Virtud Oloan discusses the importance of effective communication with oncology patients and strategies to mitigate patient anger and denial surrounding these often challenging conversations.
I have the pleasure to introduce our next guest ver tude. A. Lohan is a board certified psychiatric and mental health nurse in a legal nurse consultant. She is currently working full time as a behavioral health advanced practice nurse at Scripps Mercy Hospital in San Diego and teaches part time in an undergraduate nursing course. Her current projects, which she is actively engaged in, include care of the suicidal patients in the acute care setting, workplace violence prevention, elopement prevention in the E. D and med search units and restraint reduction, including falls reduction in the elopement Prevention in the Behavioral Health Unit as well. For two has received the Falling Professional Awards Scripts Behavioral Health Honoree from the San Diego Behavioral Health Recognition in 2000 and 19, the Nursing Excellence Award from the Philippine Nurses Association of San Diego in 2017, the Values and Action Award from Scripts Mercy Hospital in 2000 and 16, the Certificate of Honor for Excellence and Expanded Advanced Practice in Psych, mental health nursing Um, from the San Diego Psychiatric Society in 2000 and 15. The Psychiatric Nurse of the Year from Scripts Mercy Hospital in 2000 and seven, um, and faculty of the Quarter from Kaplan College of San Diego in 2000 and seven. And she is also a member of the American Psychiatric Nurses Association and the Philippine Nurses Association of San Diego. So welcome for two. Hi. Okay, so, dealing with angry patients, I'm pretty sure every nurse can relate how hard it is the energy you spend when you're dealing with anger patients. But my objective for this presentation is at the end of this presentation, you will be very confident to deal with angry patients because you have learned the tools. Uh, so, yeah, I don't have any commercial bias in this presentation. So here here are the different angry faces that I got from, of course, the Internet. But if you see a familiar face that was before in my haircut above the scripts logo that's actually May I waas a very angry family member in 2012. I want to know more about it when we have time, I'll tell you and I would also be your case study, so Oh, sorry, I have to go back. So in 2016 to 2018, a group off, researchers reviewed some literature about angry patients who has diagnosis, who has a diagnosis of cancer and how they're in colleges, deal with them and the impact on their practice. So the findings is that when we improve the ability off a provider, a clinician to perceive what is causing the anger and focus on the unmet need that is causing the anger, there will be an improved relationship between the clinicians and the patient. And there will be a therapeutic relationship, a collaboration within the patient and the clinician. So this will be the basis off our off this presentation, how to improve your skills in communicating with patients who have anger issues. So anger is a very basic emotion, just like sadness, just like happiness. Anger is a response to any stimulus. The stimulus can be internal. It can be external stress is part of daily living. We cannot avoid stress. The moment we wake up, we already face a stressful day ahead, so all we need to do is learn to adapt to these stressors. If we cannot adapt, then we learn to modify. If we cannot modify, then maybe we have to avoid, but sometimes they stress becomes so much for us to bear that it effects our basic needs and our basic survival. We respond by either fighting or getting away or just doing nothing. It's dress, maybe internal or external, and we call this a trigger. Internal stress. This may be your thoughts. Maybe your emotions, a physical, a physical discomfort like pain. Or it can be external, like driving on their drain or sitting besides someone who is talking on the phone loud, or somebody who is sipping a cup of coffee when you are just placed on nothing for or, uM, not no food, because you are going to take your lab exam so it stress is always there. It is how we're going to handle it. But the problem is, when we are faced with a threat, it takes 1/30 of a second for us to really explode and become angry. That is what we wanted to avoid, and that is what we are going toe. Learn on how to manage this patient, who are in that state where they are ready to fight. So whether the common triggers well identified, of course, pain, it can bay the physical pain. It can be emotional pain, injustice that affect her self esteem. Fear, of course, fear. Maybe riel or fear may be unknown. And, of course, frustration. Being diagnosed with cancer is a threat before co vid. Cancer is one off those diagnosis, which is dread it. So once you are given this diagnosis, you feel a threat to your life. And so you undergo stress. You identify a lot of coping, coping, adaptive coping mechanisms, adaptive mechanisms. You research you seek a second opinion. You ask other friends, you know, you do a lot off research in order to cope up with this stress. You do a lot of actions to adapt to this kind of stress. However, because this situation continues, you come to a point where you have exhausted. You have exhausted all your adaptive mechanisms and now you feel helpless. You go into that state of crisis, and in a state of crisis, the individual is vulnerable toe anger. So in 2011, Bieler and company I studied about patient anger and how communication can affect management of these patients. They interviewed patients, they reviewed literature, and these are the reasons that they have identified So these are the reasons given by patients. And they said when they're given a diagnosis of cancer and they were told that they're going to lose a body part that makes them angry or they cannot go back to their activities of daily living or they can no longer control the function of their body, or sometimes it has something to do with the medical system. So this are the reasons that are common across the nation when, when there is anger, the anger is actually within wants itself. However, oftentimes this anger is directed outwards. When a person cannot control that feeling, that feeling that emotion, that uncomfortable emotion within it is now directed to the external environment and whoever is that person in the patient's external environment will be the recipient of this patient's anger. Therefore, we have to effectively be able to manage the anger off this patient. The best way to deescalate a person who is angry is therapeutic communication. Therapeutic communication usually is the first step you have to use before you use other means off anger management. So communication with your patients with their family members would the entire health team in order to maintain maintain consistency. This is very, very important. So the heart of this presentation is on developing an effective and therapeutic inter professional communication. So what does it mean when you do not say something or answer your patient? Sometimes when the patient is very angry, we wanted to play slave and just keep quiet. The problem is, silence is meaningful. Silence can be an effective communication technique, but silence can also be destructive. Why? Because communication is not really mostly verbal. A very small, small percentage off your communication is what you say. So even if you don't say anything, even if you don't answer your patient, even if you remain silent, the other aspect of yourself is communicating something. Your facial expression. Are you reaching your lips? God, are you raising your eyebrows? Are you looking at the clock? The tone of your voice, your movement, how you appear? Are you crossing your arms? Are you leaning back? Are you avoiding patients eye contact? Are you looking at something else? Are you doing a lot of hand movements? And how is your posture? Are you threatening, or are you trying to avoid confrontation or avoiding the patient's problem. So even if you're not saying anything, your non verbal communication is very meaningful. So what can I What tools can I help you develop so that you can confidently and effectively manage patients and family members who are angry? Tool number one is yourself So these are the four tools you the therapeutic use of yourself. You yourself is the most important stimulus When you are in front of your patients So in front of the patient you are the Onley person he can hear. You are the only person he can see. Everything that you dio and you say has a very strong impact on the patient. So self management. When you go back home tonight, look at yourself in the mirror and speak the way you speak to a patient and you will wonder. Oh gosh, This is how I appear. When I was speaking with my patient tape, your conversation talk tape, your your voice and oh, I didn't realize I sounded very angry. Oh, I didn't realize I was having a pressured speech. Very important is to have a calm, clear and pleasant tone, just like a music when you are stressed out and you play a calm music, you feel relaxed. So when your patient is loud is like what is happening here and you say, Well, I'm doing everything I can. Then the more you make the patient angry. But when you say sir or ma'am or Miss, I have called your doctor and I have verified this. So when your patient is loud, please don't speak louder. In fact, according to studies, if you is speaking a low tone, the patient will quiet down because he will try to listen to you. You do not compete with your patients. Voice monitor discussions. Please don't get out of the topic. If your patient is asking King a question, focus on that question. Don't avoid so monitor. What is he trying to say? Listen to what is the patient trying to communicate? Don't argue. Remember, he will never win an argument because when you argue, that person feels threatened and the more that person is going to fight for his idea. So instead of arguing, present the facts don't test the patient. When you agree, argue and you tell the patient is wrong. You actually lower the patient self esteem. You destroy the patient self respect and the more that will make your patient angry. What's your facial expressions? Don't roll your eyes, because when you're all your eyes, that means you don't believe the patient. Don't shrug your shoulders because that means you're helpless. Don't look like it's sluggish, because that means you are becoming impatient. So watch your facial expressions. Well, of course, you can see your own facial expressions. So if you are working with somebody and you notice that your coworker is having this negative facial expressions, why don't you ask her to take a break? Hey, excuse me. I guess there's a phone call waiting for you. Can I take over? So you want to remove that worker coworker viewers who is already showing a negative facial expression and a negative response. And don't freeze, because when you freeze yourself, then that's when your mind stops working and you don't know what to dio, and you yourself gets into that panic mode. Take a deep breath, move backward, relax so you will have all the opportunity to think off the best answer to your patients. Question. Do not respond inappropriately, so if the question is answered, answerable but yes or no. If you're patient is asking a question answerable but yes or no answer with yes or no. Don't give her a lot of explanation because the more it will confuse the patient and the more the patient will become angry. But it is okay to say I don't know. Be honest. I'm sorry. I don't know, but don't end there. I don't know, but I'm going to find out. I'm sorry. I don't know the answer to your question right now, but I'm going to find out. Please give May Ah, few minutes to call this and that to confirm this and that. And I'll give you the answer. No. When your patients anger becomes expressed verbally. Oh, when a patient is angry, the words that comes out of their mouth really are hurtful. That's when you start doing a self talk. Uh huh. Don't take it. Personal virtue. It's not personal. It's not about you. So if a patient says sorry. Okay. Have to say this just for example. And we hear this a lot. You bitch ups. Don't take it personally. You know you are not a bitch. Then why are you going to respond Duh. This patient a patient is angry, is anger itself. And you that patient is projecting it on you. So that patient actually mean Means I am. I am nobody. I am sick. I cannot do anything. I am a B but then patients projects it on you. So don't argue with a patient. You call me a B. Don't take it personal. If you cannot take it personal, take a deep breath. Turn around as someone to deal with the patient as you come yourself. As I have said earlier, target with a full is a proof that there are two. So here is your patient is emotionally unstable and now you're taking personally what your patient is telling you. Take a break. Have somebody deal with a patient Us. You distress yourself sometimes behavior benign. You know, sometimes you see this patient coming very frequently and using the same disrespectful language. Well, maybe he comes from this culture, you know, like there are culture who just like points at you and you feel offended when they pointed you. But in their culture, this is this is acceptable or it's benign. Somebody keeps on using this f word, but well, this patient grew up in a community where that effort is like, you know, I have Ah, have someone tell me Oh, don't take it seriously. You know, when I was in high school, that was the in thing. So I cannot take it off my vocabulary that before I got stuck in my tongue, you know, So if it's benign, it's meaningless. Don't take it personally. You, as I've said earlier, is your most important tool. So always keep calm. And don't let this trust of your patients get into you. Talk to yourself, but dont talk aloud because they might say you have a problem yourself. So talk to yourself silently. I am calm. I'm in control. I'm safe, I'm appropriate. I'm respectful and that will give you a self confidence. As I have said earlier, maintain a modulated voice. If you're patient gets loud, don't get louder. In fact, you get quieter because when you speak quieter, your patient was talk Why he needs to hear you. He needs to listen to you. But before social distancing before the 6 ft distance, I emphasize always maintain a safe personal space space more than an arm's length but now, actually 6 ft apart. Why? Because we don't want to get into the personal space of your patients as much as possible. When you are talking to your patient, maintain this oblique sideways posture when I say oblique sideways your shoulder to shoulder, because when you stay directly in front of the patient, even if you're maintaining a six distance. If you are directly in front of the patient, that direct eye contact can become threatening. But if you step aside and you have this shoulder to shoulder sideways distance, that is less threatening for a patient who has a problem with having a direct eye contact and please maintain or have an exit strategy. If you're working in a clinic or in an office and your patient is getting angry and your patients started to become more physical like you can see hand gestures, don't get inside your office. If a patient follows you in that office, then you have no way to exit. So go to an open place, go near the exit door so you can protect yourself. Tool number two. Don't be hammer, Abraham Maslow once said. For he who holds a hammer, the whole world is a nail. What do we mean by this? Well, when a person is angry when we're dealing with an angry person immediately, we want to solve the problem. We want this patient to stop. We want this patient to deal with it. We want this patient to just go away. No, If you tell the patients stop. If you tell the patient. Know if you tell the patient don't do it. You're not solving the problem. You're just hammering the nail. But the problem is still there. And any time that source of anger will explode. What happens if you use this hammering words? Whether the hammering words Well, tacos Taco Tuesday, Aerial of tacos. Okay, we don't love tacos when we're dealing with angry patients threatened, Don't threaten the patient. If you don't stop screaming, I'm going to call the police. That's threatening. Your patients would say, Okay, I'll try. I'll try. Don't argue. Don't disagree. Don't challenge. Don't order. Sit down. Don't get out of your seat until I tell you until they call your name. Don't shame the patient or disrespect quite all of this threatening, arguing, disagreeing, challenging, ordering, giving, command shaming or disrespecting all of this lowers a person's self esteem and self respect by nature. Every person guards his own self esteem. You know that if yourself is team is affected, everything else falls apart, you become powerless. Angry patients or persons who have a tendency to become angry are actually powerless individuals. Remember that. Why do we say that persons have the tendency to become angry and powerless individuals? It is because they don't know how to release this anger. They don't have the power. They don't have the power on how to manage this anger. So they project it on other individuals. They project this anger to other persons, so the more you make them powerless. When you disagree with them, you make them feel powerless. When you challenge them, you make them powerless. You challenge their power when you shame them. So all of these tacos, the more you make them powerless and the more they're going to assert their power. Once they feel powerless, the more they can become violent, verbally or physically. It's their way off convincing them themselves that I am powerful. I can make this person afraid I am powerful, and when they're able to exert power on others through their angry behavior, then that increases their self esteem. So you actually are reinforcing that angry behavior. So next time, if that patient comes back Thio and he doesn't get what he wants, he is going to show an angry behavior because he knows his you will be threatened and you will give in to the demands of this patient. So don't make him feel powerless by using this taco. Instead, respect your patient. Listen to your patient asked what can be done and I am talking about empathy. Empathy is very important. Resist the urge to be hammered by just nailing and fixing the problem. Clarified What's happening? Ass? What can we do about it? Listen, how does it affect you? How do you feel? What do you think about it? Because the more you listen, the more that source off anger, distress, the threat anxiety, all of those negative emotions that's causing anger will come out and soon as you are empathizing with your patient, a lion would have turned into a lamb. So how do we do this? How do we share empathy? First, share your perception. Ah, person who is angry doesn't realize that is angry. Person is screaming things is just talking normally. So share your perception. I know this. Okay? I notice you've been pacing the whole way. I heard you. Your voice was loud. I saw you on your phone and you look very upset. Okay, So share. What do you see? What do you hear? And then clarify the emotion? Emotion is subjective Onley The person experiencing the emotion can say what it is, so don't presume not because his voice is loud is angry. No, maybe his death. That's why his voice is loud. So you have to clarify. I heard you talking and your voice sounds so loud. What's happening? Patients says, Oh, because I lost my ear piece so I can hear There you go. You got a problem instead of saying Hey, you're so loud. You're angry. Quiet down! So please clarify the emotion. We want to deal with the correct emotion. Never make a conclusion, Never make Presumptions and then expressed empathy. Be careful when you express empathy. Empathy is when you express understanding. But sometimes you the way express it is misunderstood when you say I understand how you're feeling and the patient will say, How will you understand? Have you been in this situation? So instead of saying I understand how you are filling, then just tell the patient. I know. I know that this matters to you a lot. I can see. I can see that you are in pain. I can hear your frustration. Okay, then identify the trigger. So what is causing your frustration? What is causing your restlessness? What is making you impatient? And once we know what's happening, that's the unmet need. What is that need? Now we can work with the patient. We can know peacefully, sit down with the patient toe, work on eliminating, reducing or modifying whatever that unmet need or the stressor that is causing the patient's anger. Uh, on the third slide, it says that when a group of psychologist studied the causes of anger among patients and their response off the colleges or clinicians, they found out that there is an unmet need. So the common cost, the common theme off the reasons for their anger is there is an unmet need. Now let's work on that unmet need positive positive framing. So let's frame that unmet need and make it as a motivation. So what is that unmet need? Oh, I can no longer go back to my previous functioning. Okay, So you need to function. We can improve that. So now set that as a motivation. Said that as a goal. If you come to your clinic consultations regularly if you take your medications regularly. If you work on this, uh, this therapies or treatments regularly, then we can go to that. So use that so that is a positive reframing. But please don't give don't give impossible promises. Okay, So those that are realistic don't give unrealistic. Don't set unrealistic goals through the patient goals that can be that can be achieved within within the medical state or the capacity off the patient and help the patient work through that partner with the patient. Get the patient's collaborate with the patient. Yeah. So there was this so so reframing anger that was actually presented in slide number three that when we know what is causing the anger, we can help the patient reframe the anger and make it become a motivation. And as I have said, it's the unmet need. So there was this study that identified the ability off the clinicians to communicate where the patients, which is causing the anger of the patients and so they planned on a training program. It is just an hour of training, So look, this is the agenda. Five minutes, 15 minutes. So first they watched a video about somebody who is angry, and then they identified What is they try to understand what are the verbal and nonverbal cues that it's not out by this person who is angry. And then they had a practice on how to communicate effectively. So the trainer demonstrated this commute therapeutic communication. And then there was role play. So it was a very brief training only in our training. And they found out after their clinicians and healthcare workers completed this training program, they actually has improved their own confidence, and they felt there now more effective in managing angry patients. So I hope this presentation can be considered a like a training on your parts, which you can bring with you when you go back to your own workplace training those four using those developing those four tools that we have mentioned earlier. Another, another research also worked on developing a model again, this model is focused on therapeutic communication, how to respond to an angry patient using therapeutic communication. And after having their staff go through this training model, they rate their self confidence. And the staff said that they felt more confident dealing with angry patients. So this is example of the model. This is a blueprint. I'm sorry. This is a blueprint off the communication model that was presented to the staff. No, not in all cases will your therapeutic communication or why do I say not in all cases, because sometimes the need we're trying to make meat remains unmet. Or sometimes the patient has an underlying condition, which is beyond your control. Say, for example, the patient has a PSA key. Patrick diagnosis. The patient is off medication. The patient is responding to internal stimulus like voices, these frightening voices. And at that moment, you don't have the psychotropic that can manage. This threatening voice is and your patient becomes more violent. Trust your instincts. If you think your therapeutic communication is not working, Stop, Stop call for help. So how do you know if you're therapeutic? Communication is not worth it. Once you use empathy. Once you use empathy and you feel you are not getting into the filling of your patients, then please call for help. Don't deal with the patient alone. You also have to think off your personal safety so back off and call for assistance, especially if patient as a weapon or there is an object in front of the patient, or or especially if the patient starts to manifest some physical gestures like racing a close Fisk or, uh, getting closer to you those already close. Don't wait until the patient gets near you and release the anger to you physically, so call for assistance. Don't be embarrassed. Toe shout for help. Shout for help. Don't feel embarrassed. That is not a sign off weakness that is actually one. All the interventions we teach to our staff when you feel all the therapeutic skills that you have learned is not working. Something else is happening. So stop and call for help Security. If you don't have a security, then call the police. If, however, you were able to collaborate with your patient, which is using your four tools, I would say 80 to 90% of the time You are very effective. Please write it down. Take the opportunity to collaborate with the patient. What makes you what makes you feel and safe? What triggers you? What makes you angry? What makes you stressful? What? What do you find? Threatening? Take note of those. Take note of those and then ask the patient So earlier when you were very restless, This is what we did. So what else? What else can we offer you? A cup of border? Can we offer you this and that? So as the patient, How do you manage your stress? How do you usually What makes you come down? What makes you feel better? Right? All of those. And put it in the communication. I don't know, but in epic I usually put it under the nursing communication under the care plan. Make care plan. Uh, identify there. These are the common triggers toe the patient's emotions. This triggers anger identified. And this are identified by the patient US. What works To calm down the patient that should be communicated toe every member of the health team so that this plan of care will become consistent Because if we don't communicate the plan of care. Like, how do we manage this patient? How do we call even, like, How do we call the patient? How do we address? How does the patient wants to be addressed? Sometimes if you address the patient in a different name on patient feels disrespected. So all of those very minor, very minor details. But actually, it helps a lot in preventing, uh, the anger of a patient from escalating. All those should be written down in a part of your documentation or chart and should be communicated to everybody. So you wanna hear what made me angry? Thank you for two. For your informative and animated presentation. I went to the way in person. Do I have time to share my anger on my my? Yes. Please go ahead. Yeah. So if you look at my first slide that that's me with the longer hair. In 2012, my husband was diagnosed with prostate cancer, so he went for a biopsy. He was a night shift nurse. Well, my husband is also a psych nurse. Not in this hospital. He's retired. So he wasn't like shift nurse. So when he woke up, he reviewed his voice message, and there was a voice mail from his doctor saying Your biopsy came back positive. You have prostate cancer and you will receive a call from my nurse practitioner thing. That's it. Then my husband checked the next voice message. This is the nurse practitioner I attempted to call you, but got no answer. I, however, will be going back on vacation for two weeks. I will call you when I come back. Oops. Getting a prostate cancer diagnosis by phone and that having any? There's a lot of questions. So I called. I told my husband, I'll call back the nurse practitioner. Maybe she hasn't left the office, but unfortunately, I got the out of office response. By the way, this is this clinic is not in any way affiliated the scripts. Okay, so I would like to emphasize this clinic is in no way affiliated the scripts. It's not a part of the scripts health system, So I called and cold and cold. I was kept waiting and hanging. They're giving me a doctor's appointment, which is longer than two X. So we went to the clinic and I said, Give me someone I can talk to I'm not going to live this clinic unless I am able to talk to someone. Can I talk to your supervisor? Oh, my supervisor is busy on the phone. Can I talk to this and that? Anybody? Oh, they're having a meeting. No one wants toe talk to me. I said, I just want an answer to my question. When is the most? When is the earliest time my husband can can be seen? You called my husband saying he has a prostate cancer and you're not giving us treatment options? I don't even know what stage of cancer is. And I don't even know what are the treatment options. Are we doing this and that? I was, like, already loud there with all my hand gestures and everything, and no one is entertaining May until I believe they called everybody and somebody a very kind doctor came to the desk and say, May I help you? What do you need? So I come down. I told him what's happening? And he said, Your husband's doctor is having a surgery right now. Can you take? Can you wait after an hour? I said, sure, So there you go. All I All I just need is someone to answer my question. But they were all avoiding me. So that went on for four hours. I was frequently by the desk. My voice is becoming loud. My hand gesture is becoming like. But if somebody just listen to me and listen to my need, I would not be an angry family member. So I hope everybody when you go back home, use those four tools. But the best tool is yourself. It's any question. I still have three minutes. Thank you for tube. You're welcome. It looks like we have a question. A couple of questions that came in on the first question is, what advice can you give to help affect change in a culture where office staff members are no longer angry but cynical? Can you say it again? What advice can you give to help affect change in a culture where office staff members or are no longer angry? But they're cynical? Oh, I would say let's have a workshop and we'll start with self awareness because it always it always begin with being aware off yourself. Maybe this is tough, are not aware that they're becoming cynical. Maybe they have been like what we wanted to say. Absorbed into the system. They become what I wanted to say, like frigid. You know, they're used to it, and because they're used to it, they think it's just a part off what's happening so and they're not aware of it. So let's start with self awareness. But unfortunately, workshop is not possible at this time because of the social distancing, I know. But that would be a very, very good way to start it, because self awareness is really not on Lee coming from you, but coming from others. Because in self awareness we have toe. There are four windows. Djohar is window. I would call it jars Window one is that part of yourself which you are not aware. But other people are aware. So we want to listen from others and then we want toe listen from you. And then we want to listen what the others know about you. But you don't know. So it's actually listening what others think about how you are and how you behave. And once you develop self awareness, then you can affect change. So that's my advice. Thank you. It looks like there was another question. What shattered? What strategies do you have for patients? With confusion due to effects from chemo chemo brain, those patients get angry and frustrated sometimes. So when a person is confused, always is tarred by always, always used short, simple sentences. I would say a minimum of five words in one sentence always begin by introducing yourself what your role ISS and what you're going to do, and then one statement at a time. And when a person is confused, they may not hear you, but they can see you. And what you say may be contrary to what you're doing. Or I said, you're the nonverbal. So when a person is confused, he's not understanding your words. But he can see your movements, the non verbal and often times It's the non verbal that we give out that we're not aware off, and that threatens the patient. But that happens also in the medical floor, like the moment you rich, the moment you reach for the patients Ivy, the patient thinks you're already hurting him. The moment you touch the patient, the patient thinks you're going to attack him. So the patient immediately responsible attacking you. Same thing when a person is confused, he's not understanding your words. He's understanding your actions. So be careful off how we approach the patient. Slowly, gently, calmly Use short, simple sentences and tell them what you need to do. Ask permission. May I hold your hand? I am doing this. Thank you. And that's so important Because, like they say, you know, our actions speak louder than correct that speak volumes. Eso it looks like we don't have any other questions that come in. But I would like Thio read the comments here that were shared. Um, there was there was a question that was asked Thio, the attendees, Do you have an angry patients story? And some of the comments here? Um, there was an attendee that said that they have noticed more angry family members since visitation has been restricted Hospital due to Cove in 19. Uh, the family often takes out their frustration on the staff. It's much easier to maintain communication with the family when they are able to be present at the bedside. Correct. And then, um, it looks like another attendee said, This is great information. It reminds us to be self aware of what you're projecting to the patient. You don't always have to have a response. Listening can make the difference on then, um, it looks like someone else added that they had a patient with a new cancer diagnosis that received her first cycle of chemo during hospitalization. It became she became very anxious and verbalize that she can't handle this anymore on. But she wanted to die on night shift. After her husband visited and left, the patient became more and more anxious and angry, was yelling at the nurses and called 911 and reported that nurses are holding her against her will needed to spend more time with patient at the bedside toe, listen to her concerns and offer emotional support. You feel what the patients feel. Put yourself in the shoes of your patient. That's actually empathy. Put yourself in the shoes of your patients, feel how they feel and then do what you want to be done to you. If you were in their place, what do you want your nurse to do to you? So thank you. I think with with your presentation, you're you're able Thio successfully show the audience how much impact, posture and tone of voice can effect communication as well. And and this is such an important topic because we are in contact with patients every day, you know, have those different types of communication tools in our arsenal to handle challenging patients and their family members as well. In order, Thio prevent that escalation as much as we can reinforce a safe environment and improve patient experience on. I really liked what you said about not taking anything personally because your son doozy had mentioned that this morning and her self care talk as well with the three piece one of the 31 of the piece was Thio, that nothing is personal, nothing is permanent and nothing is perfect. I'm glad you touched on that as well. I'm just going to give it a few more seconds here. Just if anyone wants Thio taking any last minute questions. Oh, and and there's an analogy that I just, uh, thought off when I was drinking my coffee. Dealing with anger is actually like drinking a cup of coffee when you get a cup of coffee that is freshly brewed and you immediately sip on it. It's so hot that you get scolded. So why don't you give it a time to cool down so you can enjoy drinking your cup of coffee? It's just like dealing with an angry patient. When a patient's anger is the hit, don't face the patient because you will clash. Why don't you deescalate listen, Empathize? And when the patient has come down, then the work. Now you have a therapeutic alliance with your patient. I thought about that this just before this presentation, when I was drinking my coffee, I said, Oh, this is a good analogy And these were so waken Take this in our own personal lives as well with but with the people that we come in contact with, you know, incorporating these tips and just reminding ourselves whenever someone does get angry, it's always better Thio to give them some time to just relax and think it over and then come at come back when you are both at a, um, more calm state where you can actually talk and settle out of things. And, yeah, just just always use the premise behavior. It's meaningful, right? Yeah, So I don't get upset a lot. I just like behavior is meaningful. He's doing that because something is happening. Okay, Well, thank you so much for today and speaking. It's been such a pleasure. Thio, have you want to listen to you? Also pleasure to be part of this conference. Thank you for two. Bye bye.
