Building Trust

Obviously, this is not health care specific. Building trust is an integral part of any type of relationship. This is a huge factor in the health care setting specifically. I have noticed especially in this passed week that "winning" people over is not as hard as people make it. It could be the most "difficult" patient. 95% of the time that difficult patient is truly NOT difficult, its just that YOU as the nurse or MD or whoever does not know how to adapt your personality to different types of personalities. Patients often become labeled "difficult" when they are "demanding".

As a healthcare provider "demanding" should not be seen as difficult because the essence of demanding is anxiety. People are scared. They have lost all control in the hospital. They just had surgery, a new diagnosis, or an acute flare up. It's all scary and they want to know what is going on. RARELY does anyone in the healthcare team take a few extra minutes to truly explain to the patient what is going on and what the plan of care is. You would be amazed at the difference in the patient if you just took a few minutes to involve and explain to the patient what on earth is going on with them and what the plan of care will be.

One of the days I worked this week and I received a direct admission from the clinic 20 minutes before the change of shift. I didn't even know I was getting this patient until she arrived on the floor. I was not prepared for an admission and all of you nurses out there know that the beginning and end of the shift are the busiest times. Anyhow, my patient arrives and I walk into her room the moment I look at her and I immediately flash back 5 years to a lecture in nursing school about epiglottitis. I remembered my professor saying, "you will know it when you see it". She was leaning forward mouth open struggling to breath and speak rating her pain as a 20/10 all in her throat. The only factors that were off was there was no strider (a high pitched whistling noise when taking a breath) and she was not drooling. I took her vitals there were all out of wack! I ran out to page the doctors to come up right away!! The patient was EXTREMELY anxious!! As any person would be when they feel like their airway is closing in on them and they can barely breath! Her father was at bedside who happens to be an MD himself. He did not give me a second to breath he wanted the MDs there right way! I explained to him that I have paged the doctors and they would be up within a few minutes. Well...

I get a phone call and its 5 minutes till 7 pm (when my shift ends) and the doctors that were supposed to be in charge of her care tell me they are not sure if she is their patient and are currently trying to figure it out. I told him sternly on the phone that regardless if this is not your patient someone needs to get up here NOW because this patient could stop breathing at any moment and that I needed orders for IV pain medication immediately. The doctor said okay and hung up. Needless to say the MD never came up. I was in her room trying to keep her as calm as I possibly could while trying to find a vein to start an IV on her. She was extremely dehydrated with of course makes it that much harder to find veins! I finally got an IV in her which was right when the MD walked in. It was about 7:15pm now. I had a trach kit at the bedside just in case the MDs would need to place an airway if necessary. The family was telling me they did not want surgery. It was such a difficult situation to be in. However, the most important thing for any healthcare team member in this situation is to recognize any irriational behavior or outbursts from the patient or their family is purely out of fear. They have no idea what is going and they are afraid. It is of the utmost importance for YOU as the healthcare team member to remain calm! Be reassuring, DON'T make any promises you can't keep, and work fast!!!

The MD assessed the patient and while I stood at her bedside holding her hand because she asked me to. MD decided the patient did not need a trach and would get a STAT CT scan to find out exactly what is was going on in this patients throat. It was 7:30ish by now. Once I got my patient her IV, pain meds, anxiety med, drew all her labs, and got her sent off for CT I left and went home. I was worried about her. I knew that if I just left her with no IV that the night shift nurses would take a life time to get her an IV and she would be left in unfathomable pain. I could NOT do that. Even if it meant I stayed late.

The next morning I was back and I had her back. The night shift nurse giving me report told me what a nightmare of a patient she was. I HATE when nurses do that. I told the night shift nurse that the patient was probably "difficult" because she was so anxious and scared. She just wanted to know what was going on. Needless to say the patient and I got along just fine. She thanked me for being so caring and efficient the previous night. I told her that is my job. She works for the competing hospital to the hospital I work at. She just so happens to be that hospitals PR person. I don't care about status. Everyone gets the same treatment by me. I don't care if your Kim K or the bum on the street. Everyone is a human being. End of story. However, the hospital of course made it a big deal because this patient has the power to write some really nasty things about her experience at our hospital. Therefore, they made it clear that it was imperative to take "good" care of her.

Back to the trust thing. The point of this story was its building trust. It starts from initial contact. If you don't create it from the start its hard to get it as the relationship goes on because the person is constantly questioning your motives. In the hospital if you tell a patient you will be back in 10 minutes with pain meds and don't come back for an hour, you have lost your trust with that patient. If you tell them you will call the doctor and you don't and hours pass by and they don't see the doctor, they lose trust. If you are not sincere, they lose trust. People can FEEL when you are sincere. People know when you are acting fake.

Quick basic example. I coworker of mine asked me to start an IV on one of his hard stick patients. I told him I would go take a look but I couldn't guarantee I would get an IV in. I went into this patients room and first introduced myself and told her what I was there to do. Her immediate response was, "I am very hard to start an IV on. My veins roll. They have poked me so many times." I reassure her and told her I was just there to look. If I did not see a vein that I knew I had a really good chance of getting an IV in I would not poke her at all. She relaxed a little bit. I grabbed the tourniquet and tied it around her arm. She had great veins!! I looked at her and I said, "you have great veins!". She looked at me and said ,"no I don't. They roll. No one can get an IV in." I pointed to a vein and said, "this is a really good vein. Can I try once? If I don't get it I won't poke you again? deal?" she agreed. I explained everything I was doing step by step because I new she was anxious and if you simply just walk someone through what you are doing and involve them in the process it reduces their anxiety  by probably 80%. I explained to her with veins that roll you just gonna hold them down real tight so they don't run away when the needle goes in the skin. She shook her head "yes" doubtfully at me. I told her she would feel a poke and placed the IV. She was shocked. She was so happy. I told her, "I hope it wasn't as bad as you thought it would be." She thanked me a bunch of times. The nurse that was caring for her came in to connect her to her antibiotics. She looked at me and said, "can you do it. I want you to do it. please?" I told her sure no problem. Her nurse said, "no no its ok ill do it Norah, you can go back to your patients". The patient went into the bathroom and I told the nurse caring for her that its ok that I would hook her up that I thought she was just anxious and it really wasn't a big deal. It would take me less than 30 seconds to connect her. The nurse caring for agreed and left the room. I connected the patient to the antibiotics and she told me that her trust had been broken in the hospital because so many people tell her one thing and do something else. She thanked me several times for being so kind. I really didn't do anything differently with her that I wouldn't do with my other patients. It all just goes back to that extra minute.

Take an extra minute to build the trust. Introduce yourself. Ask the patient how they are doing. Explain what you are doing! Make sure they are comfortable before you leave the room and always ask them if they need anything when you come back. Be prompt. If you say you will be back in a certain time frame do your best to be back within that time frame! If you don't explain to them why you are late. Be honest! It's that simple. Truly. Build a solid relationship with your patients. Then, if you do make a mistake or forget to get their crackers or juice or whatever, they are MUCH more forgiving. However, if they already perceive you as cold, non caring, and too busy to help them they won't be so forgiving.

Learn to swallow your pride. Stop arguing with patients. Instead, try to understand where their behavior is stemming from and target that. Learn to have patience! LOTS of patience!!

Being a nurse is as rewarding as your make it.

Until next time.

-Norah