During clinical this semester, I saw major improvements in my comfort level being around my patients. At the beginning of the semester, I was incredibly nervous to go in my patient’s rooms, and their families terrified me. The first three patients I had all had active family members in the room, and I found it incredibly difficult to evaluate my patient and spend time with them when I felt like the family members were watching my every move. I am sure my body language was a mess, with my arms tight by my side and my hands fidgeting. I would rush into the room, ask if the patient needed anything, and then rush back out for the next hour until I had to do it again. I was constantly worried that patients were going to ask me to do something I didn’t know how to do and then they would get mad that I was incompetent. I slipped felt myself slipping into customer service mode, which I am sure the patients could see was ingenuine. However, about four weeks in, I had a patient that didn’t speak English, and we were had to communicate on a very basic level. This patient was a turning point for me, and I was able to gain some confidence in myself that carried through the rest of clinical.

The patient that I had primarily spoke Arabic, but he knew some broken English words and phrases. I was able to focus a lot on my nonverbal skills, and he responded really well. I used therapeutic touch to reassure him when he got frustrated due to his confusion, and I maintained eye contact, smiled, and nodded as he attempted to explain the significance of his beads. It was one of the first times where I felt like my interaction was very genuine, because there was no point in putting on pretenses that the patient couldn’t understand. By spending time with this patient, we established some trust and I was able to identify his nonverbal indicators of pain. The experience felt enlightening, and I felt like I understood for the first time how to apply therapeutic communication techniques.

From then on, I have felt more comfortable interacting with patients and even their families. The very next week I was able to establish lines of communication and trust with my patient and his husband, and his situation required a lot of time and privacy. By creating a sense of comfort, my patient felt calmer and less embarrassed as I normalized his situation. Another week, my patient was on a ventilator, and she was incredibly anxious. I had to be a calming presence for her, so we could keep her oxygen stable. Making eye contact, using therapeutic touch, and a calming tone made it possible for her to relax during difficult turns and medication injections. For both of these patients, I was actively communicating with their families and providing education and updates on the patient’s conditions. By having these positive interactions, I was able to gain more confidence in my abilities and my role as a nursing student.

Unfortunately, clinical was cut short before I could make all the growth I had hoped. So, as we continue onto other clinicals, I want to improve my communication with family members. While I definitely feel more comfortable interacting with patients, I am still uncertain of my role with family members. Next year, I am supposed to be in the NICU for my peds rotation, and I hope that I can really hone my skills talking with families, because that will be the primary communication. I also want to work on discussing my patient’s emotional needs. I feel comfortable providing nonverbal support, but I want to get better at starting conversations about their feelings regarding the process. Now that I have more confidence in my skills, I want to make sure I am providing the best therapeutic communication for my patients, by staying aware of my communication and what I do right and wrong.

For today’s blog post, I decided to watch an episode of the long running television series, Grey’s Anatomy. The show follows the surgical attendings, residents, and interns at Seattle Grace Hospital. I would describe Grey’s Anatomy as a relationship drama show first and medical show second. If anything, the hospital merely serves as a setting to incite the drama. Therefore, the communication between patients and medical staff is far from therapeutic most of the time. The episode I will be analyzing specifically is episode six from season one – If Tomorrow Never Comes. The primary patient we are introduced to is Annie, who was admitted to the hospital because of an excessively large abdominal tumor. The tumor was growing for over a year, but she refused to seek medical treatment, because she was afraid of dying.

The first intern to take her case is Dr. Alex Karev. He starts his communication very therapeutically by greeting Annie by her first name, smiling, maintaining eye contact, and keeping an open stance when he talks to her. His body language and tone are very friendly and probably quite comforting to the patient. Dr. Karev does bedside reporting to his attending, keeping the patient involved in her care, but the use of too much medical jargon seems like it would affect the patient’s understanding of her care. Dr. Karev takes Annie to her MRI, and before she goes in, he explains the procedure to her, reassures her that he will be there the whole time, and gives a therapeutic touch to her hands to calm her nerves. However, Dr. Karev ends his therapeutic communication shortly after. He talks to the MRI technician about how Annie is “sick” and “warped” saying he doesn’t “know how she lives with herself” (Rhimes et al, 2005). His judgement is overheard by Annie, and she later indicates that she doesn’t think she wants the surgery because she would rather die. Dr. Karev’s lack of empathy eventually lead to a non-therapeutic relationship, causing his patient to doubt going through with the surgery. Strike one.

Another intern, Christina Yang is assigned to the case, and she interviews the mother about the health history of Annie. The mother stated that she finally decided to call 911 when her daughter was having trouble breathing, because it “felt like the right thing” (Rhimes et al, 2005). Dr. Yang proceeded to say, “the right thing would have been to call a year ago” and then shakes her head and walks away (Rhimes et al, 2005). There is no room for Dr. Yang’s judgement in this situation and saying what the mother or patient should have done is not helpful when there is nothing to be done about it now. It only serves to make the patient and family feel guilty or bad, rather than comforted. Dr. Yang even goes on to tell her coworkers “it’s like she fatally lazy” (Rhimes et al, 2005). Her attitude fails to be empathetic to the patient’s condition, and spreading her judgement only serves to solidify her opinions and alienate the patient, which could fatally impact her care. Strike two.

The last intern to work on Annie’s case is George O’Malley. It seems like he has the most hope at a therapeutic interaction with the patient. He reassures her that Dr. Burke and Dr. Bailey, her lead surgeons, are great. He also validates and voices her concerns by saying “I know you’re probably scared. (Rhimes et al, 2005)” This opens up the lines of communication, and she begins to communicate how she has been feeling about everyone referring to her and thinking about her as “the fat, nasty tumor lady” (Rhimes et al, 2005). This is where Dr. O’Malley begins to stop his therapeutic communication. He asks her “why did you let it get this bad?” (Rhimes et al, 2005). Asking “why” questions comes across as very accusatory. In the show, the question was actually well received, and it opened up some of the patient’s underlying concerns and fears about hospitals and surgery. However, it would have been better to rephrase the question to sound less accusatory. The patient shares how she just kept putting it off and the longer she waited, the more afraid she was. Dr. O’Malley reassures her that she is not alone in this experience by stating “you’re not the only one to put things off” (Rhimes et al, 2005). This can help the patient to feel less alienated. However, Dr. O’Malley takes this opportunity to self-disclose, and while mild self-disclosure might have been helpful, he overshares. He talks about his unrequited feelings toward his coworker, which is a non-therapeutic boundary crossing. He loses sight of who is in need of the support, and this shifts the problems toward himself rather than the patient. This causes patients and providers to lose sight of their role in the situation, and it can be harmful to the patient’s well-being. And that’s strike three.

Unfortunately, it’s strike three and we’re out, and so is the patient. She ends up dying during surgery, and the doctor’s judgments throughout the episode were no help to her therapeutically. If anything, it seems like they destroyed her will to live, and her final day of life was spent feeling bad about herself. Not only was the lack of therapeutic communication harmful in the patient’s condition, but it also affected the doctors who were left feeling guilty about what they did and said now that she had died. There were definitely positive moments of therapeutic communication, but I would say the bad outweighed the good. Even though this television series is fictional drama about the lives of surgeons, the lessons on therapeutic communication can be applied to us – real life nursing students. I think it was important to see these non-therapeutic interactions occurring, because it reminds us to be mindful of what we think is acceptable.

References

Rhimes, S. & Vernoff, K. (Writers), & Brazil, S. (Director). (2005). If Tomorrow Never Come [Television series episode]. In S. Rhimes’, Grey’s Anatomy. Los Angeles, CA: American Broadcasting Channel.

My biggest communication challenge has been communicating with the patients when they are unhappy. Granted, I have only had three patients. In two of the three, I noticed that I feel very comfortable talking to them when we are just “chatting” so to speak. However, whenever they have an emotional response to something and I’m expected to do something about it, I freeze. I think part of the problem is that the family or another health care professional is usually in the room watching me or waiting for me to do something, and the audience stresses me out. I’ll give you specific examples, of occasions when I “froze”.

When my clinical partner and I were introducing ourselves to our patient on the first day, we started introductions relatively confidently, but when we asked how she was feeling, she responded that she “felt like crap and now I’ve got to put up with you two for the next six hours.” My partner and I were both pretty shocked by how blunt she was, and neither of us really knew how to address such a strong response, so we just said sorry to hear that and bolted out of the room. Our patient ended up warming up to us as the day went on, but I would have liked to address her concerns in the moment instead of freezing. A different interaction I had with a patient went similarly. She had a very painful pericardial drain, and several times throughout the day was crying to her family members in the room. Every time I came in, she would try to cover up that she was crying, so I felt like I was intruding on a personal moment. Later, in echo, she started crying again and with other nurses around, I wasn’t sure what to do, since I still felt so new. Now that I’ve had two separate patients where I “froze” when they got emotional, I’ve started to sense the pattern of a communication challenge.

I think the biggest thing about me that contributes to this is my inexperience. I feel like I have a bit of imposter syndrome where I feel like I don’t know what I’m doing and shouldn’t be allowed to be (partially) responsible for patients. So, even though I might know what to do on paper, in the moment I lose the confidence and can’t act how I know I should. I also think that learning about the “do’s and don’ts” of therapeutic communication made me aware that a lot of my instincts fall into the “don’t” category. The most common example being “Don’t worry! It will be okay!” Now that I know I shouldn’t do what I normally would, I instead choose not to do anything! I think that with more time and experience interacting with patients, I will grow in confidence not only with my skills but with my communication.

I know it’s a cliché to say “practice makes perfect”, but I truly think that is how I will be successful. I also think that is why I struggle now, because I have never practiced comforting someone with a serious illness. I’m going to try and make more of an effort to be open for communication with my patients, even if it puts me outside of my comfort zone. This may mean starting more conversations or just being more readily available to my patients if they need to talk. The more I practice communicating, the more I will be able to feel what is most effective. I also plan to reevaluate if my communication improved throughout the semester, and if not, what else may be causing this barrier.

Hello, again! Today I will be describing the insights I made while people watching at OSU’s union. People watching, a socially acceptable form of being creepy, allowed me to observe how people communicate in a natural setting. My blog post will mostly focus on nonverbal communication, because it was difficult to eavesdrop on conversations that weren’t taking place immediately next to me. I switched locations in the union throughout the exercise to change up the people I was viewing. That being said, let’s dive in to the juicy stuff!

I started in the main floor of the union, and there I was able to observe mostly foot traffic and people studying. The people studying all had a similar set-up. They had a laptop or iPad pulled out and headphones in. The nonverbal communication was very clear that they did not want to be disturbed and were therefore tuning out the rest of the union. However, I did think it was interesting to see who was truly invested in studying and who was searching for an excuse to stop. People who really wanted to study kept their focus on the task the entire time, but those who were seeking something else continually got distracted by other noises, people walking past, and something on their phone. They would then spend a couple seconds looking around the room before returning to their work. The only person who was alone and without an electronic device was an elderly man sitting in a wheel chair people watching as well. It made me consider how the generation gap affects a person’s ability to be alone. He seemed perfectly content to sit and be alone and quiet. Meanwhile, every other person who was alone was connected to a device. This was especially evident when I moved into what I consider to be more social area – the dining tables.

In the union dining area, everyone who was eating alone was looking at their phone. It felt very similar to the union main floor, except there were more groups of people interacting. The first group I decided to analyze was a group of three girls, with two sitting next to each other and one across. The single girl across was dominating the conversation – I don’t think she stopped talking the entire time I was observing them. What was really interesting about the encounter was that the other two girls were on their phones. When I first saw this, I thought “well it doesn’t seem like the phones are inhibiting the conversation” but as I watched longer, I realized it was a nonverbal cue that the two girls were uninterested in what their third friend had to say. The two girls sitting next to each other also angled their bodies toward each other and away from the third friend, and when they spoke, they spoke to each other, often over the third friend’s chatter. I found their dynamic to be the most interesting, because they were giving very solid cues to their friend that they wanted her to stop talking, but her lack of awareness caused her to not pick up on the cues. An instance where use of the phone did halt conversation was taking place nearby. A boy and a girl were standing facing each other, carrying on a long conversation, when he pulled out his phone. As soon as his attention was no longer on his companion, her body language changed. She began to angle her body away from him and started looking around more – less invested in her companion. That being said, the use of a phone in one couple did not seem to hinder the conversation, but the difference was that they were using the phone together.  They were close together with their heads bent down over the screen. So, it appears that the technology does not always hinder communication between people, so long as they are experiencing it together.

I also watched two instances of communication without technology, with similar reactions. A set of girls sat across from each other, and they seemed to be really invested in their conversation. They both made lots of hand gestures and nodded enthusiastically when the other was speaking. They also both leaned closer to the table to be closer to each other. A very different interaction was occurring at the table next to them though. A boy and girl were sitting across from each other and eating, but absolutely no conversation took place. The girl looked down at her food, and the boy looked out toward the window. As they began to finish their meals, some conversation began to take place, but only the boy seemed enthusiastic to be talking to her. He leaned forward with his hands on the table and looked directly at her. However, she leaned back with her hands in her lap and looked down – not directly at him. And, to tie into my theory that people who are alone need technology, even though little conversation took place when they were together, as soon as she got up to leave, he pulled out his phone. Suddenly, when he was alone, he needed to be invested in his phone. While I was watching all of this go down, I saw a tour group out the window, and moved to get a better look at their dynamic.

Let me just say, I love tour groups. I think they are absolutely hilarious and awkward, and every tour group seems to be comprised of the same types of people. I’ve been going on college tours since I was 12, because of my older siblings, so let’s just say I’m well versed in the art of the tour group, and OSU was not an exception. The students are quite the paradox, because they are obviously uncomfortable around a group of strangers, so they stick near their families, but they are also embarrassed to be with their families around their peers and older college students. As a result, there were a lot of hands in pockets and crossed arms, and when they were walking they either walked a little in front of their parents or a little behind. When the tour guides stop to talk, the students who are embarrassed to be there rarely watch the tour guide. Instead, they were turning their heads to looks almost anywhere else as a sort of escapism. Meanwhile, the parents seem to hang on to everything the tour guides say, watching each hand gesture they make, and the tour guides make a LOT of hand gestures. The tour guides all have very similar body language, and it is all very open and confident yet casual. They make a lot of emphatic hand gestures, make eye contact, and keep their stances very open. It makes sense that OSU would hire students like this for tour guides, because they are the first impression people get of the university, so they want it to be a positive one.

Alas, that was the extent of my 30 minutes of observation, but I think I learned some interesting themes throughout communication. Technology more often than not is used as a cue that a person is not interested in starting a conversation or listening to a current conversation. It is also used in the place of companionship when a person is alone, but that seems to be mostly for the younger generations. Also, where a person’s eyes are focused, how their body is angled, and what they do with their arms and hands are very indicative of their interest in a person or conversation. I enjoyed people watching quite a bit, and I think it has made me aware of how I may appear to others through my use of technology and my nonverbal cues.

Hello! My name is Rebecca Blunt, and I am currently a second-year here at OSU majoring in business management … wait that’s not right … Nursing! I am majoring in nursing, as you could probably guess due to the fact that I am taking Therapeutic Communications in the College of Nursing. Seeing as this is my first blog post, I would like to use this opportunity to introduce you to myself both professionally and personally. Fasten your seatbelts, because it’s going to be a wild – and informative – ride.

I was born and raised in Southern California (not Cali). I’m from the city of Glendora, but seeing as how no one in California – much less Ohio – knows where that is, I will break it down for you. I am about an hour away from anything truly important: an hour from Los Angeles, an hour from the beach, an hour from Disneyland, an hour from the mountains, etc. Despite being far from the action, I managed to pick up a couple of hobbies throughout the course of my life. I like to consider myself relatively artistic or crafty. Unfortunately, I lack the attention span to become truly invested in any one subject. As a result, I can knit, paint, draw, felt, water color, and sew with slightly above average skill. I am also a lover of books, movies, and stand-up comedians. My two favorite books are The Glass Castle by Jeanette Walls and Born a Crime by Trevor Noah, my two favorite movies are Pride & Prejudice and Love, Simon, and my favorite comedians are John Mulaney and Trevor Noah. From my hobbies, you are probably assuming that I must be very pale from all the time I spend indoors. While you technically wouldn’t be wrong – I am very pale – I do enjoy a plethora of outdoor activities too. I like to play tennis, kayak, swim, zipline, and relax in my hammock. I also like to travel, especially to places with good food and good beaches! My dad made it his mission to see all 50 states, and because hiring a nanny was too expensive, my siblings and I have each been to about 35 states with him. This coming summer I am about to go to Europe for the first time to visit Spain and Portugal. I hope I get the chance to go back to Europe soon, because Greece, Italy, France, and Ireland are all high on my list of places I would like to see. Because it’s going to be expensive to travel to all of those places, I decided I better find a good job. That’s why I decided to become a nurse!

Just kidding! More thought went into my decision to pursue nursing that that, but I needed a segue into my next paragraph. And, would you look at that? Here we are! Almost every person I tell that I am going in to nursing asks what specialty I want to pursue, but I still do not have an answer. I am interested in many specialties, and I have very little knowledge about the intricacies of each. Luckily, we have clinicals, so I can see where I find my niche. As of now, I am interested in working in the ICU, NICU, or labor and delivery. I like the idea of something fast pace that constantly changes. Truth be told, I am open to anything. I just want to get as much experience as possible, so I can be a confident and highly-skilled nurse wherever that may be. My only experience nursing, aside from the one-day of clinical I have had so far, was this past summer training as a CNA in a rehabilitation center. My favorite part about the experience was working with all the people. I found their quirks incredibly entertaining, and I am looking forward to a future of working with people from all walks of life.

I think that pretty much sums up the majority of my life right now. Hopefully I didn’t completely bore you with all the detail. I am looking forward to the semester ahead, and I especially cannot wait to dive deep into the content of this course. Thanks for your time!