Regardless of what specialty we choose in nursing, we all have defining moments that shape our practice. Some are heartwarming, others heartwrenching. Many positive and negative interactions have influenced my practice over the last 23 years. One special patient continues to remind me to remain patient-centered and provide nonjudgmental, holistic care.
One day, I was performing an intake assessment on “Annie” who was being transferred for inpatient psychiatric treatment following a suicide attempt. She had been described as agitated at the transferring facility, requiring PRN medication and restraints. Staff had been assaulted physically and verbally. The nursing handoff was peppered with words such as “manipulative,” “attention-seeking,” and “uncooperative.” Reading through the clinical evaluation, I saw evidence of an extensive history of abuse, multiple suicide attempts and self-injurious behaviors.
The transport staff brought Annie into my office. While sitting with her, I asked several questions that were met with angry responses or an obscene gesture or shrug. I continued the interview and offered her something to eat and drink, a blanket and the opportunity to call a support person to be part of the interview.
When I asked Annie about her home life, childhood and trauma issues, her demeanor changed. The anger turned to a deep sadness. Annie recounted numerous abusive atrocities she experienced throughout early childhood and more recently. I could not imagine having to live through those experiences. “I am sorry that all of these things have happened to you,” I said. “You didn’t deserve to have that happen.”
Her aggressive and angry edge began to dissipate. “Thank you,” she said. “No one has ever said that to me before.”
Annie has been offered help by many healthcare professionals over the years, and while I don’t believe I was the first to say those words to her, I believe she was responding to the fact that the message was delivered with genuine kindness and sincerity.
As we finished the interview, she said, “I didn’t mean to hurt those people, you know. All I have is my rings that they wouldn’t let me keep because they said I would hurt myself with them. I have three babies who were taken from me and those rings are the only things that keep me going some days. I hope to give the rings to [my children] when they are older. They are gone now just like my babies. Thank you for being kind to me.”
The next day I stopped at the transferring facility and tried to track down the rings without success. I saw Annie several times over the next few days. She was no longer having episodes of anger or violence, but instead was experiencing despondency and a debilitating depression.
Surprisingly, about a week later the transport company delivered an envelope to me with the rings inside. I took the rings to Annie. She grabbed my hands and began to cry. “Thank you,” she said. “These are my hope.”
I have taken many de-escalation courses over the years, and the bottom line has been that aggression is a way to communicate when all other communication has failed to address fears or meet needs. If we keep that in mind rather than labeling or judging when an individual’s behaviors are escalating, we can make strides to break down barriers and facilitate healing.
I have heard healthcare professionals say they could never work with psych patients. But no matter what specialty you work in, at some point you will care for someone in a psychiatric crisis. It may not even be a patient, but possibly a patient’s loved one or a co-worker. Mental illness does not discriminate, and while strides are being made, stigma still exists.
My interactions with Annie early in my mental health career allowed me to learn the value of accepting people where they are in their journey. The key to developing and maintaining rapport is speaking from the heart while being mindful of therapeutic boundaries. Ask yourself what fear the person has that is not being addressed, and how you can keep him or her safe while addressing the person’s needs. •
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