October 1, 2012

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Have we lost our ability (and our sensitivity) to communicate in healthcare?

By Donna Cardillo

While recently accompanying a man who had just been admitted to the hospital, the nurse looked at his wife and asked, “Are you his P-O-A?” We all (including me) looked dumbfounded so she repeated the question a little louder. I finally spoke up and said, “You’ll have to tell us what “P-O-A” stands for. She replied, “Power of Attorney.” OK, now at least I knew what she meant but the patient and his wife were still not sure how to answer.

Another nurse came in and told the same patient that he would be getting “FFP”. Once again, even I did not know what it stood for so I asked. The answer: fresh frozen plasma. Even at that, the patient had absolutely no idea what that was or what it meant. I politely asked the nurse, “Can you please explain to them what that is and why he’s getting it?” So she did.

A fellow nurse relayed a story about taking her elderly aunt to be admitted to a rehabilitation facility. The admitting personnel asked the older women if she was a “DNR” which most healthcare folks know stands for “Do Not Resuscitate.” Just as in my first example, when the woman did not respond, the admitting person repeated the question a few decibels louder. When the nurse who had accompanied the patient to the hospital explained what they were asking, and after the poor patient had also just been asked if she knew which funeral home she would be using, went into a panic saying, “Don’t put me away yet. I came for therapy — right?” OK, I understand that certain questions need to be asked but if we have gotten so entrenched in filling out forms and checking off boxes that we can’t or don’t consider to whom we are speaking or why, how our words will be perceived or understood (or misunderstood), and why we even have a job in the first place, then we need to take a step back and refocus.

A friend of mine’s husband was once diagnosed with a serious neurological disorder. He was close to death and she asked his physician whether he would survive. By her own admission, she was hanging expectantly on his every word, looking for some reassurance. The answer she got: “This is a self-limiting disease. Your husband has a fulminant case. It could prove to be lethal.” Honesty, I’m not even sure what that means myself and I’m in healthcare for a long time. When, at a later date, she questioned the same physician about whether her husband was ready to be discharged for rehab he said, “This disease is typically monophasic – his clinical signs are improving.” My friend, who is not a medical person, was happy her husband was improving but still didn’t get an answer to her question.

You may be thinking, “These are extreme examples.” But I’m not so sure about that. We get so locked into our own world sometimes we simply lose our ability to relate to those we serve. There are times when nurses and other healthcare folks don’t even understand each other! Fellow nurses often make statements to me loaded with acronyms, abbreviated words, and the jargon of their particular specialty. I frequently do not understand what a nursing colleague is saying and have to ask for a translation.

So, just a reminder for all of us, including me, wherever you work, or whenever you are speaking to lay people (even other healthcare folks), speak in plain simple English. Use whole words instead of acronyms but avoid jargon and medical terminology as much as possible. If you do need to use jargon, at least explain what it means. Also consider to whom you are speaking and how your words, including your questions, may be interpreted. If you speak and people don’t understand what you say, you may as well remain silent. And once you lose your ability to communicate clearly, effectively, and compassionately, you lose your effectiveness as a care provider.

Donna Wilk Cardillo is the Career Guru for Nurses and “Dear Donna” columnist for Nursing Spectrum, NurseWeek, and www.nurse.com. Donna is also an ‘Expert’ Blogger at DoctorOz.com. She is author of The ULTIMATE Career Guide for Nurses, Your 1st Year as a Nurse, and A Daybook for Beginning Nurses. Ms. Cardillo is creator of the Career Alternatives for Nurses® seminar and home-study program. You can reach her at www.dcardillo.com or www.nurse-power.net/blog.

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