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Unlike many other types of laboratory professionals, a phlebotomist's job centers on interaction with patients. Obtaining a blood draw from some patients can be quite a challenge. Having to soothe scared patients and getting the blood necessary for tests and screenings is a difficulty all phlebotomists need to acknowledge and prepare for.
Why Patients Are Afraid
There are really only two reasons why patients would be nervous for a blood draw, said Dennis J. Ernst, MT(ASCP), executive director of the Center for Phlebotomy Education. "Either they've never had a venipuncture before, or they did and it wasn't pleasant," he said.
Patients who have not had their blood drawn before tend to come to the lab with misconceptions of the procedure, usually given to them by people who had their blood drawn improperly or who may be exaggerating or embellishing the pain of the experience, Ernst explained. "Regardless, those who have never had their blood drawn before require an extra measure of patience, compassion and time invested to gain trust, confidence and acceptance," he told ADVANCE.
Phlebotomists may have their work cut out for them even more when a patient is nervous because of a prior bad experience of their own. "You have to respect their fear and explore its roots," Ernst advised. "Maybe the patient's first draw was at the hands of someone who wasn't properly trained, or just not trained to minimize the trauma of a venipuncture in the form of physical pain and mental anguish. Maybe the patient is needle-phobic. Because you never know what kind of prior experience anxious patients might have had, you must be prepared to slow the process down and invest in a positive outcome."
 Calming Down Younger Patients
If a patient doesn't come right out and say he's nervous but starts showing some telltale signs-perspiring, hyperventilating, etc.-be prepared to try various techniques to soothe the patient's fears. First and foremost, explaining what will happen in the procedure from start to finish is important to squash the fear of the unknown, whether the patient is 5 or 85.
"The technique that works best for me is to distract the patient," explained Lisa Scott, assistant supervisor of Phlebotomy Services at the Greater Baltimore Medical Center. "For example, with younger children, we tell them to look at the animals in a painting we have in the room. For older children, I ask them about school or something else they'd like to talk about. Once they start talking, they're not aware of what's going on."
Studies have shown that TV and movies are effective tools of distraction during pediatric venipunctures, Ernst added. "But if that's not possible, have a cooperative parent provide a distraction like a colorful object, stuffed animal or a picture book," he said. "If parents aren't capable of helping because they're too nervous themselves, ask if they'd prefer to wait outside of the room. Children take their cues about what to be afraid of from their parents, so you don't want a fearful parent in the area."
Doing a "dress rehearsal" of the procedure (while showing none of the equipment except the tourniquet) is another way to put little patients as ease, Ernst suggested. Remember to give them a task during the blood draw, such as counting to ten once the needle is inserted. "Whatever the device, you want to turn them from the object of the procedure to a participant in it. It's powerful," Ernst said.
Nervous Patients of All Ages
Phlebotomists can assure their patients that they are in good hands by letting them know that they are having a venipuncture performed by a skilled professional.
"One of our policies is that, when we go to draw blood, we have to state our name to the patient and tell them how long we've been at the job," noted Karen Penrod, PBT(ASCP)CM, phlebotomist at Columbus (IN) Regional Health. "I always tell my patients I have been drawing blood for more than 30 years. That seems to calm them down! I also try to listen to my patients' concerns, and respond with sincere kindness and empathy. It is just a courtesy we try to give to the patient to make them more comfortable."
Remember to be friendly and maintain eye contact, added Julia Higgins, phlebotomist at Northwestern Memorial Hospital, Chicago. "If you act confident in your skill, it will come across to the patient. Do not rush to calm a patient because that will only make him or her feel nervous, and you may make a mistake while rushing," she advised.
It also may help to validate the patient's fears. Telling them that it's OK to be nervous and that it's a normal fear is something that Scott does. "I tell them, 'People have phobias about many different things; yours just happens to be a phobia of needles,'" she said.
Offer the patient to recline on a cot or gurney instead of sitting upright, Ernst suggested. "Make your compassion reflect in your face, body language, tone of voice and choice of words," he said.
It's All About Compassion
There's much more to phlebotomy than knowing how to perform a proper blood draw. Showing compassion, care and a calm demeanor to patients is absolutely essential, and a major part of the job.
"Patients don't typically look forward to having a blood test," Penrod said. "My job is to treat all my patients with the same level of courtesy, respect, professionalism and honesty to ensure they have the best experience possible."
If you realize that calming anxious patients is not one of your strong suits, see if someone else on your team could perform these venipunctures. "I hear too many stories about patients who were ridiculed and belittled for being nervous or afraid of needles. There's no room in healthcare for people without compassion," Ernst stressed. "Those who realize they're not wired to draw from anxious patients should find someone else to perform the procedure. Otherwise, the patient's fears will be realized, and they could develop a lifelong aversion to healthcare. Nobody wants to be responsible for that."
Amanda Koehler (amanda.e.koehler@gmail.com) is a freelance writer for ADVANCE.
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