Barriers to Communication

My biggest communication challenge has been communicating with the patients when they are unhappy. Granted, I have only had three patients. In two of the three, I noticed that I feel very comfortable talking to them when we are just “chatting” so to speak. However, whenever they have an emotional response to something and I’m expected to do something about it, I freeze. I think part of the problem is that the family or another health care professional is usually in the room watching me or waiting for me to do something, and the audience stresses me out. I’ll give you specific examples, of occasions when I “froze”.

When my clinical partner and I were introducing ourselves to our patient on the first day, we started introductions relatively confidently, but when we asked how she was feeling, she responded that she “felt like crap and now I’ve got to put up with you two for the next six hours.” My partner and I were both pretty shocked by how blunt she was, and neither of us really knew how to address such a strong response, so we just said sorry to hear that and bolted out of the room. Our patient ended up warming up to us as the day went on, but I would have liked to address her concerns in the moment instead of freezing. A different interaction I had with a patient went similarly. She had a very painful pericardial drain, and several times throughout the day was crying to her family members in the room. Every time I came in, she would try to cover up that she was crying, so I felt like I was intruding on a personal moment. Later, in echo, she started crying again and with other nurses around, I wasn’t sure what to do, since I still felt so new. Now that I’ve had two separate patients where I “froze” when they got emotional, I’ve started to sense the pattern of a communication challenge.

I think the biggest thing about me that contributes to this is my inexperience. I feel like I have a bit of imposter syndrome where I feel like I don’t know what I’m doing and shouldn’t be allowed to be (partially) responsible for patients. So, even though I might know what to do on paper, in the moment I lose the confidence and can’t act how I know I should. I also think that learning about the “do’s and don’ts” of therapeutic communication made me aware that a lot of my instincts fall into the “don’t” category. The most common example being “Don’t worry! It will be okay!” Now that I know I shouldn’t do what I normally would, I instead choose not to do anything! I think that with more time and experience interacting with patients, I will grow in confidence not only with my skills but with my communication.

I know it’s a cliché to say “practice makes perfect”, but I truly think that is how I will be successful. I also think that is why I struggle now, because I have never practiced comforting someone with a serious illness. I’m going to try and make more of an effort to be open for communication with my patients, even if it puts me outside of my comfort zone. This may mean starting more conversations or just being more readily available to my patients if they need to talk. The more I practice communicating, the more I will be able to feel what is most effective. I also plan to reevaluate if my communication improved throughout the semester, and if not, what else may be causing this barrier.

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