Just wondering if other nursing schools made a point bringing up false reassurace when talking about communication issues, specifically to stay away from it. An example: pt will be having open heart surgery in the morning, is crying and expressing fears about what may happen; the nurse tells them "it will be alright."
The reason I ask, I have heard many nurses I work with say somethign similar to this to pts and it really bothers me when they are dismissive toward their pt's feelings. (and I'm not trying to say that they are not good nurses by saying this--many who have said this are otherwise great nurses)
Thanks in advance, interested to hear what others have to say....
I think dismissing a certain type of response out of hand is actually the easy way out. Taking the time to listen (and I mean for a minute here, not sit for an hour) to get a read for your patient will help you make an appropriate response. Some people simply want reassurance, some people want questions answered, some people just want you to listen and not say anything. It depends on the situation and the person, at least IMHO. Also, I think in a lot of situations the responses that nursing school teaches as therapeutic, would come across as very patronizing.
Which is exactly why you don't want to tell them "It will be alright"
Since we don't live in a perfect world, and nothing is black and white, it is entirely dependent on the professional, to know what to say, to their patient. I could tell you I would say, such and such, but when the time comes I may say something different. I believe those who care, speak what is needed when the opportunity arises. Even in inadequacy, we are comforting. Sure some nurses have a better gift than others, just as some people are better speakers in general than others, we are no different. But taking the time to comfort someone, no matter how awkward, is better than doing nothing. IMHO.
"Most people facing (fill in procedure here) feel anxious/ nervous, that's normal and to be expected. Heck, I would be too. However, there are great people in (fill in department)... you are in good hands."
Specializes in Trauma Surgery, Nursing Management.
This is a toughie. While you don't want to come across as patronizing, you do want to alleviate anxiety as much as possible. I will give you a couple of scenarios that I have experienced:
1. A few years ago, I saw a teenager who was about to undergo surgery. She had an INCREDIBLE anxiety about her procedure (a partial colectomy). She was tearful and obviously scared. Her mother was with her at the bedside. Nurse begins to interview pt and mother. Rather than asking the pt to talk about what was the scariest part of having surgery, the nurse tells the pt to "get over it, you will be fine. Time to put on your big girl panties. This is part of your disease process, and this is likely one of many procedures that you will have. Better get used to it." OK, pause for a second, because this is hard to digest...I know. I think that this nurse was trying to do the tough love thing or something, but it left the pt TERRIFIED and the mother OUTRAGED.
2. Pt comes in for an emergent D&C. She is tearful, her husband is tearful, and she is in shock that she must undergo ANOTHER D&C. Nurse comes in to interview the pt. She sits down next to the pt, introduces herself. She does not beat around the bush, but instead says, "You are going through an incredibly difficult time in your life now that I cannot even begin to understand. What I can tell you is that we are going to do XYZ in XYZ order. It is clear to me that you are scared. Do you think that you can pinpoint what is scaring you so much? Is there anyone you would like for me to call? Would you like for me to call your husband when we are starting surgery and again when we finish? I CAN assure you that I will be with you the entire time you are in surgery...I will not leave your side. When you wake up, I will be there, and when you have recovered in the PACU, the nurses will call your husband back as soon as they can. If you would like for me to arrange for a grief counselor to talk to you and your husband, I can do that for you. Now let me tell you what to expect while you are in the OR."
I cannot imagine telling a pt, "It will be ok." I have no idea what they must be feeling. I can use my imagination and the experience that I have had in dealing with the same disease process with another pt, but I don't know what that pt is fearing the most unless I ask them point blank. For all I know, the pt undergoing a CABG may fear not emerging from anesthesia, and then worrying about providing for his family if he does not recover well. And then the young woman who is undergoing a lumpectomy may fear the results of her surgery, or may fear what her breast will look like after the surgery.
The point is that I DON'T know, and will not pretend to know. What I WILL do is find out what my pt's greatest fear is, and then talk about it. I can find out where their "happy place" is and have them focus on that during induction. It may seem trite, but it can mean the world to a pt who is scared and NEEDING guided imagery to get them through a crisis.
Specializes in Trauma Surgery, Nursing Management.
excellent responses, canoehead.
also:
"dr. dud has performed this surgery nearly a thousand times...
and has only lost 3 pts, tops."
leslie:D
Les, you kill me! One of our CRNAs tells pts that since it is Thursday (or whatever day the pt is having surgery), policy states that we MUST have a 100% survival rate, and we don't intend on messing it up now!
For all the people who think it is OK to say "it will be all right:"
You say to a close friend.."my spouse just got laid off, my daughter just applied to college, I'm not sure she will get in, but I don't know how we would pay for it even if she did get in, and my sisten has cancer..." The friend they says "oh, I'm sure it will turn out okay."
Well, it may be the easy way out to provide that false reassurance (I've done it myself), and it feels 'natural,' but that does not mean it is the right thing to do and I feel that it is not very helfpul to our patients' feelings...
Yes, you're right, being reassuring when a patient needs it and when were in a position to give honest reassurance is exactly like telling our close friend with cancer/job loss/academically questionable daughter that everything will be ok. It's absolutely as black and white as it is on nursing school exams.
I had a pt tell me "i don't want to die, Im to young to die" she was in pure panic...........she is an EOL pt . what do you say to that? I said " Its really scary to face the unknown............." its all i could come up with it didn't seem like the best answer but i didn't know what else to say. She said it later to someone else and they responded "i don't think your going to die tonight" that seemed to be more calming to her........
Specializes in Trauma Surgery, Nursing Management.
I just have to add this, with the knowledge that I am taking the risk of being tarred and feathered by you guys...but I hate HATE HATE it when someone tells an anxious pt to "just relax." Like being in a situation requiring health care is somehow conducive to relaxation.
Give me some bait, a nice breeze and some deep ocean reefs and THEN I will "just relax".
breaktime
71 Posts
I think dismissing a certain type of response out of hand is actually the easy way out. Taking the time to listen (and I mean for a minute here, not sit for an hour) to get a read for your patient will help you make an appropriate response. Some people simply want reassurance, some people want questions answered, some people just want you to listen and not say anything. It depends on the situation and the person, at least IMHO. Also, I think in a lot of situations the responses that nursing school teaches as therapeutic, would come across as very patronizing.