How do U approach new patients?

southernbelle08 · Aug 16, 2007

I always tell them I am a student, it's something we're supposed to do at my school. I introduce myself and tell them the college I am from and let them know I'll be helping with their care for the day.

As far as my assessment goes, I always chit chat while I am doing it. You can find out tons of information you will need (example - my Needs Assessment Guide) for your paperwork and I think it helps ease any anxiety for you as well as your patient. I will tell them what I am going to do, I don't just go in touching and grabbing, but while I am doing those things I do strike up a conversation if at all possible. Lots of times I will look for things in the room to start a conversation...flowers, cards, etc!

I haven't had a problem doing it that way, I don't get so caught up in conversation that I forget and I always keep a small notepad with me to jot things down as I go. You'll find what works for you and develop your own routine, I promise! :)

merCful · Aug 16, 2007

I introduce myself, "Good morning Miss my name is ____ and I am a Nursing Student. I'll be caring for you from this time to this time." Then I ask the big question.

"How are you this morning?"

I usually make eye contact with them when I ask this question. I have seen some doctors and even nurses ask the patients how they are feeling all the while looking in a chart or doing something else. I'm guilty of doing it before myself but not on the initial visit. Still I know it is wrong. A few of the patients have shared with me how such behaviors from healthcare providers can be very demeaning.

First impressions are very important, so make it good. Have a smile on your face and look like you want to be in that room taking care of that human laying on the bed.

arciedee · Aug 16, 2007

I absolutely introduce myself as a student. Patients have so many people coming in and out, I'm guessing they have no idea who half of them are. So I tell them that I am a student nurse from University X and that I will be working with their nurse Y today to care for them. I don't get into specifics as to, "I will do A, B, and C with you today" but I let them know that I am there and will do all within my power to make sure that they are well taken care of.

I do tell my patients what I'm doing. A lot of patients with chronic health problems are well aware of their conditions and are interested to know what their temp is today, where their BP is at, etc. It's an excellent teaching moment, because by explaining what you're doing the patient has an opportunity to learn more and ask questions, not to mention that they may know that what seems to be an alarmingly low HR is actually within their normal range or whatever. You, as the nurse, learn so much more by having the subjective info as well as the objective and you only get that by establishing rapport and trust with the patient. Sometimes that conversation about so and so's dog at home gives you a ton of info about their home life, what their concerns are for discharge, etc. And I contend that a lot of the care is in the ear that we provide as much as the tasks that we perform.

TakeTwoAspirin, MSN, RN, APRN · Aug 16, 2007

Aside from the great advice given above, all I would add is that I don't chit chat exactly during a physical exam, but I do tell the patient what I am about to do next at each stage of the examination. I always feel like this gives the patient a heads up about what is going to happen to their body next, what part of their body I am going to be touching. It is their body after all! I think this reduces the patient's anxiety a little, and is respectful of them and their privacy.

Also, make sure that any body part that you are not directly examining is covered at all times.

I also repeat several times that if the patient feels any discomfort or pain at any time during the examination they should tell me. I also watch the patient's facial expression during the exam for any signs of discomfort (some patients are stoic and won't tell you even if you are hurting them).

Always thank them at the end of the examination for letting you do the examination. Let them know what you will be doing next (I will be reporting my findings to the doctor who will be speaking with you later, etc) and ask them if they have any questions or concerns.

Daytonite, BSN, RN · Aug 16, 2007

here's the viewpoint of a seasoned nurse for you.

i was just in the hospital for 11 days of iv antibiotics and a few other things. because i have a picc line and a deep incisional wound that needed packing and dressing i was assigned to a number of student nurses and new grad orientees to get some experience doing these procedures. i have to tell you that only one orientee actually introduced herself as being a new grad orientee. the rest i found out by asking as it became obvious to me as they were doing their assessments or what all with me. most also wore their name badges turned backwards so you couldn't see their names and titles! now, i wasn't particularly bothered by this at the time, but i don't think it was a very good way to start a relationship with a patient. i think it's important to be honest and straightforward. "hi, i'm xxx. i'm a student nurse who has been assigned to take care of you today." i don't think you need to say much more than that. i'm not going to give you a hard time about it. i know that some patients might, but the reality is that some people can be like that. don't feel bad. . .they get the same pissy way with the regular staff too.

the way i was taught to do a physical assessment was to also ask questions relating to the review of systems as i was assessing each body system. when you are first learning to do this, your questions and "chit chat" may seem a bit stiff. over time, however, you develop a routine at this and you can incorporate these questions into some general conversation. your focus all the time, however, is to collect data even though the patient doesn't know this. you can tell the patient each thing you are going to do if it makes you feel comfortable. normally, i would just say, "i want to listen to your lungs. can you sit up for me?" i learn a couple of things: the patient can follow a direction, how well they can breathe, their lung sounds, and some degree about their mobility. most patients, if they have been seeing a doctor, should be familiar with this routine anyway and shouldn't be surprised by it. in the event you run into a patient who is new to it all, then you can explain in a step-by-step fashion what you are doing.

i agree with your director of nursing. we were told to have a "professional face". in other words, never let your facial expression show the patient what you are really thinking. i also believe that you have to use your voice as an instrument as well. body language is sometimes forgotten about. actor and actresses. . .yes. sometimes a patient or doctor will let go of a bomb that would normally make you gasp out loud, but you can't, at least not in front of the patient. patients are looking for that little betrayal on your part, if only to confirm their own feelings and emotions about their condition.

i have to confess that since i have been in the healthcare system and am being tested for metastasis of a cancer, i am closely searching the body language and listening to what is said to me looking for any hint of a piece of knowledge that my doctors or the nurses know that i don't. it's not that i don't trust them to tell me the truth, but the uncertainty eats away at me and it's almost unbearable as my future is hanging in the balance here. i imagine that this is going on with many patients. the last thing you want to do is let them get the wrong impression about their care or condition. emotions are powerful things that have a strong effect on our thoughts and behavior and as professionals we need to be very aware of our effect on people.

alkaleidi · Aug 17, 2007

I second the above poster.

When I was a student, I introduced myself something like:

"Hi , my name is Amanda. I'm a student nurse from IVCC and I'll be taking care of you today [with if there is a staff nurse also assigned to the pt]." Then of course asked if I could assess them, and always asked every time before I left the room if there was anything else I could do for them before I leave.

The word game kind of plays a part here. If you say "nursing student" it sounds more like a student... if you say "student nurse" it sounds more like a nurse. Both are the same, but the wording is more appropriate because in the hospital, you are acting and learning as a student nurse. And I think that little detail might add a fraction of comfort to the pts you take care of. *shrug*

good luck!

future L&Dnurse · Aug 17, 2007

I always tell my patients that I am a student, because I think it's something they deserve to know - that I may be asking another nurse for help, that I may have questions, or that I may be in their room more often because I forget to do everything in one single trip. I've never had a patient refuse. I just say hello and tell them "I'm (my name), I'm a junior at (my school) and I'll be your nurse today." And then go into my assessment. I think the patient needs to know. Some patients are not okay with students, and that's their right. They deserve the opportunity to refuse being cared for by a student (I had one refuse, in a community setting. Fair enough, it was absolutely his right to do so and I can't say for sure that I would be okay with a student in every situation, either).

APBT mom, LPN, RN · Aug 17, 2007

We have to introduce ourselves as a student nurse school policy. I usually tell them what I need to do/ get from them then ask them how they are doing and if they need anything before I start. Certain procdures I know that I'm able to continue a conversation with the patient and others I tell them that I need a moment of silence while I do ..... If the patient asks if we've done the procedure before our instructors told us to tell them yes we just leave out the part that it's the first time we've done it on a person. I think it also helps if you show confidence on the outside even if your flipping out on the inside.

al7139, ASN, RN · Aug 17, 2007

Here is my two cents:

I am a new grad. I have been working for about three months. In school, you MUST inform your patients that you are a student nurse. In school I found that in most cases, patients and families are receptive to having students working with them. I always let them know what I neede to do, and made sure I got their permission (it sounds wierd, but examining someone without their consent could be considered assault). I asked "I would like to examine you, is that alright?" I also made sure that any procedure I was not totally confident at, I went over before, had my teacher or RN in the room, and explained what I was doing, and that because I am a student, so and so is here to watch because I cannot do whatever unsupervised yet...I would usually get the question " You have done this before?" "Oh, yes, lots of times!" They don't really need to know that it was on a plastic dummy at the school.

As a new grad on orientation and when I started, not yet taken the NCLEX, I made sure to tell pts that I was a new grad, and introduced myself and my preceptor.

As a student and a newbie not yet on my own, I still only once had a pt say they did not feel comfortable with a student caring for them.

Don't take it as an insult, some people don't understand that we are not going to do use them as "guinea pigs".

Anyway, the moral is never hide what you are...not legal. Confidence comes with time, and pts are much more understanding (most of the time with students).

Amy

WDWpixieRN, RN · Aug 17, 2007

As a student and a newbie not yet on my own, I still only once had a pt say they did not feel comfortable with a student caring for them.
Don't take it as an insult, some people don't understand that we are not going to do use them as "guinea pigs".

Excellent information to add to what's already above. We had 2 students this semester who were "dismissed" from their pts. They took it very hard and I honestly didn't understand why. People are human; when you're in the midst of some healthcare crisis, it's understandable that someone may not want a student caring for them. It's not usually personal.

And contrary to what you mention, sometimes they are "guinea pigs". I worked as a SN intern this summer, and you can bet that everyone of those pts who got an IV start or a foley for the first couple of weeks were, in essence, my guinea pigs....I had never started one on a live person prior to that, lol.

I did have one or two who wouldn't let me start their IVs when my preceptor introduced me as a student. Even though I had probably started 30 when one gal's mom wouldn't let me do hers, I wasn't the least bit offended. That was her prerogative as she felt like she was looking out for mom's best interests. There were 30 more after her this summer.

But definitely, always, introduce yourself as a student. Most of my patients have been fascinated to learn I was a student and many were WONDERFUL about helping ME!! One student's patient kept asking us if we had learned anything every time we went to care for her (she had multiple medical problems); she would reply, "Good" when we would tell her yes.

elisabeth · Aug 18, 2007

I'm starting my nursing program in just over a week, but having been a patient in a hospital, I've told a student nurse to hit the road as well.

I was 13, in the hospital with leukemia. The nursing student walked in, told me she was a student, which was fine, and then insisted on washing my feet. There was nothing wrong with my mobility, I'd been bathing and I don't like my feet touched. After several attempts to persuade me to let her wash my feet (that was all she wanted to do by the way) I just asked her to go.