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A few months ago I was required to explain to a patient that we needed to get a blood sample from him for a series of laboratory tests in order to make a satisfactory diagnosis of his condition. He was experiencing urethral burning during urination and his urine had strong odor and a cloudy appearance. Among the tests to be carried out was one for Urinary Tract Infection (UTI) and also an HIV test to explain the persistent recurrence of the symptoms and the resistance to medication.
From his talk the patient seemed to know so much about the medical details surrounding his condition and he was making conscious effort to make me feel inadequate and incompetent. The patient was condescending in many ways. There arose a moral issue when I informed him that we needed to an HIV test just for the purposes of clearance of doubt. He imagined that I was moralizing his lifestyle and behavior. He understood that to mean that he was sexually irresponsible and immoral and started defending himself. He was rather sensitive about discussing his condition with me probably due to the secrecy and the privacy attached to the whole issue. He seemed scared of a positive HIV result and completely declined to discuss his fears with me instead choosing to mask and venting out on me. He questioned my medical knowledge and stated that he was not ready to have me attend to him.
I must admit he managed to make me feel inadequate, I felt incompetent and I was doing my best to impress him, to get him on my side, he really mattered, his opinion of me mattered so much. I needed him to apologize and withdraw the mean things he had said to me so that I could feel like a nurse again. Even after he agreed to let me get the blood sample I was severely nervous and annoyed at the same time. It was as if I cared and did not care at the same time. My hands were shaking and I was really scared of him noticing it and of making a mistake or causing an accident. I was afraid that I would not be able to collect the blood and run the tests and thus confirm my incompetency to him. Probably due to his appearance and the authority in his talk, he represented some strict authority figures in my life effectively escalating my anxiety. It was a very sad and confusing moment for me. I was distressed because I have always intended to be the best nurse there is to be and now here I was shaking, not able to collect a blood sample or even talk to the patient like a nurse is supposed to. I managed to get some blood out of him after some begging but a hard struggle trying to firm my hands.
The issue that I will explore in this paper is that of anxiety in the work place. The paper will be about my feelings as a nurse in the working environment and how confident I feel in myself and the skill that I have learnt since joining college to date.
The issue I tackle in this paper is broadly psychological in that it deals with my feels as nurse in the job and my confidence in my knowledge and ability to perform the task ahead of me. I believe that t6he dread and fear I went through emanate from my innate need to be very good, to be an excellent performer in various areas of my life and more importantly in my career. This in turn leads to perfectionism where I am so hard on myself to the point that I cannot take myself making a mistake no matter how small because to me a mistake is equal to failure and incompetency. When I was not sure what to say to make the patient see the sense and importance of the operation that I was about to undertake I started being impatient with myself then nervousness and anxiety set in. The patient was not doing much to help. Probably after noticing that I was a little shaken he decided to capitalize, and went out of his way to put me down realizing I was just but a rookie nurse. The anxiety increased and I was not able to think straight in terms of my relations with the patient. I chose to defend myself from the accusations of the patient (some of which were true, indeed I am inexperienced, I am just a trainee) instead of focusing on the important issue which was the test that was to be performed and the general wellbeing of the patient.
I then borrowed from my earlier life experiences with strict teachers and guardians and need to feel appreciated and worthwhile and I was totally displaced. The scared patient sort of knew what I was after and was denying it to me intentionally or so I thought. My anxiety increased and even after the patient cooled down and was actually listening to me I was the last to know, I was still in the fight mode. My hands were shaking and that spoiled it all, because it led to more anxiety which led to more shaking, it was a vicious circle.
I had not until this day known what getting a difficult patient exactly was. I always imagined that once the person is sick they will comply with what is said by the doctors and nurses because they know better and importantly because the patient is sick and wants to get better. I never encountered a patient who thought knew much better than the practitioner or who actually knew much more than the practitioner. In my naïve way, I did not know that such an occurrence was possible. I chose to wish it away, to circumvent around it a hope it never happens again as opposed to getting it tackled amicably and in a way that should it recur I will know just what to do.
According to Johnson (2005) nursing like many other careers with human life in their hands is very stress provoking because of the knowledge of the cost of a mistake even so slight. The efforts of trying to be very careful and accurate are very strenuous and can in themselves lead to many of the mistakes being avoided. Wilkinson (2009) states that whereas mistakes do happen it is advisable not to focus so much on them while the nurse is working in the ward, theatre or elsewhere in the hospital but instead focus should be on doing the job the best way they know how. Worrying about what could happen will only lead to nervousness and anxiety which will in turn cloud judgment and may cause accidents.
Christian , J.A (2007) views that a new nurse is supposed to recognize and acknowledge the instances that lead to anxiety and plan a course of action to try and counter it. The nurses can form networks of people in similar situations and together they can share experiences and encourage each other. In case of anxiety provoking situation like mine was a nurse should be able to get assistance from the senior personnel who are more experienced.
Christian (2007) also states that it is important that nurses set aside time for adequate rest to keep burnouts at bay. This will ensure that the nurses will be motivated to give their best while on duty and they will be fresh and open to new knowledge and experience. This will also enable the nurses to renew and maintain positive attitudes toward their jobs even when they could be going through difficult times. It is also necessary that the nurses understand emotional and psychological selves and cater for the needs and concerns that consequently arise so that they do not get in the way of their jobs. This may involve talking to friends or family or even mental health professionals like a counselor to deal with emotional reactions or situations that rouse feelings of anxiety.
Whereas it is normal to feel inadequate and challenged in certain aspects of the job especially when one is a new entrant or a trainee Brewer, J.A. (2005) advises that one is should look for ways of turning the negative experiences and feelings into positive. For instance when a trainee feels that they are not equipped emotionally or psychologically to deal with difficult patients like I did with this particular patient they are advised to focus on what it is they did right and to point out the points of their weaknesses and embark on an effort to improve their knowledge on those said areas. This will ensure that in a similar situation the nurse will be well prepared and even more confident to deal with the issue.
After the analysis I realized that in my encounter I was wrong to allow myself to get hurt by what the patient said forgetting that the he was actually in a difficult condition due to his illness. I also realized and appreciated the confidentiality involved with the patient's illness which was possibly the reason for his reaction.
I also leant that it was useless of I to be hard on myself in the effort trying to the best nurse there is. I realized that perfection takes time and patience and that it is necessary to make a conscious effort to improve my performance through wide reading and constant inquiry.
I have also realized my behavior that could easily pass for lack of concern in the patient's welfare. If I was in that situation again I would try to take the client slowly and patiently through the process and the importance of the test instead of putting my feelings and experience in the line.
After the analysis I have realized the importance of being aware of myself and my reactions to various types of patients. I have recognized that patients or at least most of them are going through difficult situations in their lives due to their health conditions and as reactions to them they may act in way that make me, or any nurse, anxious, agitated or even mad. It is important therefore to react to different patients differently according to their specific experiences, conditions and the behavior they present.
I have decided that it is my duty to ensure that my emotional reactions and personal life does not get in the way of the relationships that I shall create with the patients because that way I will be able to make sound judgment without being influenced by what the patients say or think of me but instead what I believe and know is right After the analysis I have decided that I will actively observe my inadequacies and areas where I feel less confident handling on my own n seek appropriate assistant from my experienced seniors and more importantly to keep reading widely to increase my knowledge and thus improve my nursing practice.