1. Section Editor(s): Schoonover-Shoffner, Kathy

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Recent nursing experiences reminded me of the immeasurable importance of offering presence-our full, undivided caring attention if only for brief moments-to our patients. I had been at work less than an hour when I heard a commotion and ran to find one of my patients screaming, banging doors, and hitting walls. Nursing staff's first reaction (including mine) was containment; make the patient stop! This could be done by verbal or physical force, medication (taken voluntarily or involuntarily), or de-escalation (talk to the patient). As the nurse responsible for this patient I took control and encouraged other staff to give space while I silently asked God for help. I had never met this woman previously. Calmly walking toward her, I gently said, "What can I do to help you right now?"

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She screamed, "Get me the hell out of here!" as she tried to kick over a chair. She stared at me with fire in her eyes. I kept my eyes on her, trying to communicate I was listening.


"I hear you saying you want out of the hospital. Can you tell me what just happened?" Every neuron in my brain focused on this patient. We went back and forth a few moments and her story unfolded. She believed a staff member had made fun of her and now she wanted to "hurt them very badly." Her larger issue was post-traumatic stress disorder and irrational distrust of others. I listened and asked simple reflective questions.


At some point in this difficult conversation the woman realized (and believed!) I was trying to help, that I cared about her. We ended up going to the person she thought had made fun of her and talking things through to a satisfactory resolution.


Not long after this incident, I was introducing myself to patients at the beginning of a shift when a patient began complaining loudly about everything: his room, the bed, other patients, and on it went. My first thought was to say something like, "I'm trying to meet all of the patients right now, I'll get back with you..." and stall until things calmed down or maybe the patient bothered someone else. Realizing this wasn't an optimal response I decided to stop, give the patient my undivided attention for a few moments, and listen. I learned his bed moved every time he got up, he was in pain, his room was hot, and that another patient was being inappropriate toward him. After he figured out I was listening and would help him, his demeanor changed. A few simple fixes changed everything (locking the bed wheels, assuring him we would deal with the inappropriate behavior, administering acetaminophen, turning down the room thermostat). We had a great shift and excellent therapeutic conversations.


Thinking about these tense situations it occurred to me yet again: people just want to know we care. Our patients desperately want to be heard, to know we will help them. Offering true caring turns everything around for our patients. It decreases anxiety and fear; it helps patients and family relax knowing we are there, we are watching over them, we will intervene. This caring presence is the most indispensable nursing intervention we can offer, especially in pressured circumstances.


Jesus is the supreme example of caring under pressure. On the night he was arrested in the Garden of Gethsemane, mayhem broke out when the Apostle Peter drew his sword in an impulsive act to stop Jesus' arrest and cut off the ear of Malchus, the high priest's servant (John 18:10-11). The situation could have escalated with Peter killed on the spot and others injured. But Jesus remained focused and quickly took control. He said, "No more of this!" (Luke 22:51), told everyone to put back their swords, healed Malchus' ear, relayed his willingness to be arrested, and protected his disciples as he surrendered to be taken away. Later after Peter denied he even knew Jesus, Jesus strategically arranged for a rooster to crow three times as he lovingly looked at Peter, once again showing his care (Luke 22:60-62). Even under arrest and knowing he was to be crucified, Jesus cared for others.


Jesus offers an excellent example of grace under pressure. How do you care for patients under pressure? What strategies do you employ when you are stressed? Take a moment to formulate a response, then be prepared to respond accordingly the next time you feel pressure mounting.