By Patricia O’Rourke, BSN, MBA, RN (retired)
As far as nursing skills are concerned, the single most important one is compassion. The nurse must have compassion for all patients. Not empathy, because God knows you do not want to feel their pain and anxiety. Not sympathy, because you cannot stay in the profession very long if you feel sorry for the patient. Compassion is the human emotion that allows us to respond to and mitigate the pain and anxiety of others.
Observation also is a key nursing skill. The nurse must observe and evaluate the patient during all interactions. Talk and then listen. While listening, observe for signs of restlessness, pain, stress, anxiety, anger and fear — not to mention observing color, circulation, skin integrity and mentation. Mentation is a critical component when assessing the patient’s condition. I have read accident reports that have said: “The patient suddenly bit me,” “… suddenly scratched me,” or “… suddenly struck me.” The patient did not do anything “suddenly.” He was anxious, hypoxic, in fear or in pain. Go see your patient, talk to him, relieve his pain and fear. Do not sit at the desk waiting for an alarm.
Remote patient monitoring has its advantages, but also its disadvantages. We can sit at a desk and see the EKG, heart rate, oxygen saturation, and then respond to an alarm. But the patient’s status is also in his face, in the feel of his skin, in the words he utters. Early recognition and treatment or intervention will help prevent the patient from becoming angry or violent. Anger and fear use up valuable oxygen in the blood, emitting adrenaline for autonomic self-protection, the flight-or-fight syndrome.
Helping patients to rest and relax is an important part of nursing care. When I worked in coronary care patients would say, “I’m in here because I am going to die, right?” I would say, “No, you are here because you are going to live; this is a coronary care unit, after all.”
While placing the monitor electrodes, I would explain to the patient what I was doing, but I’d add, “So now you’re wired for sound like an astronaut. This monitor picks up everything, so watch your language; even evil thoughts are picked up.” The patient would laugh. Great. Laughing causes a release of endorphins, which makes the patient feel good.
My primary goal was to reduce pain, fear and anxiety because negative emotions release adrenaline, and adrenaline puts strain on the heart and raises the blood pressure. It was to everyone’s benefit that I provided reassurance as well as medication as needed and a calming and soothing atmosphere.
I have sat next to patients to chat with them and help them relax. I recommend this; it’s good for both of you. I’d dim the lights and partially pull the curtain after 8 p.m. or so. Critical care units can be so bright and so loud 24 hours a day. This adds to the patients’ anxiety, and decreases the chance they’ll get a good night’s sleep. Dim the lights and the noise.
Yes, the single most important nursing skill is compassion, and it is that human emotion that allows us to respond to and mitigate the pain and anxiety of others.
Patricia O’Rourke, BSN, MBA, RN (retired), worked for 10 years in critical care nursing at Miami Heart Institute and Kaiser Foundation Hospital in San Francisco and worked for 36 years in occupational safety. She retired in 2012. She also has attained Six Sigma Black Belt Certification.
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