Just Relax?

[canesdukegirl, BSN, RN]

I see medical professionals say this all the time to patients who are experiencing stress/being combative/are not oriented. This is a pet peeve of mine, and I am just wondering if anyone else feels the same way.

To me, "just relax" is being on the beach with a nice tall margarita in my hand and an umbrella over my head. It kinda makes me cringe when I hear someone say this to a patient. I always say, "You are safe, you are just waking up from surgery, you are in the hospital, let us take care of you", etc.

What do you say to patients experiencing acute stress?

[vlomankill]

i'm in dialysis and when a pt (particular pt comes to mind) starts to cramp i tell her to calm down. this is because she will start to hyperventilate and start a panic attack on top of the cramping; of course I try to talk her through the cramping, but calm down isn't inappropriate in all cases.

[canesdukegirl, BSN, RN]

I agree that "calm down" is not inappropriate at all.

[MassED, BSN, RN]

I say just relax. Sometimes it works. Sometimes it's a variation of the just relax theme... take a deep breath. I work in the ER, so I'm not dealing with someone coming out of anesthesia. If a person is combative, then "just relax" is not my normal approach - more like "if you don't calm down, cooperate, and listen, then I will have to call in for some help, and I don't want to do that. I would rather us have a nice conversation like adults..." or something along those lines.... appeal to their desire to be treated like an individual who has a choice (even if they don't ). You have to play it by ear, all depending on the patient, their circumstance, behavior, visitors, etc. Sometimes it's not quite so sweet, other times a sweet approach works....

[gymnut]

I always say, "You are safe, you are just waking up from surgery, you are in the hospital, let us take care of you", etc.

This is a wonderful thing to say to patients. I know personally it's what I would want to hear instead of 'just relax'.

Waking up after surgery especially if you have no recollection of how you ended up there is I would imagine a truly terrifying experience. Having someone tell you to just relax after you nearly died, have tubes galore coming out of most of your orifices or you're waiting for test results is just crazy.

Also I don't like it when doctors or nurses tell me they understand. My father was in SICU and pretty much in a coma for over a month after becoming severely septic due to a burst intestine that became necrotic. He had a trache put in because they couldn't leave him on a ventilator anymore because of risk of infection. When he finally came around he obviously had almost an impossible time talking and it was VERY frustrating to say the least. Well the one RN who was the most chipper thing ever (bless her heart) said to him that she completely understands what he's going through and how hard it must be for him not to talk. I could see it PO'd my dad greatly because it was obvious that she didn't and could never understand what he was going through. Heck I wouldn't even be able to understand! It was such a horrible traumatic event.

I know that may sound nitpicky and I know that RN meant well but I'm sure you guys know what I'm getting at.

[canesdukegirl, BSN, RN]

Oh lord have mercy, I would NEVER tell a patient that "I understand" unless I have actually experienced what they have. I remember one time when I was younger, one of my best friends had to deal with the suicide of her mother. While hugging my friend, a well meaning woman said, "I understand," while HER mother was standing right beside her! That just went all over me. I can relate to your frustration at this very trite comment. Well meaning as this nurse might have been, it is the semantics of our comforting words that must be kept in consideration.

[sunnycalifRN]

Oh lord have mercy, I would NEVER tell a patient that "I understand" unless I have actually experienced what they have. I remember one time when I was younger, one of my best friends had to deal with the suicide of her mother. While hugging my friend, a well meaning woman said, "I understand," while HER mother was standing right beside her! That just went all over me. I can relate to your frustration at this very trite comment. Well meaning as this nurse might have been, it is the semantics of our comforting words that must be kept in consideration.

You are so right! It would be like a husband telling his wife in labor, "I know the pain is bad, but you can get through it!" If I had said that to my wife during labor, she would've broken my nose!!

[gentlegiver, ASN, LPN, RN]

I have to agree, I would never say I understand to someone unless I had experiences what they had. A friend of mine lost her baby shortly after birth, everyone was saying I understand. I told her, I don't know what your going thru, I don't understand, but, if you need someone to stand by your side while you scream & cry, call me. Some how that made us closer than we were before.

[AgentBeast, MSN, RN]

It's more or less a semantics problem. Something conveying the same idea as "Just Relax" is fine, however using those words (Just Relax) is pretty insensitive.

[sunnycalifRN]

Or, another well-meaning but off-the-mark comment that visitors make to some of my ICU patients is, "Get some rest". Ha ha, sure, get some rest while alarms go off constantly, while we turn you Q2, while we poke and prod every body orifice, while 10 different docs ask you the same questions.

[nursemike, ASN, RN]

I also deal with a patient population for whom it's more appropriate to tell them they are safe and in the hospital, etc., and I don't think I'd have a lot of success with, "Just relax," although I might use it on an oriented patient before starting an IV.

I'd like to make a point about "I understand," though. Taken literally, NOBODY understands. All of us are alone in this world, no one can ever know what it is like to be someone else, we're born alone, we die alone, and in between we surround ourselves with people who may love us, but don't really know us. It's a pretty grim view of life, but accurate, if you want to be precise about it.

Or, you can choose to believe, as I do, that I do understand a good deal about what a new mother is going through. You can distinguish, as I do, between having empathy for someone and actually being them. My mother died when I was ten. It wasn't suicide. I still do have direct experience of losing a parent at an early age in a sudden, dramatic event. I don't have direct experience of losing a child, or a spouse, but I have an understanding of what it's like. I can empathize, by relating a loss to losses I've experienced, by imagining myself in another's position, and even by recalling things I learned in Psych 101. I don't need to cut off my arm to comfort an amputee.

When people say, "I understand," they don't, they can't, but they are trying to. It isn't a challenge to debate whose life has been most tragic. It's an expression of care and concern. So next time you hear someone say they understand, thank them. And just relax.

[brownbook]

I tell the patient it is ok to be scared. Then tell them what ever fits their situation. We do hundreds of these procedures every month, no one has ever not done well. We always call our patients the next day to check on them, no one has ever said "I was in terrible pain all night, it was awful." Their surgeon is one of the best, I would choose their surgeon if I was going to have the procedure done. The anesthesiologists will be at the head of their bed the whole time monitoring their heart and breathing."