The Anxious Patient, the Monitor, and the Nurse's Presence
Mr. Park is a 45-year-old man admitted for palpitations and new-onset atrial fibrillation. His heart rate is 128 and irregular; blood pressure 132/84. He has been started on a beta-blocker and anticoagulation. He repeatedly presses the call light, checks his own monitor, and asks, "Am I going to have a stroke? Is my heart going to stop?" He has not slept in two nights and is drinking six cups of coffee daily from the cafeteria. He becomes tearful and says, "No one tells me anything." The nurse has three other patients, one of whom is due for medications.
1. What communication approach should the nurse use, and how should she prioritize her time?
Read the worked answer
Presence over information-dumping. Mr. Park's escalating anxiety is driving the call-light behavior; a rushed, task-focused response will worsen it.
Prioritized approach:
- Safety first - confirm the medication due time and delegate or sequence so the other patient's meds are not late; then give Mr. Park focused, uninterrupted time (even 5 minutes).
- Sit down, lower your voice, make eye contact. Physical presence signals safety and reduces the need to summon help.
- Use open, reflective listening: "Tell me what worries you most right now." Reflect back: "You're afraid this could be a stroke." Naming the fear reduces its intensity.
- Give clear, honest, simple information about what is being done and what is being monitored, in small chunks with teach-back.
- Address modifiable drivers: discuss reducing caffeine (six cups is a likely contributor to palpitations and poor sleep) and offer sleep-supportive measures.
- Set a shared plan - agree on scheduled check-ins ("I'll be back at 2:00") so he has predictability and doesn't need to press the light.
Reasoning: Anxiety is a holistic concern, not a nuisance. Predictability, presence, and honest information are therapeutic interventions that also reduce call-light burden.
2. How should the nurse respond to "No one tells me anything" while maintaining boundaries and honesty?
Read the worked answer
Validate, don't defend. Responding with "We've been very busy" or "I did tell you" blames the patient and escalates.
Response: "You're right that this has been confusing, and I'm sorry. Let me make sure you understand what's happening now." Then clarify the plan in plain language, check understanding, and write key points down or involve the provider for a bedside update.
Boundaries: Be honest about what is unknown ("I don't have all the answers, but I will find out and come back by 3:00") and keep that promise. Do not overpromise or give false reassurance.
Reasoning: Acknowledging the patient's experience repairs trust; honesty about limits preserves credibility. This is the essence of therapeutic communication - the patient feels heard, and the nurse remains accountable.