How to help fearful/anxious patients

  1. Today, I was doing surgery prep for an 18 year old girl was supposed to be having a cyst removed from her neck. She was really scared, so I did my best to comfort her and I explained what I was doing as I went and what would happen once she was asleep. Right before I inserted her IV, she passed out, so her surgery was rescheduled.

    Patients never seem to respond to my attempts at relaxing them. I have always struggled when helping patients overcome their fears before and during procedures, and I'm hoping you might have some advice about what to say to them. Thanks.
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    About LeahC18

    Joined: Jun '09; Posts: 1

    8 Comments

  3. by   HolisticSandz
    I'm a NS and working as a Phlebotomist at a very busy clinic. I've noticed that Pt.'s that are very nervous respond well to a no-nonsense kind of confidence. I really have to gauge each Pt's level of anxiety. Some are easier to read than others. If I've noticed any fear I always ask because the quiet ones will need the reclining chair! Most of the time if I can get them talking about themselves (hobby, nice shirt, etc.) or the weather it relaxes them somewhat. That and the "this is how it's going to be" type of confidence usually work together nicely. Now I better not miss! Not exactly the same setting, but hope it helps. Also, I sometimes ask exactly WHAT or Why they are afraid. Gives me a chance to educate and sometimes it really works. Every Pt is different. lol
    Last edit by HolisticSandz on Jun 17, '09 : Reason: forgot to add
  4. by   ohmeowzer RN
    i ask them to tell me what their fears are. i explain all i am doing and going to do for them. i give them positive reinforcement and let them know all will be alright. i answer all the questions i can for them. i use a soft spoken voice and let them vent. sometimes people just need some info and TLC ...
  5. by   rngolfer53
    Quote from LeahC18
    Today, I was doing surgery prep for an 18 year old girl was supposed to be having a cyst removed from her neck. She was really scared, so I did my best to comfort her and I explained what I was doing as I went and what would happen once she was asleep. Right before I inserted her IV, she passed out, so her surgery was rescheduled.

    Patients never seem to respond to my attempts at relaxing them. I have always struggled when helping patients overcome their fears before and during procedures, and I'm hoping you might have some advice about what to say to them. Thanks.
    My . Sometimes being matter-of-fact is effective. Projecting confidence in yourself is also important, even if you don't always feel that way.

    By "matter-of-fact" I mean acknowledging Pt fears, but don't dwell on them. "Yes, there is some risk with this or any surgery, but Dr. So and So is very good (assuming that's true) and there is a full, trained team in the OR that will be watching you the entire time, so if anything out of the ordinary does happen, they can react instantly."

    Distraction, as another poster mentioned, is helpful too. As is focusing on the positive results of successful surgery.

    Pay attention to what the Pt sees and hears around the bed. Back in nursing school, I watched a C-Section on an LPN/mom. She knew what was going to happen, but got very anxious prior to the surgery. The VS monitor was in her view, and she could see her HR increasing, which made her more anxious, leading to an even higher HR. Someone noticed, and simply turned the monitor away from her in a natural way, and that broke the chain. You could see her relax. And, everything worked out beautifully.
  6. by   chicookie
    A smile always helps. When I was a patient advocate I would go in see they were nervous, smile and ask them how they were doing. It helps relax them.

    Just think about if you were in their situation, what would you want? Maybe a hand squeeze, a smile, etc.
  7. by   nerdtonurse?
    I remember my first surgery when I was a teenager, and I was shaking like a leaf. The anesthesiologist noticed, stopped, took my hand and asked me what I was so afraid of. I told him I didn't want to choke on vomit (one of my cousins died postop that way just about 3 months before). He listened, and told me he'd make sure I didn't throw up, then gave me pentathol and knocked me out cold. So....

    1) ask them specifically what they're scared of.
    2) address it
    3) touch. Humans crave touch when frightened, even if it's just holding a hand or brushing a forehead. Let them know that there's still a person in there behind the mask.
  8. by   leslie :-D
    Quote from nerdtonurse?

    1) ask them specifically what they're scared of.
    2) address it
    3) touch. Humans crave touch when frightened, even if it's just holding a hand or brushing a forehead. Let them know that there's still a person in there behind the mask.
    spot on, nerdster.
    just taking a few minutes for a focused 1:1, steady eye contact, hand on leg/arm, and discussing concerns w/a healthy dose of reassurance, goes very far in abating anxiety.

    perfect answer, nerd.

    leslie
  9. by   Virgo_RN
    Quote from nerdtonurse?

    1) ask them specifically what they're scared of.
    2) address it
    3) touch. Humans crave touch when frightened, even if it's just holding a hand or brushing a forehead. Let them know that there's still a person in there behind the mask.
    This. Some people don't need the gory details, and in fact, that can serve to heighten their anxiety. They've already given their informed consent for the procedure, so what they really need is reassurance, not more information to process.

    Some techniques I use at the bedside are: direct, gentle eye contact, open body posture, active listening, avoiding pat/canned responses, and giving them positive feedback (i.e. "You're doing great! Keep breathing, you're in the home stretch."). For people in pain, I learned this one from a tattoo artist. I ask the person "If this is as bad as it gets, can you handle it?", which, once they realize that the pain is at its worst and won't get any worse, they are able to relax and cope, because often what the painful person is really worried about is that the pain will get worse, and so they are just a big tight ball of tension.
  10. by   CrufflerJJ
    A kind touch, a smile, and about 5 mg of Versed should do the trick!

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