- Email: [email protected]
Coping with anxiety about patient interviews
Betty Ann Haggard, RN
Coping with anxiety about patient interviews Now what do I say? Many nurses are interested in doing preoperative interviews, but they are not sure they will know what to say to the patient. What will I say if a patient asks me about his prognosis? What if he asks if he’s going to die? What will I say if a patient asks if the surgeon is good? These questions are sure to come up during the interviews. If someone from the operating mom volunteers to answer patients’ questions, some of the questions are likely to deal with fear and emotions. If mishandled, will a patient’s recovery be affected? When we began the preoperative interview at Huntington Memorial Hospital, Pasadena, Calif, OR nurses were apprehensive. They accepted the need for patient interviews and wanted to expand their practice in this area, but it had been some time since they had conducted formal interviews with patients and family members. The nurses’ greatest fear was that they would not be able to answer questions. Identifying stuff needs. The first impulse was to start a clam on interviewBetty Ann Haggard, RN, MS, is a management development coordinator at Huntington Memorial Hospital, Pasadena, Calif. She is a graduate of Michael Reese Hospital School of Nursing, Chicago, and earned her BSN at Pittsburgh (Kan) State University, and her master’s degree at California State University, Los Angeles.
ing techniques and communication skills. But was that really what was needed? The nurses were experienced, competent practitioners, well aware of the principles of good communication. They could ask open-ended questions, reflect, be nonjudgmental, and follow all the other strategies for conducting productive interviews. What the OR nurses wanted was help in coping with their anxieties about the interviewing process. At staff meetings and individually, they requested a class on handling problem questions. The decision was made to conduct a class that would force the participants to confront their fears and decide how to handle them before interviewing a patient. Two goals would be met. First, the nurses would confront their fears in a nonthreatening environment, giving the nurse a chance to decide on a n appropriate response. Second, analyzing and dealing with a difficult situation would desensitize the nurse to some extent, defusing the anxiety about patient interviews. The objectives of the class stated that each participant would be able to: 0 State how she or he feels about a preoperative interview. What are its benefits and drawbacks? 0 Identify any situation arising from a patient interview that could cause anxiety in the interviewer. 0 Discuss the likelihood of such a situation occurring. How realistic
AORN Journal, February 1983, Vol37, No 2
195
is the anxiety? Show approaches to problem situations with fellow participants acting aa patients. Identify responses to troublesome situations, based on personal feelings and classmates’ feedback. Rehearse these responses until he or she feels comfortable with them. To elicit the nurses’ feelings about preoperative interviews, a questionnaire was constructed (Table 1). A checklist approach to the first question concerning patients’ attitudes led into the subject in a nonthreatening way. Questions two and three were designed to explore the nurses’ values. The last question was the most difficult. At this point, each participant had to write the questions she or he never wants to hear. When the questionnaires were compiled, it was found that the group had some similar concerns. Every respondent said questions about a surgeon’s competence would be difficult. Also difficult were questions about the patient’s prognosis. The common concerns made the class easy to design. A videotape of three simulated interviews was made. Three different “patients” were used. The first
Nurses confronted their fears and chose appropriate answers. interview showed a cooperative young woman who was responsive to teaching and questioning. The man in the second interview was apprehensive and full of questions about his prognosis and possible complications. He asked, “You work in surgery, so you know these things. Is my doctor a good surgeon?” In 196
Table 7
Communication questionnaire 1. When interviewing a patient, what sort of attitude do you find especially hard to deal
with? The following attiiudes are listed by rank order, with the first item beingthe most difficult attitude to deal with. angry 0 challenging 0 anxious 0 very quiet 0 medical nursing background 0 confused 0 constantly joking 0 too cooperative 0 crying 0 other 0 2. Do you believe family members (or other visitors) should be allowed to participatein the interview Yes 0 no 0 Why or why not? All responded yes. One nurse qualified her answer by saying yes “as long as the patient talks for himself.” 3. What do you think is the single most important outcome of a preoperative interview? The most common answer was “to give information about the OR and what will happen to them in the morning.” The second most common answer was “to find out information to plan care.” Other answers were “to allay anxiety,” “to answer questions,” and “to be sure patient sees a familiar face.” 4. Please list the question(s) that you think would be hardest to handle. Every respondent said it would be difficult to answer a patient‘s question about a surgeon’s competence. The second most common response was “questions about prognosis.” The third most common response was “questions with legal implications.” The fourth most common response was “questions about complications.”
the third interview, the woman was hostile and angry, stating that she had been misdiagnosed and was going to“1et my lawyer do the talking.” In each case, the nurse responded in
AORN Journal, February 1983, Vol37, No 3
an appropriate way, but not the only appropriate way. The videotape was a warm-up to group discussion and roleplaying. Each segment was presented as part of a total interview, and none ran longer than five minutes. The group process. Eight experienced OR nurses were in the pilot group. The class was small, so each participant had an opportunity to practice and test the responses she or he chose. After reporting the questionnaire results, the OR nurses analyzed particular fears using the following criteria: Is this realistic? What are the chances of this actually being asked? If asked, will it really be difficult to respond easily and comfortably? For instance, if a patient asks about the surgeon, how often would you not be able to honestly say, “I think your doctor is a fine surgeon. He should do a n excellent job for you.”? If the fear is realistic, is it appropriate for you to answer the question, or should it be referred? Tension eased when it became clear that the greatest fear would almost never happen. After thinking about the question, “Ismy doctor competent,” the OR nurses agreed every surgeon on staff ~
~~
The planned answer must be authentic to be satisfactory. was competent. By confronting these fears, the group found many of them went away. The videotape was introduced with a statement that it presented one way to respond to patient concerns. After each interview segment the tape was stopped, and the group discussed what
happened and why the nurse responded as she did. The discussions sparked lively debate at times. It was stressed that each person must be comfortable with a planned response. You may have the perfect answer to a question, but if you cannot say it authentically and be satisfied with it, the response is not right for you. Each nurse wrote a response to each of the concerns listed on the questionnaire. The group tried their responses on other participants. The role-playing was done in a nonthreatening way. The purpose was to try different approaches to see if they were right when spoken. Was the response genuine? Could it be reworded so you would be comfortable with it? The role playing led to further discussions, and suggestions were made for reworking responses. At the end of the class, everyone agreed to keep practicing and to bring any further concerns to a follow-up meeting two weeks later, just before the preoperative interview program was to start. Adapting the concept for use in your setting. If you plan a class to help staff with patient interviews, stress that most interactions will be smooth if these guidelines are followed Stress to the patient that you are her or his nurse in surgery. Emphasize you are there to explain t h e patient’s nursing care, t o gather information to help with that care, and to describe what the OR is like. Acknowledge the patient’s anxiety, whether expressed verbally or nonverbal1y. Be yourself and be comfortable with what you are saying. Do not try to answer everything, refer questions to the appropriate person. Videotaped interviews are easy to produce and are a good lead-in to discus-
AORN Journal, February 1983, Vol37, No 2
197
sions and role-playing. If lack of equip ment or funds prevents taping sample interviews, role play with another instructor or involve the group in coming up with possible patient questions. The techniques described can be done on an individual basis. List the questions you are apprehensive about and follow the process used in the class. Once you have answers that you are comfortable with, ask a colleague or a family member to pretend to be your patient. Get their reactions to your re-
sponses and make any changes you think are necessary. Remember, you are the one who has to say it. A productive way ofdealing with anxiety about patient interviews is to practice responses to questions you do not want the patient to ask. Testing each answer aloud before trying it with patients will increase confidence and prevent awkward fumbling. Defusing anxiety is best done in a small group, but can be practiced by individual nurses 0 with the help of a colleague.
Anesthetic may reduce heart attack damage An anesthetic commonly used in patients suffering heart attacks may have the unexpected benefit of reducing damage to heart tissue. Studies at George Washington University Medical School, Washington, DC, indicate that the narcotic fentanyl reduced heart damage when compared with another common anesthetic, halothane. Gertrude W Mergner, MD, associate professor of anesthesiology at the university, recently reported that the study “indicates that fentanyl anesthesia is superior during an acute myocardial infarction.” Dr Mergner spoke about the discovery at the annual meeting of the American Society of Anesthesiologists. Studies of dogs that were subjected to experimentally induced heart attacks showed that fentanyl produced higher blood pressure and slower pulse, while halothane resulted in lower blood pressure but faster pulse, she said. The artificial heart attacks were produced by clamping off a coronary artery for 90 minutes. In the area-at-risk around the infarct, Mood flow was 69% of normal under fentanyl, as compared with 39% under halothane, Dr Mergner said. Measurements of the area-at-risk revealed that in the halothane-treatedanimals 49% of this area was infarcted. In the fentanyl-treated animals only 28% was damaged, she said. Dr Mergner stated that whether the smaller infarct and higher blood flow was 198
“due to fentanyl causing a high blood pressure and slower pulse rate, or whether fentanyl has a direct effect on heart cells, is not known at present.’’
Widener to offer doctorate in nursing Widener University, Chester, Pa, will become the 24th institution to offer a nursing doctoral program in the United States. The emphasis of the program, which will begin this fall, will be preparing nurses to teach nursing students at the postsecondary level or staff and clients in hospitals and other health care settings. Students may attend Widener on a full-time or part-time basis. Widener will also have a “summer scholars” program. This program will be taught by visiting scholars. In the first year, Widener expects to accept 10 to 12 full-time students and the same number of part-time students. To be eligible for enrollment in the doctoral program, applicants must have a MSN from an institution accredited by the National League for Nursing. Before this program was planned, faculty and administrators of colleges and schools of nursing in Pennsylvania, Delaware, Maryland, New York, and New Jersey were surveyed.
AORN Journal, February 1983. Vol37, No 2
Coping with anxiety about patient interviews Now what do I say? Many nurses are interested in doing preoperative interviews, but they are not sure they will know what to say to the patient. What will I say if a patient asks me about his prognosis? What if he asks if he’s going to die? What will I say if a patient asks if the surgeon is good? These questions are sure to come up during the interviews. If someone from the operating mom volunteers to answer patients’ questions, some of the questions are likely to deal with fear and emotions. If mishandled, will a patient’s recovery be affected? When we began the preoperative interview at Huntington Memorial Hospital, Pasadena, Calif, OR nurses were apprehensive. They accepted the need for patient interviews and wanted to expand their practice in this area, but it had been some time since they had conducted formal interviews with patients and family members. The nurses’ greatest fear was that they would not be able to answer questions. Identifying stuff needs. The first impulse was to start a clam on interviewBetty Ann Haggard, RN, MS, is a management development coordinator at Huntington Memorial Hospital, Pasadena, Calif. She is a graduate of Michael Reese Hospital School of Nursing, Chicago, and earned her BSN at Pittsburgh (Kan) State University, and her master’s degree at California State University, Los Angeles.
ing techniques and communication skills. But was that really what was needed? The nurses were experienced, competent practitioners, well aware of the principles of good communication. They could ask open-ended questions, reflect, be nonjudgmental, and follow all the other strategies for conducting productive interviews. What the OR nurses wanted was help in coping with their anxieties about the interviewing process. At staff meetings and individually, they requested a class on handling problem questions. The decision was made to conduct a class that would force the participants to confront their fears and decide how to handle them before interviewing a patient. Two goals would be met. First, the nurses would confront their fears in a nonthreatening environment, giving the nurse a chance to decide on a n appropriate response. Second, analyzing and dealing with a difficult situation would desensitize the nurse to some extent, defusing the anxiety about patient interviews. The objectives of the class stated that each participant would be able to: 0 State how she or he feels about a preoperative interview. What are its benefits and drawbacks? 0 Identify any situation arising from a patient interview that could cause anxiety in the interviewer. 0 Discuss the likelihood of such a situation occurring. How realistic
AORN Journal, February 1983, Vol37, No 2
195
is the anxiety? Show approaches to problem situations with fellow participants acting aa patients. Identify responses to troublesome situations, based on personal feelings and classmates’ feedback. Rehearse these responses until he or she feels comfortable with them. To elicit the nurses’ feelings about preoperative interviews, a questionnaire was constructed (Table 1). A checklist approach to the first question concerning patients’ attitudes led into the subject in a nonthreatening way. Questions two and three were designed to explore the nurses’ values. The last question was the most difficult. At this point, each participant had to write the questions she or he never wants to hear. When the questionnaires were compiled, it was found that the group had some similar concerns. Every respondent said questions about a surgeon’s competence would be difficult. Also difficult were questions about the patient’s prognosis. The common concerns made the class easy to design. A videotape of three simulated interviews was made. Three different “patients” were used. The first
Nurses confronted their fears and chose appropriate answers. interview showed a cooperative young woman who was responsive to teaching and questioning. The man in the second interview was apprehensive and full of questions about his prognosis and possible complications. He asked, “You work in surgery, so you know these things. Is my doctor a good surgeon?” In 196
Table 7
Communication questionnaire 1. When interviewing a patient, what sort of attitude do you find especially hard to deal
with? The following attiiudes are listed by rank order, with the first item beingthe most difficult attitude to deal with. angry 0 challenging 0 anxious 0 very quiet 0 medical nursing background 0 confused 0 constantly joking 0 too cooperative 0 crying 0 other 0 2. Do you believe family members (or other visitors) should be allowed to participatein the interview Yes 0 no 0 Why or why not? All responded yes. One nurse qualified her answer by saying yes “as long as the patient talks for himself.” 3. What do you think is the single most important outcome of a preoperative interview? The most common answer was “to give information about the OR and what will happen to them in the morning.” The second most common answer was “to find out information to plan care.” Other answers were “to allay anxiety,” “to answer questions,” and “to be sure patient sees a familiar face.” 4. Please list the question(s) that you think would be hardest to handle. Every respondent said it would be difficult to answer a patient‘s question about a surgeon’s competence. The second most common response was “questions about prognosis.” The third most common response was “questions with legal implications.” The fourth most common response was “questions about complications.”
the third interview, the woman was hostile and angry, stating that she had been misdiagnosed and was going to“1et my lawyer do the talking.” In each case, the nurse responded in
AORN Journal, February 1983, Vol37, No 3
an appropriate way, but not the only appropriate way. The videotape was a warm-up to group discussion and roleplaying. Each segment was presented as part of a total interview, and none ran longer than five minutes. The group process. Eight experienced OR nurses were in the pilot group. The class was small, so each participant had an opportunity to practice and test the responses she or he chose. After reporting the questionnaire results, the OR nurses analyzed particular fears using the following criteria: Is this realistic? What are the chances of this actually being asked? If asked, will it really be difficult to respond easily and comfortably? For instance, if a patient asks about the surgeon, how often would you not be able to honestly say, “I think your doctor is a fine surgeon. He should do a n excellent job for you.”? If the fear is realistic, is it appropriate for you to answer the question, or should it be referred? Tension eased when it became clear that the greatest fear would almost never happen. After thinking about the question, “Ismy doctor competent,” the OR nurses agreed every surgeon on staff ~
~~
The planned answer must be authentic to be satisfactory. was competent. By confronting these fears, the group found many of them went away. The videotape was introduced with a statement that it presented one way to respond to patient concerns. After each interview segment the tape was stopped, and the group discussed what
happened and why the nurse responded as she did. The discussions sparked lively debate at times. It was stressed that each person must be comfortable with a planned response. You may have the perfect answer to a question, but if you cannot say it authentically and be satisfied with it, the response is not right for you. Each nurse wrote a response to each of the concerns listed on the questionnaire. The group tried their responses on other participants. The role-playing was done in a nonthreatening way. The purpose was to try different approaches to see if they were right when spoken. Was the response genuine? Could it be reworded so you would be comfortable with it? The role playing led to further discussions, and suggestions were made for reworking responses. At the end of the class, everyone agreed to keep practicing and to bring any further concerns to a follow-up meeting two weeks later, just before the preoperative interview program was to start. Adapting the concept for use in your setting. If you plan a class to help staff with patient interviews, stress that most interactions will be smooth if these guidelines are followed Stress to the patient that you are her or his nurse in surgery. Emphasize you are there to explain t h e patient’s nursing care, t o gather information to help with that care, and to describe what the OR is like. Acknowledge the patient’s anxiety, whether expressed verbally or nonverbal1y. Be yourself and be comfortable with what you are saying. Do not try to answer everything, refer questions to the appropriate person. Videotaped interviews are easy to produce and are a good lead-in to discus-
AORN Journal, February 1983, Vol37, No 2
197
sions and role-playing. If lack of equip ment or funds prevents taping sample interviews, role play with another instructor or involve the group in coming up with possible patient questions. The techniques described can be done on an individual basis. List the questions you are apprehensive about and follow the process used in the class. Once you have answers that you are comfortable with, ask a colleague or a family member to pretend to be your patient. Get their reactions to your re-
sponses and make any changes you think are necessary. Remember, you are the one who has to say it. A productive way ofdealing with anxiety about patient interviews is to practice responses to questions you do not want the patient to ask. Testing each answer aloud before trying it with patients will increase confidence and prevent awkward fumbling. Defusing anxiety is best done in a small group, but can be practiced by individual nurses 0 with the help of a colleague.
Anesthetic may reduce heart attack damage An anesthetic commonly used in patients suffering heart attacks may have the unexpected benefit of reducing damage to heart tissue. Studies at George Washington University Medical School, Washington, DC, indicate that the narcotic fentanyl reduced heart damage when compared with another common anesthetic, halothane. Gertrude W Mergner, MD, associate professor of anesthesiology at the university, recently reported that the study “indicates that fentanyl anesthesia is superior during an acute myocardial infarction.” Dr Mergner spoke about the discovery at the annual meeting of the American Society of Anesthesiologists. Studies of dogs that were subjected to experimentally induced heart attacks showed that fentanyl produced higher blood pressure and slower pulse, while halothane resulted in lower blood pressure but faster pulse, she said. The artificial heart attacks were produced by clamping off a coronary artery for 90 minutes. In the area-at-risk around the infarct, Mood flow was 69% of normal under fentanyl, as compared with 39% under halothane, Dr Mergner said. Measurements of the area-at-risk revealed that in the halothane-treatedanimals 49% of this area was infarcted. In the fentanyl-treated animals only 28% was damaged, she said. Dr Mergner stated that whether the smaller infarct and higher blood flow was 198
“due to fentanyl causing a high blood pressure and slower pulse rate, or whether fentanyl has a direct effect on heart cells, is not known at present.’’
Widener to offer doctorate in nursing Widener University, Chester, Pa, will become the 24th institution to offer a nursing doctoral program in the United States. The emphasis of the program, which will begin this fall, will be preparing nurses to teach nursing students at the postsecondary level or staff and clients in hospitals and other health care settings. Students may attend Widener on a full-time or part-time basis. Widener will also have a “summer scholars” program. This program will be taught by visiting scholars. In the first year, Widener expects to accept 10 to 12 full-time students and the same number of part-time students. To be eligible for enrollment in the doctoral program, applicants must have a MSN from an institution accredited by the National League for Nursing. Before this program was planned, faculty and administrators of colleges and schools of nursing in Pennsylvania, Delaware, Maryland, New York, and New Jersey were surveyed.
AORN Journal, February 1983. Vol37, No 2