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!
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.
"Okay" is a huge conversation filler and is used as much as "um", "like", etc. We can communicate effectively with patients, their families and our co-workers by just leaving the conversation fluff out. This is a great article...I wish everyone would print it out!
What a great point! I had a pt ask me to stop saying "okay" and I obliged; that made me feel like a warden, like I was ordering him around. However, I do see how that can diminish my authority and make me appear insecure as a professional.
I'm going to try to be more cognizant of my use of the phrase "okay" and hopefully I will notice a difference in how people respond.
This post was helpful! I'm just getting started, so I'll make it a point to be mindful of words and non-words like "ok" that undermine the relationship and make me seem unsure -- especially where I *will* be nervous and unsure for the majority of my first experiences. Thank you for writing this!
I was taught in nursing school how to speak to patients during clinical, before we started. It was never, "I am going to give you a bath now, ok?" It was, "I am going to give you a bath now, I'll go get everything we need, so we can get started." You never gave them an out. WOW, I must be really old now....lol:roflmao:
When I was in nursing school, my professors insisted that every word that came out of our mouths when interacting with patients HAD to have a therapeutic purpose. And they dogged us on it constantly.
I've had 43 years to think about this and I've decided that, for the most part, they were correct. However, sometimes a casual conversation can relax a patient and break the ice. Sometimes humor (my bad jokes) can have a purpose. And no matter where the conversation goes, I'm always assessing the responses I get, and adding that information to my on-going assessment.
This post was helpful! I'm just getting started, so I'll make it a point to be mindful of words and non-words like "ok" that undermine the relationship and make me seem unsure -- especially where I *will* be nervous and unsure for the majority of my first experiences. Thank you for writing this!
Of course you're going to be nervous at first. But it does the patient no favor to act timid and tentative. Therefore, you have to fake it until you feel it.
Specializes in Cath/EP lab, CCU, Cardiac stepdown.
I feel the use of "okay" can be construed as uncertainty, a lack of confidence. If you are giving meds or turning a person, that's not for your benefit, but for theirs. To ask their opinion of it is condescending. To give them their autonomy, do not treat them as children, even if you're doing it out of kindness. It grates on me the same way it does when I hear nurses calling patients "honey, baby, sweetie," etc. Speak kindly and firmly and if the patient has questions he or she will certainly ask them of you since you will have demonstrated confidence.
While I see your point in how it can be seen as uncertainty, I have to say that it is not black and white. It depends on the tone in which you convey the message.
Yes we are giving care and meds for their benefit but at the same time they retain their right to decide whether they want it or not. It is within their rights to refuse care or meds, which is why I personally use ok afterwards to assess whether they have a problem with it.
Please do not see that asking for permission is a sign of "I don't know what I'm doing" or as belittling them by treating them like a child because it's not. Just because we are health professions and know better, it doesn't mean we get to perform care on them, we still need permission otherwise it is battery. And when I use ok, it is not condescending in any way, rather I am informing them that they have a choice to refuse and a chance to let me know if they have any concerns.
There are indeed patients who think that just because the doctor or nurse says so, they must do it. If they choose not to do it, then I will inform them on the risks and why it is to their benefit to do it but it is not my duty to force them to. It is my job to ensure that they have the information. And by using "ok" it allows the patient to voice their concerns. If they say no, they might say why, if they don't say why they don't want to then it is an opportunity to assess as to why they don't want to do whatever it is that you are SUGGESTING, not DEMANDING. And with that data you can try to come up with a plan that will appropriately address the issue.
But like I said it's not black and white, I agree in that those who convey it in an uncertain tone or condescending manner shouldn't do it but it's not absolute that students should get rid of "ok"
I think to add to this article Episteme, one is needed on the 'I'm sorry' epidemic. Everyone apologizes for EVERYTHING. And when you do, it makes you look insincere, especially if the person receiving the apology knows it's not something to be sorry for. Let's try to limit that one too, ok?!
I think this is a very good point. When I was a new nurse, I only asked "Mr. Jones, are you ready to get out of bed?" a couple of times before I realized they were going to simply say "Nope, I'm not getting out of bed today".
I don't mean to sound like I'm putting the patient down, but its the same philosophy when dealing with young children. Example: "Little Johnny do you want to wear your red sneakers or blue sneakers with your outfit?" The phrase should be a statement rather than a request.
I'd like to second the excellent post of SNurseKylam.
Giving limited choices is appropriate for children, which our patients are not. (Unless they are, of course. If you're a peds nurse, that's a different story. Even then, their parents/guardians retain rights to dissent.)
It's perfectly appropriate to drop the verbal tic of "okay," but it's not appropriate to treat patients as if they have no right to modify or dissent entirely from a plan of care.
mge9450
22 Posts
"Okay" is a huge conversation filler and is used as much as "um", "like", etc. We can communicate effectively with patients, their families and our co-workers by just leaving the conversation fluff out. This is a great article...I wish everyone would print it out!