When my oldest daughter Molly was four she woke in the middle of the night vomiting blood. I rushed her to the emergency room at the Children’s Hospital. She continued to vomit blood for several hours as we sat in the waiting room.
Eventually, she was given a small dose of Zofran while we waited to see a doctor and fortunately her vomiting stopped. It was a terrifying night for me and my daughter. The nurse that cared for Molly that night in emergency helped Molly feel less frightened about the experience using therapeutic communication techniques. Unfortunately, the nurse displayed some non-therapeutic communication skills in her interactions with me. It is important for a healthcare provider to remember that when it comes to patients who are children, the parent becomes an extension of the patient. Therapeutic communication involves the use of specific strategies to “encourage the expression of feelings and ideas and convey acceptance and respect.” (Potter, Perry, Stockert, Hall, Astle ; Duggleby, 2019, p. 282). Sharing humour is a valuable tool for healthcare providers to help a patient remain positive and distract them from a painful procedure, such as a needle.
“Humor has been shown to have positive effects on both a person’s emotional and physiological state” (cited in Potter et al., 2019, p. 283). In our experience, Molly was hooked up to an IV to help replace the fluids lost through vomiting. She was very scared of the IV needle and the hard-plastic protective cover that was taped over the IV to prevent her from pulling at it. The nurse was able to calm Molly down by explaining that it was just like Buzz Lightyear’s control panel and used a marker to draw buttons on the protective cover. The nurse used humour to distract Molly from the painful procedure. Molly thought this was great and was upset when the IV had to come out and the plastic cover came off. Empathy is the ability to appreciate another person’s perspective in a given situation and how it may be affecting them both physically and emotionally. “The nurse needs to be able to identify and eliminate factors that can possibly make the child feel insecure” (Grahn, Olsson, ; Mansson, 2016, pp. 284-292).
In our case the nurse understood that Molly was not upset as a result of the pain of the IV needle coming out, but she was upset lose her Buzz Lightyear control panel. She empathized with Molly and gave her a new panel and some tape to take home so that she could make another one. This left Molly feeling like spending 12 hours at the hospital was all worth it. The patient or their family may not understand what the medical concern is, what the plan is to investigate further, or what the treatment plan is.
“Providing relevant information that the patient needs or wants to know empowers the patient to make informed decisions, experience less anxiety, and feel safe and secure” (Potter et al., 2019, p. 284). In our experience, I was told that the doctor thought that the blood was likely from irritation due to the force with which she was vomiting. My understanding was that any tests that were being done were to confirm this and no information was shared with me to lead me to believe otherwise. Only after an ultrasound, hours of waiting, and my finally asking about going home was I told that the doctor thought that Molly might need surgery.
This would have been less of a shock had it been communicated to me earlier. The doctor decided that she most likely did not need surgery but was to be admitted for monitoring. In contrast to therapeutic communication, which is positive, there are also many types of non-therapeutic communication. Non-therapeutic communication can have a negative impact on patient and professional relationships as it tends to “discourage further expression of feelings and ideas and may engender negative responses or behaviours in other people” (Potter et al., 2019, p.285). During this hospital visit with Molly, I experienced non-therapeutic communication in the form of an automatic response. An automatic response tends to be a generalized or non-specific statement that indicates that you are not thinking specifically about the current situation and unique individuals involved. An automatic response “tends to dismiss the other person’s feelings and minimize the importance of his or her message” (Potter et al., 2019, p. 285).
I was told that my daughter was going to be admitted for monitoring without any discussion with me. Given that at this point Molly had not vomited for almost 12 hours and they had determined that she probably did not need surgery, I did not understand why she needed to be admitted to hospital. I wanted to take Molly home. The nurse communicated to me that if Molly was her daughter, that she would allow her to be admitted to the hospital for observation. I wanted information and advice not her personal opinion.
This created doubt in my mind as to her expertise. Personal opinion differs from professional advice. Professional advice is a way of making sure the patient is aware of their options but acknowledges that the decision is for the patient to make. “When the nurse provides a personal opinion, it takes decision making away from the patient” (Potter et al., 2019, p. 285). The nurse’s reaction to my wanting to take my daughter home could also be seen as disapproval which is another non-therapeutic communication technique. “When a patient challenges a provider’s perspective, conclusion or diagnosis, the clinician needs to honor that challenge; have the emotional maturity and humility to use the patient’s concerns as data; and be willing, if appropriate, to reconsider, revise, or altogether scrap a plan of care” (Raphael-Grimm, 2015, p. 51). Instead of passing judgement, the nurse should have taken the time to listen to me to better understand my concerns. When she did take the time to actively listen, she learned that Molly had slept little of the 12 hours we had been in the hospital and was exhausted. She also learned that in addition to asking to take her home, I was willing to follow up with our family doctor to ensure that there were no further health concerns.
The nurse was than able to act as an advocate on my behalf with the doctor. Shortly after we were on our way home with an appointment in two days to see our family doctor and a Buzz Lghtyear control panel for Molly. Overall it was a positive experience for me because Molly was well cared for. I think that there are ways in which I would change the interaction to make it even better. If the nurse had communicated relevant information concerning Molly earlier, it would have been less of a shock for me to learn of the potential surgery. Molly and I may have also been able to go home sooner had the nurse kept her personal opinions to herself and been more open from the beginning to listening to my concerns.
References
DeVito, J. A., Shimoni, R, Clark, D. (2016).
Messages: building interpersonal communication skills (5th ed.). Toronto, Canada: Pearson. Grahn, M., Olsson, E., ; Mansson, M. (2016). Interactions between children and pediatric nurses at the emergency department: A Swedish Interview Study.
Journal of Pediatric Nursing, 31(3), 284-292. doi: 10.1016/j.pedn.2015.11.016 Jakubec, S. L., ; Astle, B. J. (2019).
Communication and Relational Practice. In P. A. Potter, A. G.
Perry, P. A. Stockert, A. M.
Hall, B. J. Astle, ; W. D. Duggleby (Eds), Canadian fundamentals of nursing (6th ed., pp.
271-290). Toronto, Canada: Elsevier. Raphael-Grimm, T. (2015).
The Art of Communication in Nursing and Health Care: An Interdisciplinary Approach. Retrieved from EBSCOHost Academic eBook Collection (North America) database.
