I used to stress over meeting new people. How will I behave? How will they behave? What will I say? What will they say? How will I react? How will they react? I found with a lot of experience they are as unsure as I am. Even more so. A male nurse once told me to be confident no matter what so the client/resident/patient feels good about my care. They need to be confident in the care I give. I started to approach everyone with confidence, I did not necessarily feel and I faked it till I made it. I find using polite conversation to begin is best. I introduced myself every time. I start with “Hello, I’m the nurse Julie. I’ll be helping you this evening.” 

Rapport

Build trust which will build rapport. The best way to establish trust in a short time is to do what you say you will and listen with attention. Look the client in the eyes and let them look into your eyes. Trust can be established with a shared look. I tell them why I’m in the room and ask them something about what I can do for them. I make conversation finding out about them. Sometimes, I compliment them on their clothing or something but it has to be an honest compliment for it to work and I have to be honest about what I am saying for it to work. 

Ask, Ask, Ask

I have found an easy way to establish rapport is to ask the client what they are looking for from me. I always ask their permission before starting any task. Once they agree I will have their trust for now. Trust must continue to be earned. I have to keep working towards trust every time. I look them in the eye. I let them look at me in the eye. I listen and pay attention to what they’re saying so that I can respond appropriately and this is the beginning of trust. I listen to what they have to say, it doesn’t take very long. I get permission to do the tasks I have to do. I always ask first to gain consent. I seldom get a refusal but sometimes. I listened to the refusals and came back later and this helps build trust. They may not remember me but they do remember the way I treated them.

Understand It’s Not Personal

The client can try to pull you into their reality and their mood but it is about them and not about the person helping. I must try to remain neutral with this type of situation as my feelings or emotions can feed their mood and escalate the situation. It has to start with accepting people for who they are, not putting my interpretation of them and ahead of my learning about them. I understand the issue is with the client and it has nothing to do with the nurse, doctor, PSW, or housekeeper who walks into the situation in which the client is combative. The client is in their world and we are just a guest walking into their space. 

Try Another Angle

See the situation from another angle. Maybe another approach can diffuse or distract the client enough to reduce the situation. They say don’t argue with others but opinions are unique to each person and it can be difficult to keep my opinion to myself. I try to keep my opinions outside of work. I know that is restrictive but it eliminates arguments. I try to be neutral while working. Non-judgemental.

Walk Away/Ask For Help

When the situation is stressed and I have reached my limit and I am no longer effective there is no shame in walking away and or asking for help from another. Sometimes I am ineffective in a given situation. I can get more training but another nurse or PSW may have a better effect on the client at that moment. The best option may be getting assistance from another but keep the numbers down to not overwhelm the client.

Another option is to ask someone else’s opinion and follow through with other ideas but that takes time and in the situation, you may not have the time. 

Diffuse/De-escalate

Always use the training you receive to assist you to diffuse or de-escalate any situation. Better would be keeping the situation from getting to a point where de-escalation is necessary. If I listen to what the client is saying and allowing them to feel my calm by holding their hand, speaking calmly to them, attempting to get them to take a deep breath, trying what will work in the situation. I try to see their side or find another angle to change the situation.

Think about how you approach someone new. Do you ask questions? Do you listen? 

We are taught to control the interview and are usually in a rush. Do you control the conversation or do you give and take with others? How do you build rapport? Do you listen and use what you know to gain trust? 

If you are thinking about it you will pay attention to what you are saying and how you are handling your clients. You will learn from your mistakes and improve your bedside manner. They may not remember me but they will remember how I made them feel. I find showing respect to others gains respect for me from clients, building trust, and gaining cooperation.

Bio‐ Julie Warring Amos, RN

I have worked in a hospital, nursing home, and home care. I have been a supervisor in the community and a PSW instructor and teaching chair. I have given injections in the community. I have worked as a staff nurse and a temporary nurse. I find nursing to be a growing field that is growing so fast I cannot keep up. Go team!