Thursday, October 23, 2014

Therapeutic Responses For The Patient

By Alon Calinao Dy: I was a graduating nurse when I witnessed a heated conversation between my colleague and her patient at the Community Center in the Philippines. I also handled another patient, hence it did not come to my mind to intervene. I thought their exchange of words were just a slight misunderstanding between the two of them. 

I inquired about the problem. She told me that she was dealing with a complicated patient. I asked her, "what do you mean by a complicated patient?" She then said that her patient was a doctor in one of the famous hospitals in Metro Manila. The more I heard, the more excited I got. But I noticed some tears in her eyes. I immediately knew something was wrong.

The author of Think The Brighter Side of Life blog

After I talked to my colleague, I went straight to her assigned patient and asked if everything was all right. I could see that the patient was annoyed. I said to her directly, "you seem tense." The client stated that she was having a problem with another nurse, referring to my co-nurse. I noticed she was comfortable with me, so I offered myself to help her. 

I asked the doctor, "can I sit with you a while?"

"Yes, of course," she replied.

The doctor explained to me everything, why she wanted another nurse to take care of her. According to her, the nurse was incompetent because she didn't know about the prescribed drugs from the doctors. She was asking the functions and the side effects, but she was speechless. 

I observed she must be a very strict physician to her patients and nurses. It just happened my nurse friend was the one who handled her, I felt bad for her. In the back of my mind, I questioned myself why this patient was so hard to please. I didn't talk much, but I listened to her with eager care.

I had experienced similar situations before, thus it was not new to me. I encouraged the patient of my fellow nurse to ventilate her negative impressions or feelings. Then when I got the opportunity to speak in regards with the current situation, I asked her again "how is it important for you to know all the functions and the side effects of the medicines?" She answered with confidence, "extremely important." I have just known that she was a pharmacist before becoming a physician after she confessed it to me.

I spilled the beans first to my co-nurse, and together we approached our group leader. I was concerned about the nurse-patient relationship between them, so I called the help of our nurse in charge of everything. At the office, we discussed the concerns on both sides. I shared everything that we talked about to settle the issues since I held the patient's consent. 

At the time, I wanted to show to everyone that I was in the middle and would not tolerate anyone's mistakes. According to one of the titles in The FordyceLetter, "trust is the foundation for every good relationship." I totally agree with the heading. If the patient has shown distrust in you, it would be difficult to establish a good relationship again.

I advised the head nurse to replace the patient's assigned nurse, and put my other classmate who was the number one student in our pharmacology class. She laughed so loud after hearing it, and she followed my suggestion. Everyone at the Community Center was supportive to one another. 

We all knew that we would experience difficult patients at different times, but it was part of our job. Before we handled patients in real situations, we already built a solid foundation of mutual trust and respect for all of us. That's why it was easy for us to hold each other's arms in times of troubles as any other basketball teams who wanted to create teamwork and success in their respective professions.

I told my colleague that it was a component of the learning experience of a novice nurse. I even suggested her to forget unpleasant memories because they were trash that need to be demolished. I was always a positive person, and I believe I am still positive one till now. I recognized it was only a small misunderstanding between the two of them, and sometimes it was really hard to avoid some circumstances. I advised my colleague to possess a long patience and to understand her situations; maybe she had other unresolved problems with her family and occupation.

After our conversation, I glanced the glamorous smile on her face. Perhaps, she understood well what I tried to tell her. My nurse friend thanked me for standing beside her when she needed me most and when she needed a trusted friend. I responded by saying that she would do the same thing for me if ever I am with that kind of situation. At the end of the day, we all accomplished our nursing duties and responsibilities in our designated areas.

Therapeutic Communication Techniques

The script: 

Colleague: I'm having a bad day. 

Me: What's going on here? Tell me more about it (using broad openings)

Colleague: I have a complicated patient.

Me: What do you mean by a complicated patient? (seeking clarification)

Colleague: She is a doctor. She always asks all about the medicines I'm handing her. 

Me: Really? (voicing doubt)

Colleague: Yes. What am I going to do with her? She is a tough patient.

Me: Ok. Let me talk to your patient for a while to understand her concerns. (requesting consent)

Me to patient:  Good morning, my name is Alon Dy. I'm here for you today to ask if everything is all right. (giving information) You seem tense. (making observation)

Patient: I don't like that nurse she is incompetent.

Me: Would you like to talk about it? (encouraging perceptions) Can I sit with you for a while? (offering self)

Patient: That nurse does not know all the medicines she is giving to me. I refused to take some prescribed drugs because she did not know the functions and the side effects of the drugs.

Me: It must be hard for you. (making observation)

Patient: It is.

Me: By the way, how is it important for you to know all the functions and the side effects of the medicines? (encouraging evaluation)

Patient: Extremely important

Me: I see... Do you think I could talk about your concerns with her? (reflecting)

Patient: Yes, please.

Me to colleague: I talked to your patient about your problem. She said you kept silent when she asked about her medications. I guess you must know very well the functions and the side effects of her prescribed drugs, so you could respond immediately to all her inquiries.

Colleague: Yes, I will do it. (accepting)