AACN News—February 1999—Opinions

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Vol. 16, No. 2, FEBRUARY 1999

President's Note: The Power of Nursing: Be Clear About What You Do

Mary G. McKinley

Communicating is simple. We do it every day. Practically nothing in life can be accomplished without it.

Reminders of the importance of communication are all around us. In today’s fast-paced world, there are many ways to communicate such as e-mail, fax, chat rooms, video conferencing, and virtual classrooms.

The degree to which technology has affected our ability to communicate is amazing. We no longer reach a live voice when we call someone on the telephone. Instead, we reach a series of directions to press a variety of buttons to leave a message for the person, who often “will get back to you as soon as possible.”

My concern is not so much the methods as the effectiveness of communication. Are our messages truly understood? I am reminded of the saying, “I know you think you understand what you thought I said, but I’m not sure that what you heard is what I meant.”

Between 70% and 90% of communication is screened or changed by the person who receives it, based on his or her personal history. The following story illustrates this problem:

A young boy asked 3 umpires at a baseball game how they decide balls and strikes. The first umpire said, “Well, some’s balls and some’s strikes, and I calls ’em as I see ’em.” The second umpire said, “Well, some’s balls and some’s strikes, and I calls ’em as they are.” The third umpire said, “Well, some’s balls and some’s strikes, but they ain’t nothin’ ’til I calls ’em.”

The moral of the story is that we are not alike when it comes to communication. If we assume that all people see the world as we do, then we’re likely to be wrong about two thirds of the time.

Because so much can be left to interpretation, clear communication is extremely important, especially for those of us working in critical care. We rely heavily on communication. It is one of our most vital skills. Consider the types of information you must communicate every day such as reports on a patient’s status, data that needs to be relayed to the lab, and orders from physicians that need to be clarified.

However, the most important communication for us is with our patients. We have the opportunity to share in the most meaningful and vulnerable moments of a person’s life and to learn to communicate with our patients and their families on many levels. We can communicate with our patients and families with a touch of humor or by simply remaining at their side. Sometimes, our expressions of caring are the most significant way that we communicate.

It is important that we communicate these expressions clearly and consistently. We must realize that everything we do communicates something. The way we dress, the words we use as well as the way we use them, the gestures we use, and the way we stand—they all “say” something to someone.

As a profession becomes more technical, its associated jargon becomes more intense. Because critical care nursing is an intensely technological specialty, the expressions that we commonly use around patients may be easily misunderstood.

For example, we recently had a trauma patient who was having difficulty with ventilation. The doctor ordered neuromuscular blockade and sedation to assist in the ventilatory process. The nurse casually commented that they were “putting the patient down.” Members of the patient’s family overheard the comment and were extremely upset, because they misinterpreted the jargon in lay terms.

We therefore must always be cognizant of what we are communicating to our patients and families. If we can communicate more clearly with them, perhaps they can better articulate what it is we do. As immediate past AACN President Gladys Campbell said at the 1998 National Teaching Institute™: “Our mothers don’t even know what we do.”

We must clarify for our public what it is that we do. One way to do that is through clear, consistent messages. Public understanding of what we do will enhance our power. The clearer the messages we send about the value that nursing brings to the patient and the family, the closer we come to creating the patient-driven healthcare system we envision. It’s up to you.


Don’t Use Animals for
Entertainment or Profit

I was disappointed that AACN publicized the donkey basketball fund-raising event in the October issue of AACN News.

I have no doubt that the intentions surrounding this event and the reporting of it were good. However, I believe the activity was in poor taste and damaging to the profession of nursing.

In case you don’t know, animals do not want to play basketball. This event was animal abuse, pure and simple, and I am sadly disappointed that my professional organization endorsed such an event.

Nurses are a powerful group that could influence public opinion regarding the use of animals for entertainment and profit. Physicians and lawyers have organizations that fight for the rights of animals. Why don’t we? It’s ironic that AACN would sponsor an event like this, yet advocate the pursuit of a healing and humane environment.

Dotty Welcome, RN
Honolulu, Hawaii

Think About How
the Donkeys Feel

It is both puzzling and ironic that a group epitomizing compassion and caring would agree to benefit from the cruel spectacle of a donkey basketball game (October 1998 AACN News). Although some participants may rationalize this event as harmless and “for a good cause,” donkey basketball games have no place in any humane fund-raising event.

In donkey basketball, animals are dragged around a court and forced to participate in something entirely against their nature. They frequently are “mishandled” by participants who have no experience with the animals. Food and water are withheld before games to prevent “accidents.”

Hauled in trucks from 1 strange location to the next, animals can develop unpredictable temperaments. They may lash out in frustration or fear, causing injury to participants or bystanders.
We hope compassionate people everywhere will give some thought to how the donkeys feel about their forced participation in this event.

Jennifer O’Connor
People for the Ethical Treatment of Animals
Norfolk, Va.

My Turn: Resuscitative Medicine Field Opens New Doors

By P. J. Umstetter, RN, CCRN

Blue over code blue? Never! I have had a strong interest in code blues since entering the clinical area in a mixed medical-surgical ICU a little more than 7 years ago, after working in a cardiologist’s office.

Other critical care nurses probably know the adrenaline rush that is experienced in the midst of resuscitating a patient, the knowledge that the life is dependent on what you do or do not do. There is a certain level of satisfaction one can gain in caring for a patient who is “crashing.” Each of us experiences this differently.

In the end, it’s knowing that you have affected a life.

Despite the advent of newer medications, more advanced technology, and increased educational requirements within the acute care setting, the survival rate for patients who suffer from cardiac arrest while in the hospital continues to be at an unacceptably low level. This fact, combined with my interest in cardiac arrest, has led me to my position as cochair of our hospital’s Code Blue Committee. In this role, I have become aware of a whole new field of medicine: resuscitative science.

Resuscitative science focuses on cardiac arrest, the patient population it affects, the mechanisms it sets into action, and outcomes. Using data collected, resuscitative medicine goes beyond the current processes to research, study, and test new means of caring for the cardiac arrest patient population as well as new ways to positively affect their outcomes.

Much has been written in the past about “field” arrests, those occurring before hospitalization. Many components have been evaluated and scrutinized with respect to what happens to a patient who requires cardiopulmonary resuscitation prior to entering the acute care setting. Scientists and researchers have been studying and testing new methodologies for treating cardiac arrest for years. The results have brought us to where we are with Advanced Cardiac Life Support and educational processes.

Only recently has there been much, if any, consideration of the application of prehospital concepts to the events occurring in the clinical area. Common sense would lead you to believe that, once within the acute care system, a patient’s chance of surviving a cardiac arrest would increase significantly. This is no longer an assumption we can afford to make. Many factors must be considered.

Patient demographics, event variables, and comorbid and pre-existing conditions all play a role in patient outcomes. As a critical care nurse, I quickly realized that we healthcare providers must look at what is going on in the acute care setting. We have a responsibility to maintain the highest possible level of care. If we don’t collect the data and evaluate them, how will change ever occur?

I seem to have practically created a position for myself that went beyond that of the bedside, intensive care nurse. Because I have been active in the field of resuscitative science, particularly in the hospital setting, I have continued to see my role expand daily. The options are almost limitless. The work has only just begun.

Although resuscitative science is in the early stages, I have already seen an impact in patient care. I am happy to be a part of something so compelling. Critical care nurses directly affect the care of the critically ill. Resuscitative science affords me an opportunity to do this in a new and exciting way.

Patricia J. Umstetter is a staff nurse at Lancaster General Hospital, Lancaster, Pa.

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