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Has a patient ever initiated an emotive conversation in the strangest place or at the strangest time? It’s happened to me a lot of times during my career, but this week it happened on an early shift when I was assisting one of my patients in the toilet.
We were chatting about something trivial, television I think. And I was helping the patient to change their incontinence pad, removing shoes and trousers and putting them back on, when they said, “How am I going to manage when I get home, Sian?”
At this point I was kneeling on the floor, busily putting on a trainer (the patient’s) and still waffling on. I instantly stopped and looked up, and the patient had tears in her eyes but was trying to be stoical and not let the emotions bubble over.
The truth is I don’t know how she is going to manage at home. At this point we don’t know how much recovery she will get, if any, so I didn’t want to tell her everything will be fine. Although she will manage somehow, I expect it is going to be a steep learning curve when she is discharged as this is just the start of her spinal cord injury ‘journey’.
“Patients need to be supported and guided carefully when trying to come to terms with a condition that may last a lifetime”
Emotive conversations are tricky to navigate I find. As you need a huge amount of communication skills and sensitivity to be able to reassure and comfort a patient without giving them information which could be misleading or misinterpreted.
Although I desperately wanted to tell the patient that “everything is going to be fine” when she gets home – and maybe subconsciously shut the conversation down as I had a million things to do – I know from years of experience that what the patient defines “everything is going to fine” as is very different to how I meant it.
Long-term conditions are just that – long-term – and don’t have any quick fixes. Patients need to be supported and guided carefully when trying to come to terms with a condition that may last a lifetime.
I strive to be as honest as my patients’ understanding and emotional fragility will allow when talking to them about their condition, so as not to give false hope but also not to take hope away and leave them feeling they have nothing left to work towards.
It’s not easy, and it takes time to build up the skills and confidence to be able to have those conversations with patients.
Not all patients will choose to have those conversations with every nurse. If a patient chooses to have one with you, it shows that they trust you and value your knowledge.
I urge you not to sweep it under the carpet and move on but to take a little time to acknowledge that maybe we don’t have all the answers at this time but that we will work with them side by side and go forward together.
Sian Rodger is patient education and health coaching lead, London Spinal Cord Injury Centre