Nurses deal with all kinds of patients, and some interactions are more challenging than others. Some patients get labeled as “difficult”. How we think about patients is important and can significantly impact the nurse-patient relationship and quality of care. Changing our habitual thinking can be good for the nurse, the patient, and the care that’s ultimately provided.
She continues, “What characteristics are we looking for? We define ‘good’ as mature, rational thinkers who want to partner with the healthcare team to address their problems. We think good patients treat us respectfully, cooperate, and comply with our present plan. We want questions or disagreements to be presented courteously. We enjoy interacting with good patients and can experience great satisfaction.”
Where Does Our Negative Thinking About Patients Come From?
How do we form negative habits in our thinking about patients? Naidorf has an answer.
“Nurses, like all humans, have a strong negativity bias. In medical care, we don’t jump to the conclusion that that leg cramp is something minor — we’re concerned about a life-threatening deep vein thrombosis.
“Secondly,” Naidorf continues, “nurses pick up this negative talk during their training. In the classroom, high ideals and ethics are discussed: successful nurses are organized in their thinking and documentation; they’re determined to be empathetic and efficient.”
According to Naidorf, something happens to challenge those ideals. “In the real world, student nurses hear their mentors and colleagues speak in derogatory and mean-spirited terms. A sense of distrust and resentment can permeate the workplace as more cynical nurses harshly judge how patients dress, speak, or behave. It’s easy for inexperienced, impressionable people to think: ‘Well, this is just how it is — these must be the facts.’ But these aren’t facts — this is just a story everyone in the workplace believes.”
What are Common Thought Distortions About Patients?
Naidorf relates, “There are many unhelpful thought patterns. One common one is all-or-nothing thinking. We often think there’s only one way to get something done or think about a problem. This is a thought distortion because there aren’t just two solutions to a problem — there are dozens. Patients who challenge us can have a very different way of thinking and want to do things their way. A small shift from all-or-nothing thinking can help us find common ground with patients.”
“A second is the tendency to place ourselves in the victim role,” Naidorf states. “People with a victim mentality tend to complain a lot. They also tend to blame the doctors, the supervisor, the pharmacy, or the patient. ‘Why does this always happen to me? Why did they put him in my zone? Why do I have to do another septic workup?’ Assigning blame to others and playing the victim places you in a disempowered role. A victim has no power to act or find solutions. We aren’t victims, and we have the power to solve problems and find solutions.”
Thought distortions are important to recognize, and there’s one more Naidorf highlights.
“A third distortion is resisting reality, which comes up in many ways. We think to ourselves, ‘This person should’ve been wearing a helmet; that mom should’ve given the child something for fever; that guy should stop getting drunk.’ We can’t change the past, and wishing that things should be different only makes us suffer in the present.”
How Do We Change How We Think About Challenging Patients?
“Nurses can do much to change how they think about ‘difficult’ patients,” says Naidorf. “They can remember that many of their thoughts are just thoughts, sentences in the mind that can be changed. Becoming aware of thoughts is the first step to changing them. We can ask ourselves better questions.”
Naidorf has more advice. “When falling into all-or-nothing thoughts, ask: ‘Could I be wrong? Are there other approaches that could work equally well?’
“You can also ask, ‘What else is true here? Is that drunk man someone’s father? Does that mother love her child? Is coming to the ED the only way this family can access care?’ Small shifts in thinking can lead to more feelings of curiosity and empathy.”
Lastly, Naidorf wants nurses to truly focus on their thinking, which can lead to actual changes in behavior and practice.
“One thing you can do is define what the event or circumstance is in as factual a way as possible. No adverbs or adjectives should creep into those definitions. A person with some illness or injury comes to the medical office or urgent care center, and the nurse has a thought about that person. We can choose thoughts with more intention that serve us and them better.”
And when negative thoughts arise, Naidorf has a plan.
“Some negative thought will invariably pop up, but we can force ourselves to question if anything else is true. If we think the person should not have come in, we can counter that with, ‘We have all the right people, equipment, and medicines to help this person.’ With positive thoughts, nurses will take actions that further the mission of helping the patient and will get more satisfying results.”
But can we always be positive? Naidorf doesn’t expect perfection.
“Sometimes we want to be disappointed or sad about what happens at work, and it’s appropriate and helps us empathize with patients. We work in places where people experience tragedy, so it would be weird to pretend to be always happy,” she reassures us. “It’s ok to feel sadness, disappointment, and frustration — temporary emotions that pass through our bodies. Feeling all the emotions is one amazing part of being a human nurse.”
Own Your Humanity — and Patients’ Humanity, Too
As Dr. Naiforf points out, nurses are human beings, and humans have feelings and flaws. We’re also capable of great empathy and kindness. Our patients are also humans; their lives can be complicated and painful, and we often encounter them at their very worst on some of the most challenging days of their lives.
No matter how stressful our work may be, when we summon our humanity, we can be more curious, thoughtful, and capable of being present without projecting negativity where it doesn’t belong. And sometimes, we’ll fail and fail again. But every day gives us a chance to start anew.
If you can change your thoughts, you can also change your experience and your patients’ experience. And that is a worthy endeavor indeed.
Have you ever wondered about the similarity between “hospital” and “hospitality”? Is this a coincidence, or can we identify how they’re connected? Maybe we can also discover how hospitality concepts could help repair the broken relationship between the healthcare system and its patients.
Healthcare revolves around the delivery of patient care. Thus, customer service and satisfaction must play a role in its success. After all, if our patients are unhappy, don’t feel appreciated, and have a sense that their presence barely matters, they could stop showing up, and we’d all wind up unemployed as our nation’s health suffered. Who wants to see that happen?
Back to the Roots
Sources at Harvard University identified that the Latin hostis and hospes are related to the concept of the guest. At the same time, other sources also cite Latin terms such as hospitalis and hospitem as related to the modern terms guest and host.
In this case, it’s worthwhile wondering why, if our name for the modern-day hospital stems from such roots, have we strayed so far from customer service and hospitality in how we treat healthcare consumers?
Hospitality Matters
“Can you think of any healthcare experience you’ve had that’s gone wrong? According to our research, most adults can. It’s interesting to note the culprit is rarely the clinical outcome. Rather, it’s generally how the care was delivered”, states Peter Yesawich, PhD, a consultant and veteran of both the healthcare and hospitality industries. Yesawich is also co-author of “Hospitable Healthcare: Just What the Patient Ordered!” a remarkably insightful review of how principles of hospitality can improve the patient experience.
Yesawich and his co-author, Stowe Shoemaker, PhD, ask, “How can that experience be improved?” According to the authors, the hospitality industry has increasingly gotten things right while the healthcare system falters at the starting gate.
When considering how to make healthcare more hospitable, Yesawich remarks, “Many people in healthcare default to the notion that it’s just about making staff smile, but that’s not the idea. Smiling and a positive attitude can certainly be beneficial, but it’s more about the way providers anticipate and address patients’ anxieties, needs, and preferences.”
He continues, “One of the things the hospitality industry has done very well is to get to know its customers through strategies that allow them to anticipate the kinds of things their customers appreciate.
“In healthcare, providers can prepare for the smooth delivery of care by managing things like ease of access to making appointments, providing an estimate of the cost of care in advance, ensuring a positive arrival experience, recognizing patients for their loyalty, and thanking patients for their patronage. After all, patients are also customers who have a choice when selecting the providers from whom they seek care.”
The PAEER Model
According to Yesawich and Shoemaker, their five-part model for more hospitable healthcare is broken down into an acronym from their extensive research: the PAEER model (Prepare, Anticipate, Engage, Evaluate, Reward). The authors offer specific actions practitioners can take to enhance the patient experience.
Prepare: Healthcare facilities can welcome patients by better understanding their needs and preferences. (Hospitality industry providers do this through “Customer Relationship Management” (CRM) programs that record, track, and analyze guest behavior.)
Anticipate: Once patients’ preferences and needs are more clearly understood, we can avoid what decreases patient satisfaction, which, according to the authors’ research, includes the unwelcoming nature of the check-in experience, repeated requests for the same information, ease of access to making appointments and, most importantly, not knowing the estimated cost of care in advance.
“When you take your car to the garage for repair, book a hotel room or table at a restaurant, you know the estimated cost of that service in advance,” Yesawich states. “Why don’t healthcare providers also give a pro forma estimate of the cost of the service they are about to deliver in advance, naturally with an appropriate disclaimer, especially given that they know what they are likely to charge based on negotiated reimbursement rates?”
Engage: “Yesawich states, “Hospitality industry professionals refer to the points of actual service delivery as ‘moments of truth’, the specific interactions that ultimately determine the customer experience.”
He continues, “They have developed a number of techniques to ensure these ‘moments’ yield a positive reaction, including the introduction and use of acronyms that reflect their commitment to enhancing guest satisfaction that is easy for staff to remember and recite; the introduction of service standards that reinforce the connection with their mission/vision/values (behaviors repeated over and over define the culture of your organization), and providing invoices/bills for the services they deliver that are easy to understand.”
Yesawich makes one additional point: “Many also offer performance guarantees that underscore the confidence they have in the delivery of services for which the outcome is generally predictable (e.g., clinic wait times, turnaround times for test results, prompt resolution of billing disputes, etc.)”
Evaluate: “I marvel at the fact that many healthcare providers don’t follow up with patients after an appointment to see how things went,” Yesawich shares. While this is becoming more commonplace, there’s often a pervasive feeling that providers don’t care about receiving patient feedback.
Reward: While the authors acknowledge that the law prohibits financial incentives for patients with government insurance, there are no restrictions in using recognition and reward programs to attract patients with commercial insurance.
Yesawich adds, “These could include ‘rewards’ that enhance the future health and well-being of patients. Examples include free health screenings, invitations to attend free lectures by providers or nurses on timely health topics, free admission to cooking and fitness classes, etc.”
What Can You Do?
For staff nurses without the authority to change how an organization operates, Yesawich maintains that there are still plenty of ways to introduce principles of hospitality. He counsels the first step in the process is understanding the root cause of most patient dissatisfaction: how the care is delivered.
“You can get management to recognize that most of the dissatisfaction patients have with healthcare has to do with the manner in which the care is delivered, not the clinical outcome, the author states. “Implementing specific principles of hospitality along the patient journey can positively impact the patient experience, even when the clinical outcome is unsatisfactory.”
Nurses and staff can bring suggestions regarding these concepts to leadership. Nurses can also unilaterally assure that patients feel appreciated, bringing genuine warmth, eagerness to please, and gratitude to the nurse-patient relationship. And when staff interact with patients, they can make eye contact rather than staring at a screen.
The basic tenets of Yesawich and Shoemaker’s research and recommendations are rooted in the values of hospitality. As the largest segment of the healthcare workforce, nurses can leverage their influence in service to the patient experience.
Those of us who work in healthcare want our patients to feel cared about; even the slightest effort can have positive repercussions. In honor of the aforementioned Latin origins of terms close to the heart of care delivery, why don’t we strive to reverse the inhospitable nature of 21st-century healthcare? After all, everyone will benefit — nurses, providers, and patients alike. In making such changes, we have nothing to lose and everything to gain.
Clinicians need to have a better understanding of the potential impact of patients’ anxiety sensitivity, or “fear of fear,” according to an article published in American Journal of Critical Care (AJCC).
When a patient has anxiety sensitivity, they misinterpret nonthreatening symptoms as threatening, assessing the potential meaning across physical, social or cognitive domains. These “what if” thoughts may trigger a spiral effect, stimulating the nervous system and resulting in stronger sensations and further catastrophic misinterpretations.
It may lead to a patient avoiding activities they associate with anxiety-related sensations, such as physical activities or social situations. While in the hospital, they may resist interventions, such as repositioning or being weaned from sedatives. They may avoid physical or occupational therapy or struggle with efforts to help their recovery.
“Patients with anxiety sensitivity may falsely believe that their symptoms are the early signs of something bad, such as a heart attack, cognitive decline or social isolation,” she said. “It’s important for clinicians to be able to identify the difference between anxiety sensitivity and other medical conditions,” says Leanne Boehm, PhD, RN, ACNS-BC, FAAN, assistant professor at Vanderbilt University School of Nursing, Nashville, Tennessee, and investigator at the Critical Illness, Brain Dysfunction and Survivorship (CIBS) Center at Vanderbilt University Medical Center.
For example, patients who have difficulty weaning from mechanical ventilation should first undergo a detailed workup to search for any underlying medical causes before anxiety sensitivity is considered as a primary cause.
ICU clinicians should be aware of patients’ possible anxiety sensitivity so they can use clear communication and implement pain management or relaxation techniques to mitigate distress and improve patient outcomes.
The Anxiety Sensitivity Index (ASI-3) is one tool clinicians can use to measure the extent of a patient’s physical, cognitive and social concerns about their anxiety. Providing basic psychoeducation to ICU patients on common symptoms may temper anxiety sensitivity, reassuring them their feelings are not unusual and putting their symptoms into context.
After discharge from the hospital, patients may continue to experience anxiety sensitivity and need increased assessment time, detailed explanations and extra demonstrations before participating in physical therapy or other activities.
Research specific to anxiety sensitivity in the critical care setting is limited, and future studies should incorporate assessment and management techniques across the critical care recovery continuum.
Nurses are known for their acts of kindness, but Lisa Schneidenbach does it with incredible character. She dresses up as many different characters – all in the name of lifting patients’ spirits.
Schneidenbach, an assistant nurse manager with John Theurer Cancer Center at Hackensack Meridian Health in New Jersey, says her passion for connecting with patients is the essence of being a nurse. Her now monthly costume motif has been a way to watch smiles replace fear and anxiety in patients of all ages who are battling cancer.
Daily Nurse is proud to recognize Lisa Schneidenbach as our Nurse of the Week, honoring her creative way of connecting with patients to lift their spirits. Her costumes also provide a healthy diversion for patients and staff from their daily routine with joy, laughter, and a sense of escape.
Schneidenbach says her passion for dressing up stems from growing up loving Halloween. The tradition of transforming her image at the hospital started last year when the floors began to dress up for that holiday with different themes.
She says holidays are particularly tough for families with loved ones in the cancer center. So Schneidenbach tries to go above and beyond to improve their days by finding costumes for every holiday and handing out little gifts.
The dress-up concept is now a surprise, monthly treat.
“The costume idea has a positive psychological effect on patients and staff. Patients will always ask if they can take a picture with me. No one knows when I will show up in costume. It is my nature to help people feel comfortable and to relieve their anxiety in any possible way. This is one of the most rewarding aspects of my job. For just a moment, if I can help a patient smile, I made a connection,” she says.
In the past year, Schneidenbach donned several looks, including Uncle Sam, The Statue of Liberty, and The Easter Bunny. But her favorites are Cousin Itt from the Addams Family and Scuba Steve from the hit Adam Sandler movie Big Daddy. Her fellow team members appreciate her commitment to lifting the spirits of her patients.
“She is always looking to do things for others to make them happy. She takes an interest in people and makes it a point to get to know them and understand what they have going on in their lives. If there’s anything she can do to make life easier or better for them, she will,” says Linda Casey, Director of Nursing Patient Care JTCC Infusion.
And whether she’s visiting patients dressed as a leprechaun or a scarecrow – Schneidenbach’s pure love for nursing is on display daily.
“I love that nursing allows us to reach patients across all walks of life. We get to make a difference and a connection, even if it is only a brief moment. A connection is made if doing just a little thing by dressing up brings a smile on the patient’s face.”
Nominate a Nurse of the Week! Every Wednesday, DailyNurse.com features a nurse making a difference in the lives of their patients, students, and colleagues. We encourage you to nominate a nurse who has impacted your life as the next Nurse of the Week, and we’ll feature them online and in our weekly newsletter.
Compassion is a common trait among health professionals, and compassionate care ensures that patients feel respected and well-cared for during their stay and can even speed up recovery.
However, compassion is often misunderstood in the medical world. Compassion is more than being kind to patients or checking in regularly with folks with acute illnesses. Genuine compassion requires forward-thinking and careful planning.
Nurses who want to improve the quality of their compassionate patient care should take advantage of on-the-job training opportunities to bolster their knowledge and enhance the quality of their service. Further training can help nurses adapt to new technology, which innately reduces workload and increases the time healthcare professionals can spend with each patient.
Further Training
Nursing programs are rigorous enough to put many nurses off further education for life. However, pursuing specialized credentials and further education is an excellent way for healthcare professionals to improve patient care quality. Nurses who seek additional training often choose to specialize, which can increase their salary and improve their job satisfaction.
Some nurses may be too busy to pursue further training at this time. The current nursing shortage is expected to last through 2030, meaning many healthcare professionals work above and beyond their job descriptions.
However, busy nurses can still pursue specialized credentials by enrolling in on-the-job training programs in healthcare. On-the-job training (OTJ) increases job satisfaction and does not take nurses away from understaffed units. This means the hospital can train its staff quickly without paying salaried employees who are not presently working.
There are plenty of training programs designed to improve compassion and patient care. However, nurses today should consider anti-bias training. Recent studies show that many nurses are unaware of their implicit biases and may have difficulty empathizing with patients different from themselves. Training that elevates empathetic awareness can bring a more compassionate approach to nursing and improve the overall standard of patient care.
Technology
At first glance, technology and compassion seem like apples and oranges. However, nurses that utilize newly released automation technology can free up time to spend with patients and improve the overall quality of their care.
For example, nurses specializing in psychotherapy can improve patient care quality by embracing tech like therapy notes software. Therapy notes software help reduce nurses’ workloads and helps nurses keep track of patient progress. This change in the workflow can streamline nurses’ schedules and improve organization at work. This means nurses can spend more time focusing on the patients in front of them and less time inputting data into their electronic health record (EHR) systems.
However, before switching to new tech, healthcare providers should ensure that software is interoperable within their larger EHR environment. Interoperability is the ability to share information across multiple technologies and is integral to the successful adoption of new tech. Applications that seamlessly share data can help nurses stay organized and even automate communication between electronic medical records, specialty focus systems, and ancillary systems.
Staying Organized
Organization skills are often overlooked by folks looking to improve their compassion. However, it’s hard to embody compassion without caring for one’s responsibilities.
Kirsten Drake, DNP, RN, OCN, NEA-BC, believes that organization is a skill that can be polished with careful reflection and consideration. She suggests that nurses should list daily, weekly, and monthly responsibilities and “categorize critical activities” to gain greater clarity about what they need to do every day.
Categorizing activities into critical and non-critical tasks can help you focus on the bigger picture and make more time for patients. This is particularly important for nurses climbing the healthcare ladder and being looped into emails around the clock. Drake recommends funneling emails into “action needed, follow-up, or reference” to improve email management and organization.
Ultimately, an improved organization can help nurses alleviate their work stress and embrace a more holistic approach to care. This can help nurses who feel overwhelmed at work practice self-care without compromising patient care quality.
Self-Care
Nurses are certainly familiar with healthcare’s high emotional demands, including stress. High-stress levels can impact work performance by compromising one’s ability to make decisions or communicate effectively with other team members.
In addition, researchers from the University of California, Berkeley, found that anxiety and stress reduce one’s ability to empathize with others. Recognizing the connection between stress and reduced compassion is critical for nurses who want to improve the quality of their patient care.
Nurses can mitigate stress and improve the quality of their care by seeking help to overcome chronic stress. This is particularly important today when many nurses feel overwhelmed at work. Even small interventions like talk therapy and prescribed mindfulness can be used to improve self-care and reduce fatigue.
Conclusion
Nursing is a highly demanding profession. Finding time to practice compassionate care can feel challenging when folks are overwhelmed at work and do not have enough time to attend to each patient. However, nurses can improve the quality of their patient care by embracing automation technology and seeking OTJ training. This can streamline their workday and free up time for more personalized, compassionate healthcare.
