A recent article in the Guardian talked about the relentless pressure junior doctors are under. They are so busy that they can go through entire shifts without eating or drinking, while others suffer stress, burnout, exhaustion and sleeping problems. I realised that this was probably the case for many of my colleagues and was wondering if we could help more by simply communicating better. It is important that we show each other that we care. I have included some tips below and linked them to myself and my own practice in order to help others.
I’m a bit of a bull in a china shop; I have been since a child. I tend to speak before I think and this isn’t always a good thing. One of the things I’m constantly still learning is sometimes I need to listen more and not say anything at all. So when in a pressured situation let the person you are communicating with share their feelings and thoughts, uninterrupted. Empathise with them by putting yourself in their shoes. It is important that we help people cope with the immense pressure – to help them not feel so alone. This means that you must be engaged and interested in what the other person is saying, thinking and feeling. Don’t just sit there silently for the sake of appearing attentive. This won’t be productive at all, for either party. Make sure though that you learn from the people you are communicating with so that you can develop an active listening approach and better your practice. Try to move away from a ‘them and us’ mentality. Don Berwick talks a lot in his work about; moving away from polarisation of groups and creating a more team centred approach. He suggests we stop the ‘nurses do this’ – ‘doctors do that’ language and work together more effectively, by doing this we won’t just feel happier at work but it will also improve communication and patient safety.
Seek to understand
At the very beginning of my nursing career a Director of Nursing – Carol Dight (Former Director of Nursing at Taunton and Somerset NHS Foundation Trust) gave me some very wise advice. She said “James, make sure you seek to understand”. As a junior nurse then, I never really knew what she meant by this. I would be so fixated on a problem and would want to try and solve it there and then. I would give little thought to the many other factors that contributed to that particular problem. However, once I thought about it and started to ‘seek to understand’ I could really see the benefit of this. If you first seek to understand, you will not only experience the obvious outcome of better understanding, but will also find yourself being better understood by others. So don’t jump to conclusions, but try and build solutions to problems in conjunction with others, recognising their skills and experience. Recognising you may have gaps in your understanding is a good thing and if you’re aware of this you can improve. One way to do this is to reflect. For me, reflection is everything, it was embedded in me since my student days and it can be a really beneficial to keep a diary of events from your working day (keep patient confidentiality though). Don’t be afraid to ask many questions if you’re unsure or want more information or want to clarify what someone is telling you. Good, open clarifying questions encourage better communication for all parties and fundamental for patient centred care.
Think about communication as a vital tool in your toolbox
Effective communication skills embed a positive safety culture and a have a direct impact on patients and their safety. It can also help with feeling good about yourself and raise you and your team’s morale.
- Be prepared before conversations start. I always find it useful after a handover to look at the medical notes to look at the plan for each patient. You can always guarantee that one of the first questions a patient will ask you is“what is the plan nurse?” By being prepared I can answer their questions to the best of my knowledge and answer any questions the patient may have. This will also help the nurses and doctors work together.
- Always acknowledge everyone. Colleagues, patients and relatives, bring them all into the conversation; give everyone a chance to ask questions, don’t over use medical terminology or jargon or acronyms.
- If there are name boards in the patients bed space use them to write the people looking after the patient – this helps the patient if they forget, for the relatives who want to find out who to talk to and for your colleagues who want to find out more information about the patient – keep it up to date.
- When people want to talk, introduce yourself and tell them your name. Start by saying “Hello my name is”then sit down and answer any concerns or questions. This is for patients and colleagues.
- Be friendly and relieve tension if you can – be curious, truly enjoy talking with patients and their relatives and your colleagues and this will shine through.
National Kitchen Table Week
Much of what James describes so beautifully in this blog connects perfectly with the thinking behind our National Kitchen Table Week, taking place 27 of March to 2 of April.
If you wanted to really put into practice what James talks about here, then the National Kitchen Table Week is the ideal opportunity.
James Merrell is a Registered Nurse specialising in Renal and Urology medicine. James is also a Speak Out Safely Ambassador for the Nursing Times. Follow him on Twitter @MerrellJames