A 0 RN-J 0 U R N A L _ _ _ - A P R I L 1984. VOL 39, NO S

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Education How can they tell that we care?

recently admitted my daughter to a hospital emergency department for a minor in- jury-an undisplaced ankle fracture. She is

fine now, and in retrospect, received good care. But at the time, my perceptions and reactions were so colored and exaggerated by my concern for her that I reacted as though her life were in danger. I experienced considerable distress. While the nurses did nothing wrong interperson- ally, they missed the opportunity to make the experience easier for me and my daughter. A little extra time spent with us to explain the procedures and delays would have made a differ- ence. As we nurses continue our education to become more competent professionals, do we also need to relearn that we are in a caring profes- sion?

From the beginning we should have felt the nurse’s concern in such a way that we knew we were not alone. There was not enough recogni- tion of the fact that we were individuals whose lives were changing for a few weeks because of this event. If some extra time had been taken to care for us, we may have acquired a positive, comforting attitude about that hospital that would make us feel it was our hospital and not just any hospital. Patients need a sense of in- volvement and commitment to a particular hospi- tal. As competition for patients rises, loyalty to a hospital will be increasingly important, meaning more admissions and a more sound financial base. By taking good care of others, we stand a better chance of keeping our jobs.

How could our interactions have been differ- ent? How do we let someone know that we are

concerned about him as an individual‘? Some call it first contact communications-the transmis- sion of caring in a short time to a stranger. Hotel chains, cafeterias, and department stores suc- cessfully teach these behaviors to their em- ployees.

What makes a satisfying communication‘’ Notice what clerks in stores do that makes you feel good. The words are important-but watch the other messages. Listen for voice tones and speed of speech. Sharp voice tones and rapid speech can increase anxiety. Softer, slower speech has the opposite effect and is easier to understand. Is the person really listening to what you are saying? Watch the messages the eyes send. Does the person make direct eye contact? Or does she look past you and keep on doing something else? These are basic observations, and they send strong messages.

Try another exercise. Watch interactions be- tween nurses and patients where you work. You will probably see some very caring messages, but you may also see some that translate to “I’m busy,” “other things are more important,” “you‘re in my way,” or “I don’t like or approve of you. ”The words are not said, but the message is there. The patient feels the difference and is affected by it.

Research shows that people most easily like and approve of others like themselves. Nurses, like teachers, arise mainly from the middle class of society. That means we understand other mid- dle class people and deal with them more easily than with some other types of patients. What about the patient who is drunk, unclean, or ag-

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gressive, or the patient whose lifestyle differs from yours, whether by income level, ethnic her- itage, sexual preference, or any number of fac- tors? Most of us believe that all humans are of equal worth, but we do not always carry out behavior that says that.

Effective, caring communication takes little additional time and can prevent costly errors and misunderstandings. Most inpatient communica- tions take place during another activity-inter- viewing a patient preoperatively, transporting or waiting for induction of anesthesia, teaching, or before leaving the patient’s side. The time often gets absorbed into things you have to do anyway.

What about genuineness-the wanting to make every patient feel special, to relate in a special way-and knowing that no person has enough psychological energy to do that? This is what causes burnout. Instead, become aware of what messages you are sending that go along with your words and establish a goal to at least treat all patients with respect. Every time you can, express concern and caring through verbal and nonverbal means. This may mean a touch, a pat on the hand, a moment of undivided atten- tion, an explanation of a delay, listening, a short, shared silence, a smile. There will always be patients, however, that we have no desire or even the ability to relate to more deeply. Each of us has intolerances and blocks, and we should be honest with ourselves and others about them. Ask another nurse to trade an assignment. Let him or her know that you don’t relate to that patient well. Chances are you will get a positive response, your fellow nurse will feel good, and the patient will be better responded to. No one can be all things to all people.

Another dimension of caring communication is being a good listener. Offering undivided at- tention, asking clarifying questions, and re- sponding in a way that shows you understood are powerful tools for improved listening. Beware of the traps of thinking of something else while listening, of allowing distractions to interfere, and of making assumptions and premature judgments. To check out your skills ask for feedback from your peers, supervisor, and fam- ily. This requires openness to change and some

risk taking, but is also worthwhile. In the financial climate of these next few

years, competition for patients will be high and patient satisfaction will become a priority. This is nice for nurses, because we have always been taught to individualize care and make each pa- tient special. But we have not always known how to translate that into behavior. We need to accept each other as we grow, and that will make it easier to accept, support and communicate car- ing to our patients.

As nurses we are in the best spot to be a patient advocate, because we have the frequency and intensity of contact to be most significant in patient care outcomes. If hotels and restaurants can teach employees to treat customers as spe- cial, important people, why are hospitals and nurses slow to make this a high priority? Are you an educator? Help get content and role playing about caring communication into new employee orientation. Are you a manager? Make caring communication a part of performance appraisal. Are you a staff nurse? Be a role model for others.

Most nurses do care and are concerned. Many are excellent at letting others know that from the beginning. Let’s all get even better at it.

JANET K HIXON, RN, MA DIRECTOR OF EDUCATION

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