As I write this newsletter, I am preparing for a Having Hard Conversations training which will take place at the Community Hospital of the Monterey Peninsula in Monterey, California. I will be working with hospital administrators, nurses, doctors, accounting department employees and others. It isn’t the first time I have worked with nurses, but it is the first time I have worked in a hospital since my mother passed away in February. My mother was the first reader of this newsletter each month and I miss her deeply.
During the two weeks I spent with my mother in the hospital before she died, I did more research on communication in hospitals than I ever wanted to do. I spoke to and listened to conversations across all departments. I heard how those in transport spoke to patients while taking them for an X-Ray. I heard how attending physicians spoke to patients as they came through on their rounds. And while I wasn’t privy to the conversations nurses had with each other as they transferred responsibility of care at the change of a shift, I did hear how nurses requested support from one another, talked to custodians, and reported to doctors. It isn’t an exaggeration to say that life and death depends on these conversations.
Hospitals are stressful environments for those who work in them, for patients and for their families. And in moments of great tension and pain, how one uses one’s voice matters. My mother received excellent medical care during the last two weeks of her life. And beyond her medical needs, she was well cared for. Here are a few lessons I learned about the practice of care from those working at Abbott Northwestern Hospital.
As always, if you have any questions, comments or topic suggestions, please feel free to email me at Jennifer@jenniferabrams.com. I look forward to hearing from you!
White Coats and Hospital Gowns
The Caretaker and the Cared For
I am a great patient advocate. I will assert myself and ask for what I think is needed. Yet in the end I need to know that the nurse and/or doctor I am talking to is caring for the patient. Not me. When making a decision, the nurses asked my mother what she wanted. Not me. They called her by name and pronounced it correctly. They looked at her. They gave her a sense of control. She was lying down and they weren’t. She was medicated and they weren’t. As vulnerable as she felt, I know she felt respected. Often times in education we look at the parent, not the student; the adult, not the child. In this case, I was reminded that the while the caretaker has a voice, the cared for is the one on whom to focus.
Pace and then Lead
In Cognitive Coaching, we are taught to get ‘on the same page’ with those we are working with before moving forward. As support providers, we are there to work with the coachee, not beyond them. This means a coach checks in, attempts to understand what the coachee is feeling, gets a signal that the coachee is feeling heard and only then the support provider should move on with next right action. Support providers walk beside a coachee before leading them forward.
I watched physicians make rounds every morning. Physicians with their own private practices, then attending physicians, then residents with interns in tow. Those who knew how to ‘pace and lead’ were by far more effective. Those who were ineffective came in with a false “How are you feeling?” that was more rhetorical than authentic, while those who were effective realized that only three or four minutes of really hearing about how well the patient slept the night before might get him or her to agree to do that day’s physical therapy or might get him or her to eat more at breakfast; both resulting in a possibly a faster and easier recovery. Having a good bedside manner isn’t just a ‘bonus’ for patients; it is critical to one’s pace of healing.
Leveling the Playing Field
Try lying in a bed with those in control looking down at you from above. Your feelings of helplessness are already great. You are sick. You are wearing a gown that barely covers you. Those ‘in charge’ are covered in white coats or scrubs, stethoscopes and gloves. What can one do to level the playing field? One easy thing to do is stand where you can be seen. I noticed that a resident would come in and if he or she could, he or she would stand where the patient could actually see them. Sometimes that would mean coming in and standing at the end of the bed. Not to be far away, but to have a conversation face to face. If someone can’t move her head and doesn’t have great peripheral vision due to an oxygen mask or other impediments, it is hard to connect. Eye contact matters.
Doctors I saw recognized the importance of their non-verbal communications – they would kneel or pull up a chair so to be at the same level. I kept thinking of how this related to teachers. I recalled the punitive quality of standing above a student vs. kneeling beside her. As my mother chose hospice, two residents were in the room to listen to her request. They squatted down, eye level, at her bedside. I don’t know if choosing their positions was instinctive or planned, but to see my mother, the patient, have her voice and to see the doctors looking up at her as she stated her wishes, holding her hand as she spoke, was a reminder to me to honor those with whom we work, sharing control of the outcome whenever we can.
As always, if you have any questions or comments, please feel free to email me at Jennifer@jenniferabrams.com. I look forward to hearing from you!
For further information on the concepts described above, check out the following two resources:
Each month I will share with you information about a few of my upcoming trainings.
If I am going to be in your area, contact me so we can say hello, hopefully in person!
Having Hard Conversations
Ontario Ministry of Education
Toronto, Ontario, Canada
Being Generationally Savvy & Having Hard Conversations
Community Hospital of the Monterey Peninsula
Equitable Teaching Strategies
Galileo High School
San Francisco Unified School District
San Francisco, CA
Being Generationally Savvy & Having Hard Conversations
Chicago Public Schools
For additional upcoming events, please visit my Web site.
Until next time,
Feel free to forward this newsletter to friends and colleague. You may reprint this newsletter in whole or quote with attribution to Jennifer Abrams and a link to www.jenniferabrams.com