By impactEDnurse • Jun 13th, 2010 • Category: clinical skills
Scene: Just another busy day at the busy nurses station in St Elsewhere’s busy emergency department.
Nurse 1: Hey Jen.
Nurse 2: Hey Sharon. Oh….did Dr Plux show you that dudes abdo x-ray on the viewer?
There’s a tumour the size of a full term baby!
There’s a tumour the size of a full term baby!
Nurse 1: No -way!
Nurse 2: Yeah…go check it out.
Patient 1: [ A 40 yo. male with abdo pain laying in bed across the room]
What the…? Great gobs of goose shit!!! I just had an x-ray this morning…..Ive got a tumor!!!!
What the…? Great gobs of goose shit!!! I just had an x-ray this morning…..Ive got a tumor!!!!
[Makes frantic mobile phone call to mother in Canada….who rings rest of family in Queensland….who jump in car on a mercy dash to St Elsewhere].
During WWII the US office of War Information developed the slogan ‘Loose Lips Might Sink Ships’1 in an attempt to raise the awareness amongst service men and their families, that what they wrote in letters or what they talked about amongst friends may find its way to enemy spies.
And although most of our patients are unlikely to be enemy spies2, it is important that we try to remain mindful of what we are talking about when we are amongst them. And we are always amongst them.
And although most of our patients are unlikely to be enemy spies2, it is important that we try to remain mindful of what we are talking about when we are amongst them. And we are always amongst them.
Be it at the nurses station of a medical ward, on the floor of the emergency department, in the elevator, or sitting down to ‘de-brief’ with colleagues in the cafeteria, there is a fair chance that someone is listening in to your conversation.
In-the-loop:
One thing the medical system can do a whole lot better is to keep patients informed, up-to-date and educated on what the hell is going on with them.
Poorly informed patients and their relatives will be thirsty for information3.
As soon as they recognize a staff member that has been involved with their care, their radar will be switched to ‘high’.
Poorly informed patients and their relatives will be thirsty for information3.
As soon as they recognize a staff member that has been involved with their care, their radar will be switched to ‘high’.
Black humour:
Nurses and doctors can sometimes use our so called ‘black humour’ or dark humour, at times of high stress or sadness. Its an interesting topic4, and I personally think the use of black humour can be aneffective tool to de-fuse or de-flate the emotional energy that might otherwise overwhelm our ability to continue to function effectively at such times.
But beware.
Some of this humour could easily be offensive or distressing to the lay public (or even other staff members). And not just the dark side…. the usual joking around can easily be taken out of context or be executed at the wrong time and in the wrong place.
One of our nurses at work used to have the surname Wimpenny, and we used to call him Wimps for short.
We once received a 5 page letter of outrage from a patients relative who accused us of repeatedly referring to her son as a wimp.
But beware.
Some of this humour could easily be offensive or distressing to the lay public (or even other staff members). And not just the dark side…. the usual joking around can easily be taken out of context or be executed at the wrong time and in the wrong place.
One of our nurses at work used to have the surname Wimpenny, and we used to call him Wimps for short.
We once received a 5 page letter of outrage from a patients relative who accused us of repeatedly referring to her son as a wimp.
Inappropriate conversations:
Wrong time, wrong place, wrong person, or just plain wrong.
We recently had a patient in our department with chicken-pox. The fact that the department was so overcrowded led to an ‘enthusiastic’ discussion between some members of staff over the need to isolate him.
Unfortunately, this discussion took place right in front of the patient. He later told another staff member of the deep distress this had caused him. First of all it made him feel like some sort of leper, and second, all the patients around him now knew his diagnosis.
Unfortunately, this discussion took place right in front of the patient. He later told another staff member of the deep distress this had caused him. First of all it made him feel like some sort of leper, and second, all the patients around him now knew his diagnosis.
A fragment of misunderstood conversation, a poorly communicated explanation, a juicy morsel of gossip, an off the cuff remark, all can lead to sunken ships.
Good communication is a foundation on which we build quality healthcare. It is also one of our most powerful tools.
All it takes is a slight pause before loosening the lips to engage a little mindfulness. Remembering to take care with what we say, and to promote response-able speech may just avert -dare I say it- a Titanic disaster.
Good communication is a foundation on which we build quality healthcare. It is also one of our most powerful tools.
All it takes is a slight pause before loosening the lips to engage a little mindfulness. Remembering to take care with what we say, and to promote response-able speech may just avert -dare I say it- a Titanic disaster.
- This was one of several similar slogans which all came under the campaigns basic message – ‘Careless Talk Costs Lives’. [↩]
- ….although that man in bed 6 who wont take his trench-coat off is a little suspect. [↩]
- Recently my dad was in hospital. Following a routine procedure, he was unexpectedly moved to a high care area during the night. Do you think my mum could find out why he was moved? It would have been easier to get President Obama’s home number. [↩]
- It is fascinating to see the difference in communication and dynamics during a resuscitation where a family member is present. [↩]
impactEDnurse is also known as Ian Miller, a nurse with over 26 years experience working in a busy emergency department in, Australia. This site in no way reflects the opinions of that hospital. All stories (although based on actual experiences) have been changed to protect patient confidentiality.
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