Emotions- helping patient open up

[FireyRN]

I work in home care and have a intriguing patient dealing with chemo for non-hodgkins lymphoma. She frequently becomes dehydrated and gets IVF at her tx center. A couple days ago she went in for f/u and/or fluids and got admitted. I don't have the details on why yet. She came home today, basically AMA per a brief conversation with her husband. I will be resuming her care tomorrow. Husband says she got very impatient and disagreeable with staff, calling them profanities etc. my experience of her has been that she is one tough cookie, she doesn't like to be treated like she is sick by family, always says she's fine etc. I've seen a few interactions with her husband where she gets mad at him for helping, showing concern, or reminding her what the dr said. She is very smart and is sometimes not compliant with med orders. I have a decent rapport with her. Sometimes I wish she'd open up more. She did tear up once with me, talking about the good care of her tx center and some other the other troopers she's met at chemo. Talking with her husband made me concerned about her emotions. I don't think she has ever (at least openly) cried or expressed fear. Her husband said that comments around her dc/Ama event, when clinicians told her it was too dangerous to go home yet and also around topics such as good care so she can live etc, were met with I don't care type responses. I really want to help her handle her emotions but feel unsure of how to approach. Her personality

is tough, strong, very smart, and she can have quite a bite Im sure. My gut says that the I don't care responses are a coping mechanism, that she's grieving having her life on hold, does not like to be taken care of, is maybe afraid to be afraid or let herself cry. I'd appreciate any thoughts or words of wisdom. She has really grown on me..

Thanks!

[SoldierNurse22, BSN, RN]

I understand where you're coming from, but you can't make her open up to you. If she's having difficulty coping and refusing resources/obvious help, all you can do is be an ear for her to talk to and try to respect her wishes not to be babied.

Sometimes, an empathetic person with a strong personality who respects the patient is the easiest person to open up to after the patient gets to a level where they feel comfortable with the provider. If she feels you're on the same level, she may feel safe enough to let her guard down with you.

The most important thing to remember is that even if you do everything right, she may not decide to confide in you, and that's not your fault. Just keep the option open to her and perhaps she'll come around on her own time.