What one conversation taught me about fear, understanding, and the power of being heard.
By Lesline Rostick, RN, BSN
“It feels like I’m drowning.”
That is how a patient with heart failure described his shortness of breath when I asked how he was feeling. During handoff, I had been told he was declining his telemetry monitor and oxygen. He was described as “very difficult.”
I needed to know he had declined care. But that description reflected someone else’s experience of him, not the whole person. I wanted to understand his perspective before drawing my own conclusions.
When I entered his room, I introduced myself and listened. He was visibly anxious. I asked what he understood about his reduced ejection fraction. He told me he did not know what it meant.
I explained in plain language that the heart works like a pump and that his was not pumping as effectively as it should. We talked about how his condition could contribute to his breathlessness and why the care team wanted to monitor his heart rhythm and oxygen needs. I also advocated for help with his anxiety.
After our conversation, he agreed to wear the monitor and keep his oxygen on.
I cannot say that one explanation was the only reason he changed his mind. What I do know is that listening revealed concerns I would not have understood from the label “difficult.”
Handoff Is a Starting Point
Handoff tells us what happened and what needs our attention. It cannot tell us everything a patient is feeling or understands. When a patient declines care, we need to assess the risks, but we should also ask questions without assuming the answer.
Was the equipment uncomfortable? Was the patient afraid? Did he understand its purpose? Was there another concern we had not heard? In this case, I learned that he was anxious, struggling to breathe, and unsure what his diagnosis meant.
The handoff was right to tell me he had declined care. But the word “difficult” did not tell me that he felt like he was drowning or that he did not understand what a low ejection fraction meant.
A label can travel from shift to shift. If we are not careful, it can shape how we approach someone before they have had the chance to speak for themselves. We may see the refusal and miss the fear behind it.
An unbiased approach does not mean dismissing a colleague’s report. It means taking the information seriously while allowing the patient to tell us their side.
Understanding Is Part of Care
Medical language can create a gap between what clinicians explain and what patients take away. Terms such as ejection fraction and telemetry are familiar to us, but they may be unfamiliar to someone who is sick and frightened. An explanation given is not always an explanation understood.
A patient may hear the words without knowing what they mean for the symptoms they feel or the care we are asking them to accept. They may be too overwhelmed to ask a question. If we ask only, “Do you understand?” it can be easy for someone to say yes while still feeling lost.
We can begin with, “What have you been told about your condition?” Then we can explain one idea at a time, connect it to the patient’s concerns, and invite them to tell us what they understand in their own words. If our explanation has not been clear, we can try another way.
Doctors and nurses share responsibility for that work. We can also advocate when breathlessness, pain, fear, or anxiety makes it harder for someone to take in information and participate in care.
Health literacy is not a judgment about a patient’s intelligence. It asks whether we have communicated in a way that helps the patient understand what is happening and make informed choices. Education is not simply a way to obtain agreement. It is part of respecting the person receiving care.
Listening and education will not resolve every refusal or prevent every escalation. But they can reveal something a report alone cannot give us: the patient’s point of view.
Let Handoff Inform Your Care
Let your own assessment shape how you approach the patient. Listen without judgment and ask what may be behind a refusal before deciding what it means. A patient’s choices may involve fear, discomfort, confusion, or a need they have not yet been able to express.
When we give patients the chance to tell us their experience, we gain information that a report alone cannot provide. We may not always change the outcome, but we can make sure the person receiving care is heard, understood, and treated with dignity.
The Nursing Lens 
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