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Respectful Communication Helps Patients Take Control of their Health

As a VNSNY Home Care nurse, Atinuke “Tinu” F. has treated patients for conditions ranging from postsurgical wounds to ostomy bag management. While Staten Island, where she works, is a long way from her native Nigeria, she’s found that some of the most challenging aspects of her work here are similar to those she faced as a sex counselor for teens back in Abuja, Nigeria’s capital city. “As nurses, the skilled interventions we’re trained to do are part of the job we can control,” she says. “We can’t regulate people’s behavior, though.”

One of the biggest issues, she adds, is getting patients to fully understand the part they need to play in their own care. Knowing how important it is to encourage and educate those in her care, Tinu is patient, compassionate—and persistent when it comes to helping them connect the dots between their actions and their health. Junius*, a 60-year-old man originally from Cameroon, was diagnosed with diabetes four years ago (long before he came under VNSNY’s care), and put on oral insulin. He didn’t take his medication consistently, and his diabetes got worse as a result. He was prescribed insulin injections four times a day, but he was inconsistent with these injections as well.

Eventually, Junius developed a foot ulcer related to his diabetes. It became infected and required amputation. When his surgical wound from the amputation didn’t heal properly, his doctor ordered home care services from VNSNY and Tinu became his nurse. Her goal was to get Junius to take his medication as prescribed, but she knew she’d have to earn his trust and establish a rapport before she could successfully educate him about his condition—and this involved educating herself about the challenges he faced. Her first objective was to determine why Junius wasn’t following his care plan. Toward that end, she employed an open-ended, nonjudgmental style of questioning that she learned in her VNSNY training. She stressed what was likely to happen if he continued to reject the insulin, and had Junius to repeat back what she was telling him to make sure that he understood what he needed to do.

When Junius still didn’t follow his care plan, Tinu reached out to VNSNY’s diabetes specialist, Yael R., to help. After two weeks of concerted efforts, Junius announced that he finally understood the connection between taking his medication and controlling his diabetes, and began to follow his care plan and take his medication. When his wound finally healed, Junius gave Tinu the best possible thank-you present, saying to her, “I’m very happy now and am going to check my sugar, take my insulin, and see my doctor on a regular basis. Thank you for being so patient with me.”

“Our VNSNY training teaches cultural sensitivity, which is helpful,” says Tinu. But, she adds, nurses also need to understand patients’ obstacles to following instructions to manage their conditions and take care of their health. Sometimes the obstacles are cognitive, but they can also be financially based or due to inertia, or—most commonly problem—they arise because the patient is in denial. This is where emotional connection and empathy between nurse and patient come into full play.

“How you talk to patients is just as important as what you say,” says Tinu. “Even as we’re educating, which is a huge part of the job, we need to be motivational as well.” This can be tiring, she admits, but when patients finally begin to take responsibility for their own healing, as Junius did, it feels like winning the lottery. “And that,” says Tinu, “makes it all worthwhile.”

* The patient’s name has been changed for privacy.