Avoid communication mishaps (and maybe even catastrophes) by avoiding common errors in communication. Use of loaded terms, ways of talking about brain death, and the hazards of not explaining what you are doing are discussed. I've seen new and experienced health care providers make these mistakes. Add your own in the comments!
Nursing StudentsGeneral StudentsArticle
We all make communication mistakes. As a hospital-based nurse for over 30 years, I've certainly made my share, and witnessed many more. Along the way, I've picked up a few tips that I hope are helpful to students and new nurses.
1. Avoid loaded language
Terms like "brain damage" and "life support" are riddled with emotion and unfavorable connotations for the lay person. Although it may seem counter-intuitive, there are times when "medicalspeak" is more effective for communication. It reframes concepts, sidestepping the emotion associated with certain terms in the vernacular. Think about what "life support" really means to us: vasopressors to maintain BP? A ventilator? Cardipulmonary bypass or ECMO? Then consider what it means to a layperson: impending death? Permanent dependence on a machine? A vegetative state? Hopelessness? Using medical terms for interventions is clearer and promotes understanding rather than distress.
2. Death is death
Don't say "brain death" to families and loved ones when you mean death. The term "brain death" is not clear to laypersons; they might think it is reversible or different from "real death" somehow. "Brain death" is death. Humans do not live apart from a brain, although the heart may still beat. You and I understand this, of course, but laypersons often do not.
Do not use euphemisms either. People need to hear words such as "death" and "died," not "passed on" or "expired." Do not risk miscommunicating about death by using polite terms. Families deserve and need clarity from health care providers in time of crisis. We can be compassionate while communicating clearly. Cultivate this skill in your nursing practice. Find people whose communication skills you admire and learn from them.
3. EVERYONE in a hospital room is stressed
To patients and families, a hospital stay represents a crisis, and people in crisis have limited cognitive capacity. Their recall and processing are impaired. They may not communicate well with each other. This is why they will forget what you told them yesterday and you will have to tell one family member the same thing you told another family member. They aren't being difficult, they are in crisis. Antagonism from a busy nurse only escalates the crisis, so try to be patient, and use written resources to help provide answers to the common questions (location of bathrooms, visiting hours, etc.) Help the family identify a spokesperson who can act as the #1 go-to person for questions, and refer them to the spokesperson for daily updates. Don't allow yourself to get overwhelmed with inquiries from many people; politely deflect questions to the spokesperson or written materials.
4. Tell people what you're doing
When you enter a patient's room, say, "Mrs. Jones, I have your atenolol, lovastatin, and IV antibiotic, carbepenem. Let's do the oral pills first, then I'll work on your IV medication." If someone interrupts you, say, "I'm giving medication (or whatever you're doing), and will be with you shortly." If you give the impression that you're not doing an important task, it's much easier for someone to interrupt. And don't forget that assessment and monitoring are also important. Nurses seem to forget that these essential responsibilities that are a huge part of our role save lives, prevent complications and promote healing.
5. Finally, know that you, like everyone else, will make communication errors
If appropriate, admit the error and apologize. Rephrase what you said in a better way, and move on. You will show that you are human, that you care about communicating skillfully, and that you intend to make things right. And you will gain the respect of colleagues, patients and families.
Although we all make communication missteps, communication is rarely, if ever, overdone in health care settings. Clear communication prevents errors. Try to default to more explaining, more clarifying, and more communicating, not less. You will find it makes you a safer and more effective nurse. Happy communicating!
