Communiwhat? 6 C’s Part 4

“Much unhappiness has come into the world because of bewilderment and things left unsaid.”
― Fyodor Dostoyevsky

Communication……nobody ever says ‘you know why we don’t get on? It’s because she/he is too good a communicator’.  In essence if you’re good across all domains ; written (mechanical), verbal and non-verbal then you’ll be supportive, have great colleagues, smile a lot and be effective, get it wrong and you’ll spend years, perhaps a whole career wondering why you’re in conflict a lot and why people ‘don’t get you’.

Over 4 years of intensive contact with everybody ‘health’ we’ve experienced some real stand out moments of great communication and also some real low moments where poor communication has been the root of stress, problems and hurt.

Communication is bi-lateral (or should be) and if all people in a particular communication transaction are at the same emotional state at the start then achieving great outcomes is easy.  Thing is unless you and your significant other have just won the lottery 5 minutes ago then your emotional state will rarely by exactly attuned with another person.  It’s the same with the people who have cared for Isaac ; there’s a huge disparity in emotional state, huge differences in ‘power’ and a several elephants in the room that really don’t help.  So yeah, the nurses were up against it…!.

Where to start?  Well, written communication is topical seen as you’re reading this! Rarely unfortunately can I say that this has been great in the context of Isaac’s care. A consultant’s letter that we were not initially cc’d in on which states ‘I think todays meeting came as a great shock particularly for mother(..)..father seems keen to continue a very pragmatic approach’ ; I kid you not, this is language used last year.  ‘Mother’ and ‘Father’. Call us Mr and Mrs if you must, use our first names, honestly we’re ok with it…had you ever asked?…but using ‘mother and father’ makes it sound like we’re the subject of a case study. As for the patriarchal tone and statement, that’s not unique in our experiences unfortunately.  ‘But that’s how doctors write to each other’ was one response we got when raising a complaint…because clearly we can all blame culture when we cock up cant we?

Anyhows, sorry to start on a negative there but it is for me a strong example of how poor it can be.  On a lighter note I do love how Air Liquide who provide Isaac’s emergency oxygen cylinder write to him personally for customer feedback every few months.  I’ve tried getting him to construct a written reply but it’s still work in progress!

Also on the subject of written communication ; when Isaac was on NICU the staff stopped us from seeing what info was in the folder at the end of the incubator.  You can guess our thoughts.. “Why? Is it full of things we’d worry about if we knew? Is it about things they cant think of how to tell us? Does it contain things about us as parents? What is it?”

I make the point facetiously because I DO know about data protection, sensitivity and record keeping but nobody took the time to explain at any point of the 120 days of Isaacs initial care…on one occasion I opened it just to see when Isaac had last had his cares done and was tersely told by a nurse ‘excuse me you aren’t allowed to look in there’. Point I’m making is that a bit of well timed communication could have a) stopped me looking b) allayed our anxieties and c) stopped us thinking that the nurse concerned was a bit horrible.

On a verbal communication slant, there’s been several situations where people have just not engaged brain before speaking. The problem underpinning it is like I mentioned earlier – you’re talking to parents a time where they are at their most vulnerable. Spelling it out, our twins were prem, Isaac was ventilated / CPAP / BIPAP dependent for 8 weeks, we’d barely slept for weeks, our stress levels were at top level then…..then you meet the nurse who walked over to the incubator looked in (first time she’d ever met Isaac) and said…”ooh, hasn’t he got a small chin?”. Now I look back at it and think ‘well, what were you expecting, Bruce Forsyth?’ but at the time, when there were concerns about his airway, his respiratory effort, his muscle tone and we were on Def Con 10 of stress it felt like she’d given us something we needed to know. “is his small chin related to his breathing problems? Is it that he’s got some genetic condition where he has a small chin?” and so on. It’s not rational but then again we weren’t in a place to be rational. About 15 minutes later i’ll confess that as I’m sat there trying to mitigate the effect of the comment I felt like ripping that nurses head off. That nurse still to this day probably doesn’t even remember she made the comment….but it was a grenade caused by just not engaging brain.

“The genetics people have been and seen him, they will write to you” was another from a Doctor. We hadn’t even been told he was being referred to genetics so you can imagine our shock and, as usual, by the time you get your jaw off the floor and thoughts in order the person has long gone. There’s loads of stuff I train people around in my ‘real job’ like voice regulation and intonation, active listening, eye contact, Socratic questions, reinforcement and blah blah flipping blah but NOTHING is more important than engaging brain before mouth full stop. Parents of ill children hang on your every word because as a nurse, you have the knowledge, the skills, the whatever it is that will get their child better that they themselves cant provide. As a parent you feel tiny, no-matter whether you’re a king or a pauper. I’ve never felt as ‘stupid’ or small as faced with some of the doctors, and nurses, that looked after (and still do look after) Isaac. Through my ‘real job’ I speak to groups, speak in Court and have no problems with asserting but the sheer crushing power dynamic, coupled with occasionally there being Docs or nurses who think that they are gods gift makes some clinics or hospital stays unnecessarily hard.

Non Verbal Communication is a chapter heading in itself if I (never) write a book. I’ve seen nurses shuffle in, sigh, look at their watch, sigh again and then start talking. Sorry but in 10 seconds before your mouth opened you told me that you don’t want to be there. More importantly you’ve communicated that looking after Isaac is a hassle. Now you could be the best nurse since Florence Nightingale but you’ve got some climbing to do to convince me and you haven’t even spoken yet. If you look peed off and busy am I going to feel like I can say ‘excuse me, can you get x for Isaac?’ – no, I’ll think you don’t want to know. I’ve seen some nurses that I’ve never spoken to that I don’t like. Irrational? Yes. Why do I not like them, because they looked like they don’t want to be there. You could be having the worst day ever, it could be all ‘on top’ but frankly, Isaac matters more to me. It sounds horrible but that’s what you’re up against, parents where at times’ they wont show the 6C’s to you that they expect from you to their child. SOLER will get you so far, but not if on your way to the chair you’ve looked peed off..!

Anyway, seeing as being succinct is not a communication skill being exhibited in this particular blog i’ll stop. I could talk for hours about communication, it’s a real passion of mine to help develop the skills where I can. Best thing about communication skills is that you don’t have to revise, take exams or slog to get good at them, it’s organic learning and therefore nobody should be daunted by feedback, you can ALWAYS change!

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