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Well done and nice reminder of how important communication is in the work we do every day as ambulatory care nurses.
Good content on professional communication.
Active listening is so critical in telephone triage. Multiple times a day I receive calls with highly anxious patients whose thoughts are racing even faster than their words. Deciphering the intent for the call sometimes isn't done until several minuted into a chaotic rant. Their ability to communicate is hindered often by fear, anger, frustration and sometimes even loneliness with a desperation to talk to anyone who will listen. I recall a particular call from a patient in her 90s with a simple request for a medication refill. She was delighted to hear a friendly and cheerful voice still available near 5pm, and she went on and on about how happy she was someone was still in the office. Although it took literally moments to fulfill her refill request, I stayed on the line for 14 minutes because I assessed she was alone and possible experiencing isolation and depression. Instead of filling the order, moving on to the next call and one step closer to quitting time, I was able to arrange social services to visit her and find additional resources to keep her engage. Months later, each time she calls and hears my voice, so thanks me over and over again for hearing and listening to her message and not only her words. Regretfully, the active and engaged listening in the world of telephone triage is not always well received by patients. This is especially true when assessing patients who suffer from addiction. The empathy and pauses used often get mistaken for judgement or sympathy for their situation, and harsh words are sometimes passed to the nurse. In these cares, I try to remember the valuable lesson from my 90-year old patient: listen to the message, not just the words.
I currently work with ambulatory care for past 7 years. Nurses do mostly telephonic nursing - from complicated triage, care coordination, transitional care, patient education to simple prescription renewal. We work with about 70 primary care providers who heavily rely on nurses ensuring safe and efficient care for their patients. All these were new to me when I entered this role. I got thru a lot of challenges learning the skills and processes. I think the most challenging as with every nurse I know was caring for our patients during the Covid 19 epidemic. At the on onset each one of us would get at least 30 calls per 8 hr-shift. The disease was evolving so we had to make sure we can provide pts and their family members with the best possible advice. We were reading emails with updates from our team leadership while listening to our patients, expressing their fears and concerns. We get calls from different demographics and at times using our interpreter services. I knew i should not rush and end a call to pick up another; but there were times I had to. It got overwhelming and exhausting that I felt like I was channeling my frustrations unto them. At the end of the day, patients do appreciate our active listening. Many have expressed that this was all they need, that someone was working on a solution and that they were not alone. Patients seek advice but at most times is to validate what they already have in mind
I thought this chapter was well written and serves as an excellent reminder of just how important having professional communication skills can be, not only for the patients in our care, but for ourselves as well.
Active listening is a very important part of my position everyday as an infusion nurse. Today I treated a new patient who wasn't new to the center but new to me. The patient was to receive antibiotics. I could tell from no eye contact and very little interaction that he was anxious and stressed. I asked him about his health, his day and come to find out that he was struggling with things at home. He verbalized his frustration and fear about paying his rent and that he was tired of coming into get treatment. By listening to him and empathizing with him I was able to build a rapport that I previously didn't not have established. He was a bit snappy with me in the beginning of our conversation, but by listening I was able to understand this frustration and respond in a non hostile and non threatening manner. He ending up joking with me and apologizing at the end of the conversation and said he would happily see me tomorrow for treatment. I was open, deescalated the situation and ultimately build trust with him just by listening to his story. I recall a time when a long time patient has come into get an infusion and I have known from past experiences that they are pretty difficult to deal with very demanding about where I was able to put their IV. This situation has led to anxiety with the patient and caused me to miss their IV several time. I think when you go into a situation like this having a negative outlook because of past negative experiences that it leads to negative outcomes. This anxiety is definitely a barrier to listening and understanding where this patient is coming from and could lead to missing something or an overall bad experience for the patient.
I work as an infusion nurse and I take care of peds patients as well as adult patients. I always like to take my time when new patients because I feel this helps relieve anxiety and nervousness. In the past I had a very anxious adult patient who was very agitated and frustrated because he was in pain and nervous about his infusions. I let him have plenty of time to talk with me regarding his frustrations and he slowly began to relax, open up to me, and overall feel better. I feel when you take your time and explain things to your patient and not rush, and let them express their concerns it opens the door for trust and an overall sense of well being.
Thank you for having information about gender!!!
Johanna Castillo 9/27/23 09:00 It is so important to engage in active listening. Sometimes it is not the things that a patient's says but also the things they don't say. I remember on one occasion. I called a patient for an appointment reminder for a biopsy. I asked the patient if he had any questions and he said no. I asked him if he understood the time of arrival, etc. and he said yes, "I think I got it". Because he was so quiet, I told him I was going to go over all the information again for patient safety reasons and so I told him all the things he was to expect, I explained recovery time, procedure time, pain expectations, etc. At the end he was so thankful because although he thought he understood. The reality was that he did not know what questions to ask. Nurses have to be empathetic and understand that silence doesn't mean the patient understands everything but rather don't know what questions to ask. In the other hand, I have had patients in the same scenario that when I have asked if they understood everything their tone was that of annoyance. Rathen than picking up on the cue, I have continued to assess their knowledge on the procedure which have led the patients to hang up on the call.
This is so important in caring for patients and families. Maintaining physical as well as mental health, making them feel comfortable and trust in the care provided is important in the healing process. With so much happening around the world, this is definitely a reminder for all of us in the Nursing Process.
I conduct a lot of telephone triage as part of my workflow, and I always listen first and talk second. This chapter has helped solidify this principle for me. I had a pt call regarding shortness of breath and she thought it was "no big deal" because she has struggled with it before and she has asthma. I was able to communicate to her that since this is a worsening symptom she needs to go to the ED and this potentially saved her life. My example for a scenario that didn't go as planned was when I was talking to a patient that ended up completely misunderstanding how to take their medication after a hospital visit, so I methodically went over his medication reconciliation with him so we could be on the same page with what he was supposed to take.
I work at an urgent care clinic, and we see a wide variety of patients on a regular basis. On a particular day I had a patient out in the lobby screaming to another patient’s mother because the daughter did not have a mask on and was sick. At this point, masks were no longer mandatory for everyone, unless symptomatic. This very upset patient was also giving our clerk a hard time. Me as Charge Nurse, to prevent further escalation, brought the patient back to a quiet room. There I calmed the patient down and encouraged this patient to communicate with me how best I could help her situation. After a while of talking, the patient stated she had a lot going on in her life, had recently lost a family member due to covid and seeing someone sick without a mask, triggered her to act this way. All she could think of was how covid had taken a lot from her and her getting sick or another family member getting sick was a constant fear. I quietly listened to her concerns, and she was very grateful to me for being there and listening to her as she calmed down. She acknowledged that her behavior was inappropriate and did end up apologizing to the other patient’s mother and her daughter (now masked) for overreacting. Many times, I find myself just being there for the patients and listening to their concerns whether it is in person or on the phone and it makes a difference when they feel and know they are being listened to. I do encounter a lot of patient encounters over the phone that have not gone as well unfortunately, All I can do is follow clinical protocol and remain calm to avoid patient escalation.