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.
I had a speech professor who would make the entire class "boo" at anyone who said "um" or "like" in their speeches. I didn't understand the importance then, but I do now. I start nursing school this fall... thank you for reminding me once again that I must work on this on a daily basis if I want to be an excellent nurse some day.
Specializes in Tele, Interventional Pain Management, OR.
From a student's perspective--just began my second semester of NS today, YAY!--the "okay" is more of a verbal tic to fill what we perceive as awkward silence during patient interactions. When used in that way, the "okay" is not a component of therapeutic communication. It's something we newbies fall back on to buy ourselves time, figure out what we're doing, and feel like we're including the patient.
Before entering nursing school, I worked for a number of years in retail management (I still work this job when I have time; my employer is pretty awesome and lets me jump in when I need hours and pull back when school is crazy). Anyway, customer-facing transactions are all about smooth, light conversation; dead air doesn't feel "okay" so to speak--haha.
After a semester of clinicals, I have realized that the same principle does not always apply to nurse-patient interactions. Sometimes the nurse has done his/her best job and gathered the most pertinent information simply by listening or being silent. I've made a conscious effort to break myself of the need to compensate for conversational lags with filler, including "okay." It's difficult, because as a nursing student I absolutely lack confidence and, given my work background, easy give-and-take is my personal comfort zone. But to paraphrase something I recently read on All Nurses: Just because the patient likes you doesn't mean you've done a good job as a nurse.
I'm a nursing student in Tx. I work in a very large hospital in Dallas. I often hear the nurses taking phone orders from physicians and they say ok a lot.
MD- give my patient 4mg of morphine q6 or PRN for severe pain.
Nurse- ok. This is letting the MD know that the order is understood, and she reads it back to him/her and says, ok! I think it depends on the setting and situation but perfectly OK to be used.
Specializes in LTC,Hospice/palliative care,acute care.
"OK" is lazy, it's a substitute for "do you understand?" "do you agree? " "if that's everything, I'll be going now" It's like "yeah" and "nah" It says "I am lazy and can't be bothered to speak correct Engrish...."
"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."
There are instances where it is necessary to give limitations to adult patients, especially if they are suffering from dementia or Alzheimer's. It is in no way preventing them from dissenting to the treatment being given. It merely creates less confusion.
This article reminds me of an employee of mine a few years back that said she abhorred the use of "you guys" when speaking to women or a group of both men and women. She said, "we are NOT guys, we are women." I ended up taking that to heart and ever since then I consciously make an effort not to use that phrase.
"Ok" is such an automatic, reflexive word. It will take some effort to consciously wipe that off my statements and questions!
I liked this article, I deffinetly use the word "OK" in my practice, probly too much. I see your pont as to how it can sound unprofessional. I often find myself saying it as I complete tasks just as a verbal check off. I could see how people might not understand what I am saying. I will try to pay more attention to that in the future. I also say "I'm sorry" for things I have no control over. I don't like it, but I don't know what else to say.
When speaking about theraputic communication in general, I like to use the AIDET model, it is a good way to communicate with patients, especially for a student who might be nervous about the interaction in the first place.
A- is for acknowledge "hello Mr. Smith, how are you feeling today?"
I- is for introduce "my name is elixRN and I will be your nurse today"
D- is for duration " I will be here until 7 pm tonight, I am going to listen to your lungs, heart and belly, this will take 1 minute"
E- is for explain- what you are doing, why you are doing it.
T- is for thank you, thank the patient for being cooperative with care and for letting you care for them.
It can be done in a little different order to have a more natural flow, but it works, patients appreciate the professionalism.
The use of "okay?" is integral to the implementation of healthcare that enables the client to make the decisions regarding their care.
Implying they don't have a choice goes against the patients bill of rights, unless your patient is a prisoner.
In the age of PATIENT SATISFACTION, Mr Andrews can eat as many potato chips as he wants, and Mr. Watson doesn't have to turn if he doesnt want to.
Interesting. You're raising a hypothetical about the influence and urgency of patient satisfaction scores and what they are doing to the way plan and execute patient care.
Yes... we are entering a brave new world. Things are changing.
So here is my answer. You let Mr. Andrews get discharged with his invincible ignorance about the relationship between sodium intake and another episode of heart failure. Well... you realize what happens when we discharge Mr. Andrews and he comes back in 2 weeks, don't you? CMS (and other third party payers) will refuse to pay for that admission. Oh, yeah, you better believe we have to use every opportunity to discuss his diet and sodium intake. We have no choice. (And besides, it's the right thing to do.) You understand what happens if Mr. Watson gets a decubitus while he's under our care... right? Exactly. The cost of caring for that skin break down is on the hospital. Not only that, but we fail in our QSEN and National Patient Safety scores... and EVERY bill submitted to CMS is paid at a lower rate because (in their words...) they only reward excellent hospitals.
What this means is that we have to be even more deliberate and conscious of the way we talk to patients. When you say "OK?"... you aren't really soliciting his thoughts on the issue. You're expecting a reflexive "OK" in return.
I will play devil's advocate now. I maintain that when we do the "OK?" thing, we aren't doing it for the patient. We're doing it to make ourselves feel better. It's quick and easy and makes us feel like we're being humane.
If you honestly and truly want to encourage independence in your patients, you'll develop open ended questions to take the place of "OK?". "This is your 2nd admission in the last 6 months for heart failure, Mr. Andrews. Your choices in what you eat have a role in how well your heart works. Tell me your thoughts about that?"
And Mr. Watson... he doesn't get a choice about turning, he gets choices about HOW we turn, and whether we do it now or 20 minutes after I give him 3 mg. Morphine.
You raise a good point. In the day and age of patient satisfaction scores, we'll need to master how we talk to patients about their care.
I liked this article, I deffinetly use the word "OK" in my practice, probly too much. I see your pont as to how it can sound unprofessional. I often find myself saying it as I complete tasks just as a verbal check off. I could see how people might not understand what I am saying. I will try to pay more attention to that in the future. I also say "I'm sorry" for things I have no control over. I don't like it, but I don't know what else to say.
When speaking about theraputic communication in general, I like to use the AIDET model, it is a good way to communicate with patients, especially for a student who might be nervous about the interaction in the first place.
A- is for acknowledge "hello Mr. Smith, how are you feeling today?"
I- is for introduce "my name is elixRN and I will be your nurse today"
D- is for duration " I will be here until 7 pm tonight, I am going to listen to your lungs, heart and belly, this will take 1 minute"
E- is for explain- what you are doing, why you are doing it.
T- is for thank you, thank the patient for being cooperative with care and for letting you care for them.
It can be done in a little different order to have a more natural flow, but it works, patients appreciate the professionalism.
I have used the AIDET model for about 9 years. I concur that it WORKS.
anie10
294 Posts
Perfect article!
Reminds me of my father denying my every request as a child when I used "Can I?"
I will certainly remember this going forward. Especially for my last clinical (of the semester) tomorrow!