How can I learn to not be so emotional?

[SoPoSan]

Hi there,

I'm a new grad, working in a residency in an ICU-step down for 4 months. I've been off orientation for 1 month now. Most days I still have points where I feel overwhelmed, but I am comfortable with how I'm progressing and developing my own nursing style. However, something happened tonight that really bothered me and I'm not sure if I reacted wrongly or what I should have done. I was stumped!

I had been dealing with a very critical patient all evening, and had gone to check on my other patient that had a brain injury and is extremely restless, to the point of dangerous. We keep him with up to 2 soft limb restraints and 4 siderails/pads because he is getting stronger and able to nearly slip out of bed. We only use restraints when his girlfriend isn't there because she wants him with minimal restraints (understandably, but we can't always be around to watch him when she isn't there). Him and his girlfriend are both in their mid-70s.

I walk into the room, and the patient is flailing his arms and legs around as usual and his girlfriend trying to calmly talk to him and get him to settle down. I walk over and kneel down next to the hi low bed and the patient stops and looks at me and mumbles things (he can't talk clearly yet). The girlfriend then begins grilling me about why he has to have the abdominal binder on because it is so restricting. I explain (again) about him pulling at the GT tube, and she continues to argue with me that we should just put gauze and tape over it (note: I've been caring for this patient 5 days in a row and have learned to pick my battles with her, but I have ALWAYS been so nice to her, have acknowledged her concerns, and made sure she was getting breaks and coffee and having something fun to do outside the hospital each day). Anyways, I use my therapeutic communication skills and say, "I can see you are frustrated about this. I'll go find something to try putting over the tube" She yells "No no no! This isn't about me, don't use your psychoanalysis on me!!!!" I said "I just meant to acknowledge that it's important for you to advocate for him because you know him best and are able to spend so much time with him during the day." And she says "I have to legally advocate for him! Don't you dare psychoanalyize me!!!!" She was overall just convinced I was trying to be manipulative or something, even though I've spent SO much time with them both and have always been sooooo patient and kind. All I could do after she yelled at me and after I was overwhelmed with my other patient was to look at her, blink, and sit there as tears rolled down my face. After a second I got up, went and got supplies, and silently put some gauze over the tube as more tears rolled down my face. She just sat and watched me the whole time.

It was just so frustrating. Many people don't understand how hard nursing is, or how much we really care. I sit with him and chart while he falls asleep so he isn't scared. I do range of motion exercises on his restrained limbs everytime I walk by the room. I understand that she is in a hard situation right now, and that me being young and readily available makes me an easy target. It just hurts. How bad is it to let a patient/patient's family see you cry? What should I have done? My therapeutic communication skills failed me lol.

[Aurora77]

I don't think it's a bad thing to let your pts/families see you cry. It can't be a regular occurrence and the situation can't be turned to be about you, the nurse, but tears a natural part of being human. I may be totally wrong in this, but hopefully the girlfriend will see that you are trying to do what's best for the pt and not just being an unfeeling automaton of a nurse.

Therapeutic communication is challenging and I don't pretend to be an expert by any stretch, but you could try phrasing things a little differently. When she's upset about the abdominal binder, you could tell her "Ok, we'll try the gauze and tape and see how that goes. If it doesn't work, we'll have to go back to the binder." (of course, this only works if it's safe to go with option 2). Then she's had some control, doesn't feeling like you're playing analyzing games, and you're also able to maintain control of the situation.

I think therapeutic communication probably has to be taught the way it is in school, but if you use the phrasing you're taught, you (this is the general you, not you in particular, OP), can come across insincere or like you're using psychobabble. It's a matter of taking those techniques and using them in real language that your patients and families will understand.