Discomfort

I often role-play with nurse clients as I find it is an important teaching tool in exposing the nuances of patient care gaps that aren’t obvious by using traditional methods.

 

For example, I use this format when reviewing how to convey negative results, where I become the ‘patient’ on the receiving end of the phone call. Last week, during a client coaching session, my ‘nurse’ told me about my negative result, then quickly advised me about calling with my next Day 1 to start the process again.

 

When we later analyzed the conversation, I pointed out the haste in which she discussed next steps, arguably before I had a chance to process the bad news – a common complaint that I’ve heard from patients over the years. My ‘nurse’ admitted that she knew she was rushing, but was afraid that I would ask her something that she didn’t know, or would express an emotion that she couldn’t handle, one that would make her uncomfortable. But discomfort can be a potent tool, enhancing the patient experience, particularly during an emotionally-charged interaction.

 

Learning to embrace discomfort was a lesson that I learned 20 years ago in a yoga class, when my teacher told us that once we get deeply in the pose, that we are actually just getting started. The ‘work’ of the pose is what you do from there, when your legs are shaking and you are sweating and hoping that she remembers to count the seconds, and not forget while talking to another student.

 

You have a choice: do you stay, let up, or go deeper, curious to explore what happens after that? Never to the point of pain, but not skirting around the feeling of deep sensation, sensation that is uncomfortable. The times that I persevered, I discovered something new. Maybe that my legs were weaker than I thought, maybe that my right side was stronger than my left, and, after years of practice, maybe that I had feelings that were stuck, that needed permission to be released. I even found myself tearing up without any warning in class. This is not uncommon, according to my teacher, particularly during hip and shoulder opening poses since many of us hold onto stress in those spots.

 

This taught me something else about discomfort. It is the result of many factors, not the least of which is that it can be a sign you have triggered something unresolved in your own life. Had I not pushed, not crossed that threshold from content to discontent, I would have missed out on growth potential. I discovered an insight that, in retrospect, has proven to be important in my personal and professional life.

 

Ok, back to how this applies to being an infertility nurse.

 

I’ve learned to feel honored to be the go-to nurse in the offices I’ve worked in for relaying negative pregnancy test results to patients. Of course, I don’t enjoy the part of my job where I have to sever the hope of a patient that she achieved a pregnancy that month. I do, however, realize the weight of my contribution to this challenging conversation. Even though I can’t change the news, I can positively affect the experience of receiving it.  I find that applying this perspective gives my role the appropriate level of reverence and gravity that it deserves.

 

I invite you, as the nurse, to experience what it feels like to settle into the pause between giving bad news and advising of next steps. Allow the patient to express whatever she is feeling and just listen, as awkward or uncomfortable as this may make you. No empty words or platitudes, no story about your own life or other patients’ journeys unless she asks.

 

By pausing, you are creating an environment that gives her permission and space to mourn a loss. If she asks, “why,” you can answer honestly, and appropriately, that you don’t know. That she may never have an answer to this, but that she can rely on you, and you will be there to guide her through the next steps. If she asks what these are, then advise her to call with Day 1. If she’s not there yet, then maybe the ‘next step’ conversation takes place the next day on a subsequent phone call.

 

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As a disclaimer, I am just asking you to listen, not advocating that you absorb the patient’s pain. This can lead to compassion fatigue, a very real and damaging potential consequence of being a health-care provider.

 

Finally, whenever you have to impart bad news to a patient, you may be tempted to hasten the delivery of the news or end the phone call quickly. Consider this first: settling for being comfortable can lead to complacency and missed opportunities for both you and your patient.

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