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Through the eyes of a patient

Image: Keith Brofsky | Photodisc | Thinkstock

Have you ever wondered why certain patients act the way they do around nurses? Why some are pleasant and cooperative and some are disrespectful or difficult to engage? It is easy for a nurse to have expectations of patients because naturally we all want them to be kind, cooperative, and appreciative.

But it is important for nurses to keep in mind circumstances and experiences surrounding the hospital admission, and perhaps even past experiences that could impact how the patient views this admission.

Some people may have had a bad or traumatic experience the last time they were in the hospital, or they may associate the hospital with negative memories. Nurses must remember to be mindful of each person’s unique situation and tweak our treatment based on their reactions.

PEDIATRIC PATIENTS

Interacting with patients takes on a whole new meaning when you delve into the world of pediatrics. Before I walk into a room, I must take into account the age of the patient and how to best interact with them. A good pediatric nurse tries to develop a relationship with all of her patients and performs based on age-appropriateness, instead of just getting through the day giving medications and doing procedures.

We all remember back in nursing school seeing Erikson and Piaget’s stages of development listed in textbooks and cramming the information into our brains for the NCLEX.

In pediatrics, we must put these stages of development to good use and take them into consideration when first approaching a patient and when developing a successful working relationship with them.

Below are some accounts of what a pediatric patient might be experiencing while in the hospital and effective ways for the nurse to deal with that patient.

THROUGH AN INFANT’S EYES…

Bright lights (crying). I’m cold (crying)! Cold hands (crying). I don’t smell my mom (crying). Hungry (crying).

The needs for an infant are defined by Maslow’s basic physiological needs of breathing, food and homeostasis. Nurses can tend to these needs by providing cluster care and a low stimulation environment, especially for neonates, and by swaddling the patient up after interaction.

Warm your hands up prior to touching an infant, shield their eyes when you turn on the lights, swaddle them up tightly with their hands near their faces when you are finished assessing them. Lastly, hand them to mom for there is nothing better for an infant than the mother’s touch.

THROUGH A TODDLER’S EYES…

Ahhh, who is that? I don’t know her. Where’s my mom? I remember getting an ouchy last time they came near me. What is that thing around her neck? Don’t touch me!

Toddlers are fearful, parent-oriented, and oftentimes weary of strangers entering their rooms. Also, if somebody with a white lab coat came in and gave them a shot, then everybody with a white lab coat is surely out to get them.

Approach a toddler slowly, talking to them and letting them observe you before you get close. Once you are by their crib, play with them for a couple of minute prior to assessing them- grab a favorite stuffed animal, let them play with your badge or your stethoscope.

Prior to listening to them or taking their temperature, listen to yourself first so they can see that what you are about to do is not painful. Of course, there will be instances when shots and IV sticks are unavoidable, but utilize rooms outside the patient room, such as a treatment room, to keep their own room a safe place.

This age is all about play, so interact with them, they will learn to trust you. Also, what they can’t see won’t hurt them so if the patient loses his mind when you take his blood pressure and stand over the bed, place the cuff on him and leave it, then push the button as you are walking out the door so he can’t see you. You are probably a lot scarier than the cuff squeezing his leg.

THROUGH A SCHOOL AGE CHILDN’S EYES…

I want to play outside. I miss all of my friends. This food is gross. I’m bored. Why do I have to get another shot? I don’t feel good.

These are some of my favorite years because the children are way more intuitive than most people give them credit for. You can reason with school age children, so keep them informed of the plan for the day. They are typically still very obedient because they want to make their nurse happy.

They do well on a reward system and thrive off of positive reinforcement. Distraction is an effective technique when performing procedures. They can be imaginative so expect questions such as “if you poke me with that needle won’t all of my insides ooze out of the hole?”

Take them out to the nurse’s station with you and introduce them to all of your coworkers as your bravest patient. Let them perform heart surgery on their stuffed animal. Most importantly, be honest with them about what is to come.

THROUGH A TEENAGER’S EYES

This place sucks. I’m not taking my medications anymore. I would rather die than be here. I miss my friends and my boyfriend. Why does this have to happen to me? Why won’t she give me privacy? Why do I have to pee in that stupid cup anyway? Why won’t my mom and everybody just leave me alone…

Granted, not all teenagers are like this, but it is not uncommon to see some of these manifesting behaviors in that age group. I have found that for teenagers that are over being in the hospital, sitting on the bed with them and letting them vent is the best answer. Some will talk to you, and others won’t. But if you find something that you can relate to them about, they are more likely to open up.

As with the school age child, be honest, and don’t be afraid to be frank. Tell them that if they don’t take their coumadin, they may clot their valve and possibly end up in an emergency situation.

Give the teenagers some sense of control over their care. Let them make a schedule for their day and agree that while you have to add certain things like times for medications and time for physical therapy, they can control the rest, even if it means giving them an hour of peace and quiet in the afternoon where you won’t let anyone in to bother them.

Arrange with their parents a visit from friends as long as the policy on the unit allows it. Take them out to the garden or the library. Teenage years are already some of the most tumultuous years in a person’s life, combining that with the stress of a hospitalization can be very trying.

Talk to them about their future and what they want to be when they go off to college, encouraging goals is a good way to keep the teenager focused.

THROUGH AN ADULT’S EYES…

Last time I was in a hospital, it was to see someone die. Plus, I have no privacy here…can’t get a decent night’s rest. This place is depressing and different people are just coming in and bugging me every time I finally am about to catch some shuteye.

If your 30-year old patient is emotional because the last time she was in the hospital it was to watch her mother pass away, do your best to establish a rapport of trust and encouragement, and keep her informed of all decisions that are being made.

If a 55-year old man is modest and wants some privacy, try your best to respect his wishes as long as it is safe for the patient.

If your patient is elderly and grumpy and demanding, just appease him, kill him with kindness, and ask to hear stories about his life, because realistically, nobody wants to end up in the hospital.

Throughout nursing we encounter different personalities, different ages, and different backgrounds on a daily basis. As a nurse, I pride myself on being able to deal with all of these patients and care for them effectively. Although it can be hard, try to put yourself in your patient’s shoes. There is nothing more gratifying than hearing one of your more difficult patients expressing how thankful they are for the care you provided.

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Nicole Lehr

Nicole Lehr is a pediatric nurse. She can be described in three adjectives: content, thankful and fortunate. All credit for the aforementioned description can be given to the love she has for her profession as an RN. She graduated from University of Florida with her Bachelor’s in Nursing and moved to Atlanta to work at the Cardiac Stepdown Unit at Children’s — her dream job.
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2 Responses to Through the eyes of a patient

  1. Smithteamracing RN

    After 25+ in nursing I have learned to accept the fact that some people are just nasty & self-centered & rude. Sometimes it is fear, a lack of control &/or the overwhelming nature of their diagnosis & one tries to be supportive. Sometimes they come aroundd but occasionally they don’t. I am polite & professional but don’t blame myself for their attitude. (Well, at least I try to not blame myself!)

    I really have a hard time with the people who have the money for street drugs, alcohol, cigarettes, tattoos & smart phones but still expect the hospital to provide food for their entire extended family while they are in the hospital, pay for the gas so their family can visit, pay for their discharge/home meds & write off their entire medical bill. This is socio-cultural problem that is beyond my power to fix.

    I work in oncology & like patient care. Difficult patients are just another part of the job. Fortunately, on my unit the “good” patients more than make up for the occasional difficult person.

  2. Marsha RN

    GREAT ARTICLE! I found it helpful that you included detailed advice on how to relate & interact better w/ patients across the age spectrum. I’ve certainly grasped a better understanding of “teen-age behavior” after reading your article. Thanks for providing useful interventions every RN can apply in daily practice! :)

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