event and had a CABG done within the week. For some reason I would occassionally visit patients during their hospital stay to see how they were doing. When I went to see this patient post CABG he was so happy he was going to be able to walk his daughter down the isle "next week". He asked if his son could escort me. Oddly, I accepted.

At the reception after a beautiful ceremony I noticed my patient leaning over a chair, very fatigued and SOB. I excused myself from the table and his son and went to him.

I asked if he was ok. He repied yes, just tired and I suggested he go home to rest. while hanging on to his arm at the radial pulse. He agreed.

I then went back to my table and asked his son to bring me home and explained his father would be going home. His father had confided that he had had chest pain throughout the week and did not tell anyone.

He died the following week. I remembered the sun coming up and the washcloth, and him gently calling my name after the cath. He trusted me enough to take away the washcloth while pressure was being held on him post-cath.

I can only think now that the only reason I went to that wedding was to see his glory, his delight in delivering his daughter to her future husband, and with him knowing someone was their for his own heart. What a beautiful human being this older man was, and with all his pride a very brave man.

[gentle]

About one year ago, I had a 5150 patient, who had slashed his neck and wrists. We had medically stabalized him, but were waiting for bed availability in a psychiatric facility so that we could transfer him. Through the day, the nurse aide would call me saying at times our patient would cry then fall asleep. This is an adult male crying.

We used the language line for interpretation and learned that the man had been in an abusive relationship, where he was the victim. The interpreter helped us to clarify meanings of words and phrases, and offer non-judgmental listening. The interpreter also helped us validate the patient's feelings of emotional pain and explain the purpose of going to a psychiatric unit: Meaning his heart and emotions were sick versus his "manhood". (it was the best I could do, and he got it.)

This patient had a bit of a religious background, so we asked this patient if he would like prayer and he said yes. Sooo, off I went and found his doctor, who said "let's do it". Within 15 minutes and the help of a few spanish speaking co-workers, we all--5-6 people--held hands and prayed with and for our patient. After the prayer everyone received a hug: doctor, patient, and co-worker.

I think the intervention helped the patient because the sitter said he didn't cry for the rest of the shift. He finally just slept, poor thing.

The gentlemen did end up going to the psychiatric unit for a little while, not long, I don't think. He later came with his wife and saw us. He looked better; but, I still wonder whatever happened to he and his family, as there are no quick fixes in healing from abuse.

In the end, we did the best that we could, in the time that we had, by all working together.