Verbal Anesthesia. Oh how therapeutic!

[Bedside_Life RN]

In Nursing there are so many therapeutic interventions at our fingertips. With this being said, the utilization of these skills are often sidelined due to time restraints and the ever changing necessity of meeting our patients' clinical needs.

As Nurses, we are exposed to the most sensitive and intimate experiences that our patients and their families will go through, on a day to day basis. It is too often that this exposure molds us into task oriented individuals focused on acute clinical situations and diagnosis related care. Our patients begin to be identified by their diagnosis and their identity in addition to adequate holistic care are left hanging in the wind.

This is not because Nurses are beginning to care less, but is a direct reflection of too many clinical situations/responsibilities and the increasing acuity level of the patients that we care for.

But the other day I witnessed a highly effective and easily applicable intervention that is within the scope of practice of any Health care provider.

During a cystoscopy with stent removal, with a very anxious patient, I assumed my usual role of setting up for the procedure, working the patient up, making sure that the patient had signed consent and was comfortable on the table. I ensured the patient that although they may feel slight discomfort that they were in good hands and the urologist was very gentle and knowledgeable and that I would be there for support throughout the procedure. Following all of these steps I left the room and later returned with the urologist to begin the cysto.

Upon entering the room, the patient was resting on their elbows and immediately started explaining all of the aspects of their treatment to the doctor in rapid fire. I could tell the pt. was anxious but I continued to be focused on the task at hand and assumed the role of assisting the Dr. As the procedure progressed through the usual steps and as the patient started to experience discomfort they began to breathe heavily and I noticed them beginning to pray. This is not unusual during an uncomfortable procedure; the patient was diverting their mind from the pain.

Meanwhile, I still stand there telling them how great they are doing and assist the Dr. in the procedure. About this time, the resident joins in and immediately addresses the patient by name with an abrupt but welcoming greeting. He then informs the patient to lay supine and rest their elbows, while taking their hand and placing another hand on the shoulder of the patient. The resident continuously spoke of how he wanted to take the patient's mind off of the procedure and instructed him to focus on his voice and his voice alone. The resident told the patient to start with his eyebrows and relax his face muscles then to progress in the same manner with all of the muscles of the body. The patient was instructed to take deep breaths in through the nose and out through the mouth; imagining that they were melting into the table with every breath... more and more.

I observed an immediate change in the tolerance and comfort of the patient and although it made me realize that such a significant effect could be obtained this way, I felt as if I had fell short in my duties of providing holistic care.

After the procedure, I made a point to address the resident and told them that I had noticed how significantly and seamlessly their direction had eased the patient. The resident replied, "Verbal anesthesia is real. It gives the patient support and control when they feel out of control, it makes sense to them".

Since, I have used "verbal anesthesia" during the procedures I assist with. And every time I have utilized this intervention, the results are always positive.

I wanted to not only share this with clinicians, but also give others the opportunity to expand on the topic with thoughts, experiences, practices, etc.

It has truly changed the way I function as a nurse.

[suanna]

The technique you describe is a common progressive relaxation technique I've used for myself a good number of times. It is musch more effective to have someone (like your resident) guide the patient. Unfornately in todays health care, having someone devote that kind of focus and energy isn't going to be possible very often. It's much easier to pop them with some IV versed and some propofol. Whenever I can, I try to coach my patients before any uncomfortable proceedure. I can then assist with the proceedure and offer short prompts to the patient.

[APRN., DNP, RN, APRN, NP]

I like the idea of verbal anesthesia, as it can be very effective in a setting where the “ambience” can be controlled.

I have my doubts about getting good results when [insert description of typical ER environment here] and [also insert reference to young age of patient here].