Early in my nursing career, I learned that communicating and connecting with patients is critical in advocating for them as humans, not just patients. As a new nurse, I wanted to be the best patient advocate I could be, which was one of the main reasons I entered the profession.
My career began as a nurse on a medical step-down unit. I was excited to start working in the clinical setting, connect with patients, and make a difference in their lives. However, most patients on my unit were unresponsive and nonverbal on mechanical ventilators, which I found to be challenging at first. Lack of communication has been reported to increase distress, anxiety, fear, and frustration in patients and their families.1 My patients were transferred from the ICU to my unit for mechanical ventilator weaning-a transfer that entails a substantial change from being a patient in the ICU. Adjusting to those changes, including having a new nursing staff and different monitoring systems, can be fear-inducing for patients and their families.
Most patients were unable to easily express their concerns with a tracheostomy tube and mechanical ventilation. Their worries included their current needs, fears related to their treatment, or just being able to talk with the people taking care of them. I quickly decided I was going to find a way to help alleviate those concerns.
I had the wonderful opportunity to care for a patient, DV, for several shifts spanning several weeks. DV had a tracheostomy tube, required mechanical ventilation, and struggled with mouthing words. His family lived in another state and could not visit as often as they wanted to. Shortly after DV was placed under my care, I made a goal to find a better way to communicate with him. I saw how anxious he was by the tension in his shoulders and the way he was gripping his call bell as if it were his only lifeline. I first started using communication boards, but he could not use his hands well enough to point at what he needed or a certain letter. Seeing his disappointment, we tried other strategies, such as asking him to nod his head or gesture with thumbs up or thumbs down to indicate "yes" or "no." The latter strategy worked, and I soon started learning more about him through our interactions.
I learned that he had gone to school in Baltimore, loved sports-football being his favorite-and that, at times, he felt extremely lonely in his room. One day during football season, I asked DV, "What game am I trying to track down for you?" I started with the Ravens, as both of us went to school in Baltimore, so it seemed like a promising idea. He lit up-the biggest smile I had seen on him in weeks. I asked, "Are they your team?" I did not think one could sense enthusiasm from a thumbs up, but I certainly did at that moment. We started bonding over our love of football and the Ravens. That night after giving the report, I pulled up a chair and sat and watched the game with him. I saw him relaxing in bed, no longer tightly gripping his call bell; he just lay there watching the game with the same big smile on his face.
This experience-among several other similar experiences-has shown me that the smallest efforts in connecting with patients can have a substantial impact on their care. By taking the time to communicate effectively with patients using different strategies, nurses can help them overcome various challenges, understand what is truly bothering them, and build connections to properly advocate for them.
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