It’s almost uncanny how vividly I can remember this moment. A student came out of a patient’s room, documented their assessment, and approached me, their clinical instructor, to review their assessment. The student’s general head-to-toe assessment was factually accurate. But then I asked, “Why is your patient crying?”
The student looked at me and said, “I don’t know.”
“Okay,” I said calmly, at least on the outside. “Why don’t you know?”
“I didn’t realize I had to know.”
It was one of those “air left my body, vision tunneled” type of moments. This was very troubling. The most important part of being a nurse, in my opinion, is being able to connect with your patient. When a connection is made, facilitation of care is tailored to best fit the patient.
Had an emphasis on exam-taking and completing assignments taken away from their preparation or education of establishing the student nurse-patient relationship? It sort of felt like a forgotten practice. But that didn’t mean it couldn’t be revived.
I introduced role-playing at the beginning of the semester, mostly in post-clinical conference. I provided a script to the participating students, and each scenario was different. For example, I instructed one student to pretend to be a patient and to refuse all patient-care. It was up to the other participating student to use therapeutic communication to understand why they were refusing and how to help the patient. As a clinical group, we were able to help provide feedback if communication was therapeutic and effective. And if it was not, we would discuss different approaches; then students would re-act the scenario.
These were my objectives:
For me, as the clinical instructor:
- Identify barriers for therapeutic-effective communication among nursing students.
- Implement a therapeutic communication orientation with activities (i.e., role-playing).
- Facilitate the first student-patient interaction.
- Follow up with the students and their patients.
- Evaluate post-conference participation and reflective journaling.
By the end of the practicum, my student nurses will:
- Complete an interview session that will entail who the patient is, where they are from, and details regarding their family, employment, hobbies, and personal belief system.
- Actively listen to how the patient’s co-morbidities or current illness affects them personally and within their community.
- Identify the patient’s support systems.
- Develop a plan of care that will assist in patient coping.
- Advocate for the patient.
There is such a positive impact when nursing students have a strong relationship with their patients. Recently, a student approached me and stated that “something was not right” with their patient. The student was able to describe that their patient was talkative all morning and early afternoon and then all of sudden became quiet and withdrawn. The student and I did basic vital signs and asked the patient some assessment questions. We noticed there was a decrease in blood pressure and elevated heart rate. This event prompted the student to alert the patient’s medical team. The patient received expedited care all because the student had a relationship with them and noticed a change in their behavior.
The effect it has on patients is truly profound, too. Here’s what I’ve heard from patients:
- “It felt really good having company. I felt like I was being heard.”
- “The students got to know me rather than being looked at as numbers.”
- “My student was amazing. She really got to know what was important to me instead of others telling me what was important.”
- “He made my father feel important. He went out of his way to get an interpreter phone so he can get to know him and make a plan for the day.”
After adjusting how I instruct clinical, I personally noticed an increase in time spent between students and patients. Toward the end of a semester I observed students much more comfortable speaking to patients, their family members, and members of the patient’s medical team.
Passing nursing exams is important; however, being able to connect to patients and establish a relationship is one of the main ingredients for meaningful and successful patient care. I’m proud of my role in that connection.
Heidi Gerostergios, MSN, RN, PCCN, is a clinical staff nurse and clinical instructor at the University of Massachusetts Lowell. She is a member of Sigma’s Chi Epsilon Chapter at Endicott College in Beverly, Massachusetts, USA.