As a student you learn that the nurse-patient relationship is critical for effective, humane, holistic patient care. You also learn that the communication necessary for a nurse-patient relationship is a two-way street. There is what we say... and there is what the patient hears. Both of these must be precise for optimal nurse-patient interactions to occur. Unfortunately, we all have deeply ingrained linguistic habits that too often garble our communication efforts... and we should NOT be OK with that!
NursesAnnouncementsArchiveArticle
I have noticed over the years that student-patient interactions are loaded with relationship killing words and phrases. The students are not being unkind. Rather they are speaking without thought or purpose.
Though I don't want students to feel stilted and confined and "fake" when they converse with patients I do want them leave linguistic tics and mannerisms at home. These are fine in "everyday life" but they impede the development of a therapeutic nurse-patient relationship in professional interactions.
The most common example of conversational "tics" is the way we (Americans, at least) punctuate much of what we say with "OK". "OK" is a multi-use tool in common speech. For example:
* We use it to end a conversation. ("OK, OK. I get it. OK?")
* Sometimes we use it to take the sting out of what we've just said. ("Honey, slacks with horizontal stripes are not a good look for you... OK?")
* We use it to determine if our listener is still with us. (Remember teaching lowest-common-denominator to your 5th grader? Having pointed out that 4 goes into 12 as does 3 you look at your child and say "OK?" And of course, their eyes are glazed over!)
But this tic is hugely counter-productive at the bedside. The most common way students use "OK?" seems to reflect some distorted sense of courtesy. For example I often hear students say something like:
"No, Mr. Andrews, those chips your visitor brought you don't go with your cardiac diet. OK?"
Think about what the student did in that interaction. Initially he/she was speaking as a nurse, conveying important information. Then instantly became a petitioner asking the patient if he would be "OK" with refraining from potato chips. The student turned a therapeutic relationship into one that was ambiguous. The patient, hearing this "OK?", is entitled to imagine the student is making a suggestion instead of giving him important information about living with congestive heart failure. This was a "teachable moment" and it was wasted. How much better if the student had said...
"Mr. Andrews... those chips have a lot of salt in them. You'll have to avoid salty foods at home and let me explain why... etc."
The habit of saying "OK?" is also insincere. Students commonly say things like
"Mr. Watson, we have to turn you to your other side now... OK?"
Well, no. In Mr. Watson's mind it is not "OK" because turning hurts. He knows it. The student knows it. And Mr. Watson also knows it's futile to tell the student "no". In this interaction, the student was not honestly asking Mr. Watson's opinion about turning. But... the student could have used this simple nursing task to give the patient some much needed autonomy. The student could have said
"Mr. Watson. It's time to turn. Would you rather face the door or the window?"
Note two things. First, this is a sincere question. As a result, the nurse-patient relationship is strengthened. And second, a previously helpless patient is invited to participate in his care. He is being treated like an adult.
There are times a patient may be going on at some length about a concern (Not uncommonly, this is a "problem patient". Often one the nurses prefer to avoid) For most students the impulse to nod and say... "OK." "Uh huh." "OK" is irresistible . Unfortunately, doing so adds nothing to the conversation and the patient eventually realizes the student nurse is trying to hurry her to the end of her soliloquy.
A much more therapeutic approach is to make eye contact with this patient and listen for recurring themes. (Things that she is telling you multiple times in different words.) These can then be reflected back at appropriate times. In this manner, the student is engaged and the patient knows it. This patient who was previously acting out (because no one would pay attention to her if she didn't)... now feels she has an advocate she can talk to, someone who understands. The nurse-patient relationship is strengthened.
In real life, all of these nursing measures don't work all of the time. But sometimes they actually do. On the other hand... without hesitation or equivocation... I can tell you that just reflexively saying "OK" when speaking to patients adds nothing to your plan of care and may actually impede it.
