Courtesy of Stanford Univ. Medical Center	More NurseWeek Features   Smoke-Free Zone   Nurses and patients tackle nicotine addiction   Bloodless Survival     Surgical techniques to use when transfusion drops out of the equation
Peggy Szafranski, RN, a crisis nurse at Stanford University Medical Center in Palo Alto, Calif., encounters a variety of challenging patients as she floats between nine acute care units.

Peggy Szafranski, RN, walked into the patient's room in the intensive care unit feeling somewhat apprehensive. Her colleagues had described the cardiac patient she was about to visit as loud and uncooperative.

The man sitting in bed, a Giants baseball cap on his head, eyed her warily before returning his gaze to the National League playoffs on television.

"Has Barry Bonds been up to bat yet?" Szafranski asked.

Although the question had nothing to do with the man's condition, it had everything to do with gaining his trust. The two lapsed into friendly conversation about Bonds and the San Francisco team. After several minutes, Szafranski started an IV on the man, who gave her his full cooperation.

Nurses agree that difficult patients come with the territory in caring for the public. The odds for tense interactions have increased as the nursing shortage reduces the time nurses have available for patients.

Often, the contact that does occur is brief and can convey an impression that the nurse is rushed, which in turn fuels the negative feelings of already disgruntled patients.

Szafranski, who works as a crisis nurse at Stanford University Medical Center in Palo Alto, Calif., encounters a variety of challenging patients as she floats between nine acute care units.

"I've discovered that finding common ground with patients, giving them a little time to talk and then offering them some control of the situation can often work wonders," Szafranski said. In the case of the Giants fan, she established rapport and, after a brief chat, asked whether he would prefer to have the IV placed in his left or right arm.

"This patient was upset because he had tickets to a Giants playoff game, and instead of sitting in the stadium as planned, he was in a hospital bed with chest pains," Szafranski recalled. "It's a frightening experience to be in the ICU and, unfortunately, many patients take their fears and frustrations out on nurses."

While working in the hospital's emergency room, Szafranski has encountered a range of challenging patients-from the man who thought his ER visit would last only a matter of minutes to the elderly woman brought in by ambulance who lacked the transportation or funds to return home.

"When people sit in the ER for hours, it gives them more time to obsess," Szafranski said. "I've found that regularly updating patients, letting them know when their tests results will return or when the specialist is expected works well in reducing their fear."

Szafranski also relies on a team approach to assist her in many difficult situations.

"In one case, I had an elderly lady who was in tears because she was being discharged from the ER at midnight and was frightened because she had no way to return home," she said. "I knew that under certain circumstances, we could provide taxi vouchers to patients, so I contacted our social worker and reassured the patient that we would find her a way home."

Next Page