English is not my first language. And anyone who adopted a second language as an adult can probably relate when I say that certain words and turns of phrase will remain foreign to me, in spite of using American English (almost) full time for the past 30 years. For example, I can never make myself say “cool” other than in reference to the temperate side of the temperature scale (cool breeze, skin is cool to touch). I’m sure I can exclaim “cool!” (to mean excellent) when I see the mean arterial pressure rise above 65 in a patient with sepsis receiving a saline bolus, but it would not be me. In my mind, I would sound inauthentic. Effective nurse-patient interaction is part science and mostly an exercise in the art of deliberate tuning in with another human being and their surroundings. Because patients inhabit a unique space in the healthcare landscape, our manner of speaking must be recalibrated. In other words, we have to watch our language, to abandon mindless clichés and take up mindful communication.
“Awesome” and other lies
Every language has a prolific supply of filler words and figures of speech that run the gamut from the chirpy (“Great job!”) to the downright puzzling (“How are you?” Not as a question, but as a greeting). In quotidian chatter outside the hospital, they are benign. At the bedside, not so. Consider these two conversations overheard from behind closed-curtains in a hospital room.
Patient (2 days post bowel resection): “I just had a bowel movement for the second time in the last hour.”
Patient (peering into a medicine cup): “Is this my pain medication?”
Nurse: “Yes. Enjoy!”
The first scenario begs the question why? and the second how? I’d like to imagine the nurses in these examples meant well, and were kind and attentive to the patient. But, since when did having two bowel movements in an hour inspire great admiration? And when did the mock stern but cheerful command “enjoy,” start punctuating med admin? Perhaps these linguistic misadventures would not trigger a call to The Joint Commission, but they need consideration in the overall context of the patient experience, given that bedside-level interaction is at the core of patient-centered care. Florence Nightingale understood this when she wrote in Notes on Nursing “I would appeal most seriously to all friends, visitors, and attendants of the sick to leave off this practice of attempting to ‘cheer’ the sick by making light of their danger…”
For the well-informed anxious patient, reflexive banalities such as “everything will be fine” and “you’re doing great” do little to allay their fears. It can even exacerbate the stereotype that healthcare workers have no time to listen to patients. In the first scenario, an alternative reply could be “I shall monitor you for diarrhea.” In the second example, “I’ll come back in 1 hour to check your pain” would be a more clinically focused response. After all, the patient is in the hospital and not at the local diner about to consume the day’s combo special. Our role as interpreters of maladies is to attempt to be as unambiguous as possible when translating to our patients and their loved ones their predicament and to convey caring in no uncertain terms.
Clear and present
Several years ago, I entered a patient’s room to check on the patient, whose heart monitor showed asystole—the inescapable flat line that underlines the finality of life as we know it. The patient’s advance directive indicated no resuscitation. I found the patients’ wife asleep, holding the patient’s hand as she kept vigil at the side of her dying husband. When I tapped her on the shoulder, she opened her eyes and asked “Is he gone?” I said “yes.” For a few minutes, I simply stood there in the stillness of the room with her quiet sobbing. Then, I said “I will leave and come back in a few minutes.” This experience reminded me that our patients and their loved ones appreciate unadorned, honest and empathetic communication. Presence speaks louder than words. One should never be compelled to speak more than necessary.
I have heard some healthcare providers’ express preference for patients who can speak English. This makes me wonder. Infants and domesticated animals do not speak English, yet neonatal, pediatric nurses, and veterinarians do so well with them. I think the magic lies in the ability of these providers to anticipate the needs of those who can’t articulate them in words and in being truly present, with their caring instincts fully engaged.
Don’t be “tone” deaf
Language, any language, is infused with colorful idiomatic expressions. This sometimes makes communication “a hard nut to crack,” to use one example, especially for patients with limited English proficiency. Tone gives language and speech their many shades of grey. Amid the din of the nurse’s station chatter, one can hear the ubiquitous “may I help you?” in response to the call light. Now and then, when I really pay attention, I would notice a dissonance between the words and the tone of the voice of the responder. Impatience, exasperation, annoyance, even anger can be discerned in the verbal offer to help.
True, there are instances when the patient-customer is not always right. But, we will minimize the mutual wear and tear on our nerves if we acknowledge that patients experience time and timing differently from the providers. It is beyond simply imagining ourselves in their shoes. It is more about being trusted for our prompt caring than for being forgiven for our callousness. If we take communication as a metaphor for life, our respect for the tonal congruence between our words and our actions signifies our willingness to uphold the spirit of civility in the way we behave and speak. Next time you answer the patient’s call light, speak kindly and coolly. That, would be really “awesome”.
Fidelindo Lim is clinical associate professor at New York University – Rory Meyers College of Nursing.