1. Rossiter, Beverly MSN, CRNP, CPNP

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Slowly, quietly, I entered 85-year-old Ronald Dixon's room. I was nervous. After 24 years as a pediatric nurse, I was seeing my first adult patient. As a professional, I knew the cries of a hurting baby, the stoic demeanor of the frightened school-age child, the need to put "Dolly" in a toddler's surgical bed as she headed to the operating room. But would I achieve the same understanding with my adult patients? Before starting this new job, I asked myself: Would what I knew about caring for children be of any use with adults?


As an admissions nurse, I didn't have to rush, and by habit I entered slowly and spoke softly. Fast movement and speech can be frightening. Mr. Dixon's reaction was my immediate reward-mirroring my relaxed demeanor, his dark eyes shone with warmth under a shock of bright white hair. Although frail in his white and blue hospital gown, his welcome was hearty. He introduced me to his daughter, Margaret, and his granddaughter Vicki. I shook hands all around.


Pulling a chair to the head of Mr. Dixon's bed, I sat down and looked into his eyes. Standing over a patient can be authoritative or frightening. He had chronic obstructive pulmonary disease and had been admitted from the ED with pneumonia. "I read the ED report," I told him. "It sure sounds like you've had some struggles. Why don't you tell me how you've been feeling?" As Mr. Dixon explained his medical condition, I touched his hand. Show them you are not running away. His speech slowed and his story gained clarity. He told me about his wife, who'd died only three years prior. They'd been married nearly 50 years. She had cancer, and he was her caretaker until the end. As he related the story he averted his eyes; I did the same. Mirror the patient's tempo and temperament to establish rapport.


I then turned my attention to Margaret and Vicki, who were standing at his bedside. Margaret was obviously troubled; she'd crossed her arms tightly and her hands were tugging on the elbows of her silk blouse. Who else in the room is in need? "It sounds like you've been having a rough time. You must have been really scared when his breathing trouble started."

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Margaret described difficulties at work and problems with getting her dad to doctor's appointments. "His breathing's been bad, and it's getting worse. We don't know what to do anymore," she admitted. "You're doing the right thing," I reassured her. "Is there anything special that we should know to ensure your dad gets the best care?"Family can provide invaluable insight into the patient. We discussed his tendency to get out of bed at night without using his cane. She was comforted when she found that the bed alarm would ring if he was to make any major movements during the night. Gain the patient's trust by gaining that of his caregivers.


Finally, I performed assessments, explaining each step along the way. Engage patients in their own care. As I showed him how to use the pulse oximeter, I explained, "This helps us see how well you are breathing." Margaret interjected that his breathing trouble arose mainly at night ("We're always so worried when he goes to bed," she said). I assured her that we would watch his breathing through his monitor. Remind them that comfort is always nearby. My time with Mr. Dixon showed me that my pediatric eyes-trained to see what my young patients couldn't, or wouldn't, tell me-would remain invaluable in this new field.


Before I left, Mr. Dixon told a few jokes. His daughter had heard them a hundred times before-she rolled her eyes as he spoke. But at each punch line, we all laughed and laughed, like it was the first time.