Communicating assertively and responsibly with distressed clients and colleagues

Chapter 25


Communicating assertively and responsibly with distressed clients and colleagues



Objectives



1. Discuss the effect of distressed behavior of clients or colleagues on the nurse


2. Assess the situation and choose the assertive response for a variety of situations


3. Participate in exercises to build strategies for assertive communication with distressed clients and colleagues





Mad, sad, glad, and scared . . . nurses bear witness to all the human emotions


Watson (2008), who introduces the science of human caring, calls us to be present to and support the expression of positive and negative feelings (Gallagher-Lepak and Kubsch, 2009). When clients and colleagues are distressed we work to respond in helpful ways, yet we can be stressed by their distress. We are beginning to study the experience of suffering and how people find meaning in the illness experience (Pollock and Sands, 1997). Nurses witness suffering and distress. They must deal with the moment-to-moment lived experience of illness. Clients convey their anguish verbally and nonverbally. Changes in health status, illness, and hospitalization are just some sources of distress in clients. Their loss of composure is a signal that they are disturbed by what is happening to them.


The changing healthcare climate causes stress for us as nurses and for our colleagues. In addition, nurses may pick up the sadness of clients, called shadow grief (Smith-Stoner and Frost, 1998), which can lead to burnout. We may find that we have less energy, experience no zest for living, and talk about our clients continuously, even on our off hours. How we respond and how our clients respond to distress depend on personal history, culture, and experience. We experience the constraints of time, the emergent nature of a situation, and unanticipated change (Sheldon et al, 2006). We need to develop ways to relate to distressed colleagues and clients that soothe their distress without upsetting ourselves. Maintaining our sensitivity to others so that we can respond in a caring way without being overcome and losing our objectivity is one of a nurse’s most inviting challenges—the gift of your presence without giving yourself away.


Interpersonal problems experienced by health professionals clearly reveal that our reactions to emotionally laden situations interfere with our ability to act effectively. Nurses may ignore their responses to being overwhelmed with emotional demands, called compassion fatigue (Vaughn, 2001). Untoward reactions can come from within ourselves (feeling unsure or inadequate about how to act), the situation (feeling overcome or impotent), or the distressed person (feeling distress ourselves).



imageMoments of Connection . . .


Rx: Knowledge


“We had an 11-year-old boy having a nonmalignant tumor removed from his spine. He was labeled a ‘brat’ due to his demanding behavior. One day, I had a few extra minutes and went and sat with him. We took out his science book and talked about what was happening with his surgery and about his fears. From that time on, he was much less anxious and became one of our favorites.”



The suggestion has been made that nurses develop a protective barrier against others’ pain, or become insensitive to the discomfort of others, because they encounter so much suffering in the course of their daily work. If we become too involved with others’ distress, we overload ourselves emotionally and become ineffective. If we avoid the distress of others by ignoring or belittling it, we are left with the feeling of not giving the attention and support that are expected. Some nurses feel helpless about how to be therapeutic with distressed persons. Others feel annoyed or irritated that clients or colleagues cannot solve their own problems. Thoughts about our own inadequacies, or judgments about the appropriateness of others’ behavior, prevent us from acting in the best interests of the distressed person.


Kaufman and Wetmore (1994) suggest four common events that can cause stress: loss of control, change, sense of threat, and unrealized expectations. When nurses face distressed clients, these are the issues. Remember that it is not the situation itself that causes problems, but our reaction to it. The teaching of communication skills implies that if we say the right thing, clients or colleagues will have an “Aha!” experience, that is, they will immediately see our point of view and become both compliant and grateful. Consider a new view; that is, the extraordinary set of circumstances, the distress, is not a failure or a lack of compliance, but an opportunity. This is the opportunity for nurses to learn from others’ experiences and to build new skills that increase communication effectiveness.


Ideally, we need to remain calm enough to be able to understand the reason for another person’s distress, to remain nonjudgmental so that we can convey appropriate compassion for the situation at hand, and to remain clearheaded enough to act responsibly on behalf of the other person. Ascher (1994), in her memoir of grief at the death of her brother from acquired immunodeficiency syndrome, paints a picture that demonstrates the complexity distress can present. She defines grief as a “landscape without gravity.” Of her family she says:




Ascher called it a “journey into paralysis.” We must remain humble at the pain and anguish of suffering clients and their families, and yes, of suffering colleagues, too, to whose stories we may have no access.



WIT&Wisdom


Poetry is a way some people share their distress. Ken Saulter, coping with early memory loss, and his wife spoke at Innovations in Dementia Care (2010), where he shared a poem his wife identified as important in their relationship. As you read “Between Us,” think about offering writing as an expressive outlet for distress.



Between us


Losing my memory,


Losing my memory to a terminal disease,


Is getting to be a problem.


Like when I’m in a group


And people talk to me and then,


Suddenly I fall silent,


While my brain skips a beat.


We know it’s not a simple senior moment.


Eyes divert to shoe laces or thereabouts,


Anywhere else but the ceiling.


The moment becomes one of deep discomfort.


And here I am, a fraction of a person,


A clown without make-up or costume,


Waiting giant seconds to recover.


I’m told I will not remember


These bricks of separation


In the wall that is, regrettably,


Being built between us.


I worry a lot about forgetting habits, like


My locker combination, after 20 years of use.


And then, someday maybe, remembering where I live;


Or, luckily, maybe not.


But, against our will,


The wall keeps getting higher and higher.


Yet I keep on living, accepting the losses and


Focusing on what I’ve got, and you.


And trying to lower the wall between us


Or slow it down,


Or build a gate,


Or do something.


© Ken Saulter. Used with permission.




How to improve your communication skill with distressed clients and colleagues


In the rest of this chapter you are given situations involving distressed clients and colleagues. Assess each situation, determine the request being made, and choose the most assertive and responsible communication strategy.


A critique of all the response choices for each situation is listed at the end of the chapter, beginning on p. 284. It is worthwhile to read the advantages and drawbacks of each option.



Communicating with upset clients


Step 1: assessment of the data




Mr. James is a 58-year-old avid outdoorsman who has been hunting in the woods near your rural hospital. While climbing steep terrain, he slipped and fell 50 feet down a ragged incline. In addition to suffering multiple bruises and scratches, he broke his glasses. Today he was admitted to your hospital for overnight observation. As you make your first round on the evening shift you go into his room to introduce yourself:





Mr. James raises his voice as he is talking and turns away from you. He squeezes the bed sheet in his hands and looks exasperated.



Thoughts: Mr. James thinks that he cannot manage without his glasses. He is aware that he must reach his wife so that arrangements can be made to get his spare glasses.


Feelings: He is upset that he cannot read, write, or see to drive. He feels trapped in this remote rural hospital. He desperately wants to talk to his wife about arranging to get home.


Request: Mr. James wants you to understand how frustrating it is for him to be stuck in this unfamiliar hospital. He is trying to get you to comprehend how dependent and immobile he is without his glasses. He wants you to help him contact his wife. Indirectly, he may be asking to be comforted; that is, to be helped to feel more at home in this strange place.




Step 2: communication strategies and desired outcomes




It is appropriate to meet Mr. James’s request for understanding and action. A warm, genuine, respectful manner would convey that you care about him. An empathic response would ensure that he knows you understand his predicament and would reduce any embarrassment he might feel for displaying his upset feelings in such a volatile way. If his upset behavior agitates you, then you can calm yourself and focus on his distress, using positive self-talk and imagery to prepare yourself to communicate assertively and responsibly.


This strategy would help Mr. James relax and feel accepted. He would likely look calmer and feel more patient with his circumstances. Your compliance with his requests contributes to the development of a trusting rapport.



Step 3: implementation and evaluation of your communication strategy




As you review the following choices, look for those that are congruent with your assessment of Mr. James’s requests and your desire to communicate in an assertive and responsible way. (Notice that the choices are not listed alphabetically. This is to prevent the temptation to quickly scan all the answers without giving yourself the benefit of evaluating each response.)










Communicating with upset colleagues


Step 1: assessment of the data




Joe is the intern on the medical unit where you have been a student for the past 6 weeks. Because you are both students working on the unit at the same times, you have become good friends. This day Joe looks preoccupied and you have noticed that he is not his usual good-natured self. He snaps at you for not having your client ready for his physical examination, even though he had not warned you about his plans. Later he approaches you with the following:






Thoughts: Joe knows his wife is pregnant and is aware that his preoccupation with this unexpected, and not yet welcome, news is causing him to be short-tempered with you. He wants to be a father but does not think the timing is good.


Feelings: He regrets that he snapped at you. Joe is shocked by the news of his wife’s unexpected pregnancy and is worried about how he can cope with the added strain of being a father when he is having difficulty juggling the two roles of intern and husband. He likely is tired because he has not been sleeping, and he is upset that he cannot think straight.


Request: Joe is asking you to accept his apology for snapping at you, and he wants you to understand how the news about the pregnancy is turning his life upside down. Indirectly, he may be asking for some comfort for his predicament.




Step 2: communication strategies and desired outcomes




Warmth would show that you feel kindly toward Joe and you do not hold a grudge. An empathic response would convey your understanding to Joe. A self-disclosure about adjusting to the news about your own pregnancy (or another major event) would provide him with hope that getting used to the idea comes in time.


It is appropriate to meet Joe’s requests. This strategy would make Joe feel relieved that you understand the reason for his outburst and that you forgive him. The hope you might give him—that he will work things out in time—would be comforting.



Step 3: implementation and evaluation of your communication strategy




As you review the following response choices, be looking for those that are congruent with your assessment of Joe’s requests and your desire to communicate in an assertive and responsible way.










Communicating with clients who are sad or depressed


Step 1: assessment of the data




Jim is an 18-year-old client on your unit. He has just had a surgical repair after breaking his leg in a football game. Jim is an all-star athlete who knows he won’t be playing any more sports this year, his senior year. He is worried about getting behind in his schoolwork because of the advanced placement classes he is taking. Every day counts if he is to keep up with the fast pace of the class. This is Jim’s final year in high school, and he is worrying that his grade point average may slip, because a football scholarship is now out of the question. He is tearful and seems embarrassed.



Related posts:

  1. Expressing opinions
  2. Humor
  3. Spirituality
  4. Warmth

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Oct 26, 2016 | Posted by in NURSING | Comments Off on Communicating assertively and responsibly with distressed clients and colleagues

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