Using technical jargon with patients-EYE OPENER

Nurses General Nursing

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I had an experience today that I thought should be shared because it was such a powerful lesson. Yesterday, I had to attend a customer service training session that showed a video of a man talking about the loss of his son due to a med error. He did not want to sue the hospital, but wanted to use the opportunity to teach the staff what could have been better about the handling of his son's case. He said two things that stood out-Statistics make no difference to a family member when their loved one lay dying, and that a healthcare professional should never assume what a patient can understand about their family member's condition.

Today, I was working med/surg and was caring for a man who was not improving despite aggressive treatment of his condition. We spoke with the POA and it was decided that comfort care only was in order. Everything seemed to be in order, but some more family arrived and the POA was unable to explain to them why comfort care only was being given. Some felt we were "killing" him. I called the MD and arranged a family meeting, but by the looks on their faces, they were still not understanding. The MD was using a lot of jargon and statistics about his chances of survival. After she left, I stayed and slowly explained lab results and other things in plain English. After about one hour, one family member caught me and told me how "outstanding" I was that I took the time to listen to their concern and that I didn't treat him like a statistic.

It's a powerful thing to know you've made a difference in someone's difficult situation, particularly when the easy way would have been to simply say, "they just won't get it.". I'm glad that the training made me more aware of jargon use, and that a family may rest easier knowing absolutely everything was done to try to save their loved one.

Specializes in ER/ICU/Flight.

I have overheard MDs/RNs etc "explaining" things to patients and their families as if they had the same level of understanding as us.I told a CRNA once: "the family knows that you know what you're talking about...but they still have no idea what you just said. You need to go back in there, start all over again and take a different approach this time." He was stunned and apparently didn't recognize the blank stares that had been looking back at him.I've never understood why, after years of schooling, that some of us can walk away from a conversation knowing for a fact that we haven't imparted information in a way that would be useful to the patient. And we call it "informed consent".

At the end of this kind of conversation it's a good idea to have the patient/family tell you what they think you're saying to them. If they can't or if their meaning differs greatly, the job isn't done yet.

This is an area where medicine is more art than science.

I always admire the doctors who are able to explain a patient's medical condition in a way that people understand without talking down to anyone.

When my mom died I became hunted by the fact that I did not try to do cpr , she had olney been died about 30mims -45 mins ( I had heard of people being dead over an hour and being brount back ) when we got to the hospital and where told what happend . I did not understand how she could die she was an DNR and it just seemed to me that they let her died ..

It was not untell a co-worker sat down with me and explaned to me that my mom would have died no matter what because you can not live with you lungs full of **** .

Specializes in Critical Care (SICU/Trauma).

Yes, where I work, it ranges from those described in the making water comment to the ones who read WebMD profusely and think they're doctors. Sometimes you just have to feel them out to see what their medical knowledge is. And then there's my favorite reply "I don't know but I'll find out!"

I have to do this with my grandpa!

He is very polite and becomes very afraid in the hospital.

He feels it is impolite to question "experts" and too intimidated by "medicine" to ask "what do mean by that?".

He is thrilled he has many children and grandchildren with medical knowledge to help him out.

Not everyone has that.

He is an intelligent man but "hemoglobin" and "O2 sat" doesn't mean pucky to him.

Specializes in Acute Care Cardiac, Education, Prof Practice.

I can still hear my instructors from nursing school in the back of my head when it comes to jargon and patients.

When my grandmother was in the hospital I found it interesting how some people knew how to thoroughly explain something in layman terms, and how others simply dumbed it down to basically meaning nothing. By the second day I was asking them to "lay it out for me" and then I was translating it to my family.

Specializes in ER/Trauma.

I'll never forget the card (and my co-workers enjoyed the box of chocolates) that the family of a patient sent in: "to Dad's awesome nurse Roy. Thank you for taking the time and patience to explain what Dad was suffering from. Not only did you look after Dad, you looked after us. Your kindness won't be forgotten."

My pt. had been suffering from new onset heart failure following a recent CABG. This wasn't his first episode (and it won't be his last :() of "shortness of breath" that brought him to my ED. Each time, the doctors talked to family and explained treatment plans and treatment was carried out.

It wasn't until the 5th visit in a year that one of the family members broached the subject when I was about to administer lasix to the pt.

"What are you giving him now?"

"I'm going to give Jack some lasix. It's a drug that'll help him with him breathe easier."

"But it's not a nebuliser! How will that help his breathing?!"

"Because Jack has what we call congestive heart failure. His heart has difficulty pumping blood. Lasix will help him by making more urine and that'll ultimately help his lungs breathe easier".

At this point I looked around the room and the family and realised that I wasn't getting through. So I said, "give me a moment. Let me give the Lasix and get Jack more comfortable and I'll try to explain things better".

I thought quickly and drew inspiration from a similar case from nursing school.

I pulled a couple tissue sheets from the wall dispenser over the wash sink and drew a rough sketch of cardio-pulmonary circulation. I explained that while Jack was having difficulty breathing, the problem wasn't his lungs but his heart. I explained the heart cycle and it's intricate relationship with the lungs and oxygenation. Then I added on the kidneys and reminded them that one of the primary functions of the kidneys was regulation of fluid balance and blood pressure.

It took me about 15 minutes but by the end of it, most of the family seemed to get it.

What I got from that episode predominantly was that - even though it was the 5th instance - the family heard "heart failure" and they thought "bypass surgery wasn't successful, Dad is close to death". It took a good bit more explaining to assure them that HF isn't uncommon in bypass patients and that many patients live for years with HF if well managed.

I tend to agree that it's not ALL doctors who are guilty of the same. I work with a bunch who are absolute gems. I also work with a couple with who don't think twice about saying "your Father is very sick. He needs pressors and ventilation for his sepsis. We'll put him in the ICU. But before we do that, do you consent to heroic measures if the unthinkable were to happen?"

Really? :nono:

cheers,

Specializes in ICU.

I was handed endorsement in the ICU from this book smart nurse, but not much common sense. It was a new admission, she was new onset rapid afib. The nurse tells me she wants to be a DNR, I need to call the Dr to get the order. I look at her from the nurses station, she is not old, later 60's, no real previous chronic medical conditions. She is sitting in bed with a smile, makeup, nicely done hair.

I forgot to mention, she speaks broken English, but her primary language is Spanish, which this nurse can speak fluently.

Anyways, I go assess my patient and speak to her. She is on a Cardizen gtt, converted back into SR in the 90's. Very pleasant and understanding my English. I am not about to pick up the phone and call the Dr for a DNR order.

I told her what the previous nurse has said to me, and I explained a DNR to her, in very plain english, and very plain layman's terms.

She tells me No! If my condition was irreversible and there was no meaningful hope of recovery, I have my wishes stated in an Advance Directive.

Imagine I would have called the Dr and asked for a DNR??? I would have looked like an *******.

Moral of the story, make sure your patients and their families truly understand what you are talking about before they make life altering decisions.

I can still hear my instructors from nursing school in the back of my head when it comes to jargon and patients.

When my grandmother was in the hospital I found it interesting how some people knew how to thoroughly explain something in layman terms, and how others simply dumbed it down to basically meaning nothing. By the second day I was asking them to "lay it out for me" and then I was translating it to my family.

That's a danger we run- sometimes in trying to make it easier to understand we dumb it down so much, it means nothing

I'll never forget the card (and my co-workers enjoyed the box of chocolates) that the family of a patient sent in: "to Dad's awesome nurse Roy. Thank you for taking the time and patience to explain what Dad was suffering from. Not only did you look after Dad, you looked after us. Your kindness won't be forgotten."

My pt. had been suffering from new onset heart failure following a recent CABG. This wasn't his first episode (and it won't be his last :() of "shortness of breath" that brought him to my ED. Each time, the doctors talked to family and explained treatment plans and treatment was carried out.

It wasn't until the 5th visit in a year that one of the family members broached the subject when I was about to administer lasix to the pt.

"What are you giving him now?"

"I'm going to give Jack some lasix. It's a drug that'll help him with him breathe easier."

"But it's not a nebuliser! How will that help his breathing?!"

"Because Jack has what we call congestive heart failure. His heart has difficulty pumping blood. Lasix will help him by making more urine and that'll ultimately help his lungs breathe easier".

At this point I looked around the room and the family and realised that I wasn't getting through. So I said, "give me a moment. Let me give the Lasix and get Jack more comfortable and I'll try to explain things better".

I thought quickly and drew inspiration from a similar case from nursing school.

I pulled a couple tissue sheets from the wall dispenser over the wash sink and drew a rough sketch of cardio-pulmonary circulation. I explained that while Jack was having difficulty breathing, the problem wasn't his lungs but his heart. I explained the heart cycle and it's intricate relationship with the lungs and oxygenation. Then I added on the kidneys and reminded them that one of the primary functions of the kidneys was regulation of fluid balance and blood pressure.

It took me about 15 minutes but by the end of it, most of the family seemed to get it.

cheers,

sorry roy, but i disagree w/your explanations to family.

much too wordy and involved.

nurses/dr's need to keep it simple, i.e., lasix will remove the excess fluid in your dad's body, and he'll pee it out.

families are already stressed enough.

they're not going to retain a long, involved explanation.

just sayin'.:twocents:

leslie:)

His explanation worked well enough for the family to take the time to thank him and send him a box of chocolates.

But I agree with you, too, Leslie. Simple, clear explanations are usually the best.

Again, I suggest having the patient/family tell you in their own words what you just told them. That's when you can see if they really got it or not. Two minutes of communication follow-up can give you a second chance at bat if they haven't truly understood.

I used this technique with my kids for many years, and, boy, did it work wonders.

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