This guest post was written by Monica Moore, MSN RNC
As a nurse-educator, I often role-play with nurse clients as I find it is an important teaching tool that exposes nuances of patient care gaps that aren’t obvious by using traditional methods. I use a format of nurse discomfort when reviewing how to have challenging conversations, dealing with emotional patient-care situations, or conveying negative results. I pretend to be the ‘patient’ on the receiving end of bad news, or the relative who is angry and frustrated and the nurse is, well, the ‘nurse’. Last week, during a client coaching session, I was a patient who presented to the offices actively miscarrying her pregnancy.
My ‘nurse’ took care of me medically, gathering supplies, reviewing the next steps, but made limited eye contact and seemingly wanting to be anywhere but there. When I (as the patient) asked my ‘nurse’ why this was happening to me, she responded by telling me a story of when she had a miscarriage. When we later analyzed the conversation, I pointed out her body language, lack of eye contact, and “conversational narcissism” a term coined by sociologist Charles Derber where you focus the conversation on yourself in an effort to empathize with another person. My ‘nurse’ admitted that she knew she was not being fully engaged and present but was afraid that I would ask her something that she didn’t know or would express an emotion that she couldn’t handle, one that would make her uncomfortable. But nurse discomfort can be a potent tool, enhancing the patient experience, particularly during an emotionally-charged interaction like this.
The Power of Embracing Nurse Discomfort
Learning to embrace nurse discomfort was a lesson that I learned 20 years ago in a yoga class when my teacher told us that once we get deeper in the pose, that we are actually just getting started. The ‘work’ of the pose is what you do from there when your legs are shaking and you are sweating and hoping that she remembers to count the seconds you are in the pose and not talk to another student and forget. Do you stay, let up, or go deeper, curious to explore what happens after that, never to the point of pain, but not skirting the feeling of deep sensation, sensation that is uncomfortable. The times that I persevered, I discovered something new. Maybe that my legs were weaker than I thought, maybe that my right side was stronger than my left, and, after years of practice, maybe that I had feelings that were stuck, that needed permission to be released. I even found myself tearing-up without any warning in class, which is not uncommon, according to my teacher, particularly during hip and shoulder-opening poses since many of us hold onto stress in those spots.
And this taught me something else about discomfort. It is the result of many factors, not the least of which is that it is a sign that you may have triggered something unresolved in your own life. But had I not pushed, not crossed that threshold from content to discontent, I would have missed out on growth potential by discovering an insight that, in retrospect, has proven to be important in my personal and professional life.
Ok, back to how this applies to being a nurse.
When I worked in Labor and Delivery, I became the nurse who was often assigned to the rooms in which there was a loss or other difficult circumstance, and I learned to be humbled and honored by this role. Of course, I don’t enjoy the part of my job where I have to deliver bad news or be in the midst of an intensely personal and private situation, such as mourning a loss. I do, however, realize the weight of my contribution to this challenging situation, and even though I can’t change it, I can try positively affect the experience of the patient during it. I find that applying this perspective gives my role the appropriate level of reverence and gravity that it deserves.
I invite you, as the nurse, to experience what it feels like to settle into the pause after giving bad news.
I would ask you, in a sad or emotional situation, to make eye contact with the patient and act as if you want to be there, even if you want to be anywhere else but there.
I would hope that you can allow the patient to express whatever she is feeling and just listen, as awkward or uncomfortable as this may make you. No empty words or platitudes, no story about your own life or other patients’ journeys. By pausing and just listening with full attention, you are creating an environment that gives her permission and space to mourn a loss. If she asks, “why”, you can answer honestly, and appropriately, that you don’t know, that she may never have an answer to this, but that she can rely on you, that you will be there for her to guide her through her next steps.
Realize that, at this time, the person who needs to feel heard is the patient, not you.
At worst, she will be upset or angry and you won’t know how to respond, maybe all you can do is express regret or apologize. Allowing yourself to be vulnerable also has its benefits by promoting human connection, just ask Brene Brown.
Just a disclaimer, I am just asking you to listen, not advocating that you absorb the patient’s pain. This can lead to secondary trauma or compassion fatigue, a very real and damaging potential consequence of being a health-care provider.
I hope, after reading this, that you will experiment with how to navigate uncomfortable circumstances, and consider that settling for complacency can lead to missed opportunities for both you and your patient, even when dealing with patient deaths.
As the Founder of Fertile Health LLC, Monica travels the country training fertility nurses and their teams in her area of expertise, reproductive endocrinology. Earlier in her career, she was patient-focused working in the Neonatal ICU, Labor and Delivery and a busy infertility practice. Through this experience, she identified a clear need for better training embodying evidence-based science that would empower patients in their personal health and fertility choices. She calls Ponte Vedra Beach home.