I’m an oncology nurse navigator and my job description states that I must be a good communicator. Well, of course, I am a good communicator! It’s what I do all day long with my patients, their caregivers, and my colleagues. But what does that really mean?
Reflecting on the Past Year
COVID-19 has made it increasingly more difficult to communicate due to working from home, telehealth, remaining 6 feet apart, and wearing a mask, and/or face shield. In these trying times, my patients and their caregivers have taught me how to listen to what they are saying, or in some cases, not saying.
Height of the Pandemic
In June 2020, I was on the phone with a patient’s daughter who lived 120 miles away and was unable to visit her mother. She asked me as the thoracic oncology nurse navigator to check in on her mom. The daughter voiced concerns about being able to care for her upon discharge and inquired about rehabilitation placement. Since her lobectomy, her mom had been “acting crazy, confused, speaking nonsensical.” I was listening to what the daughter was expressing and could hear the fear and concern in her voice. I explained how elderly patients can become confused, especially at night and away from their usual surroundings, and assured her that her 68-year-old mother would be much better at home than in an inpatient rehab unit. I also told her I would visit her mother in her inpatient room.
As I set off to see the patient, I thought about how the patient I knew was not the same person the daughter was describing to me.
Where Am I?
As I arrived on the post-surgical unit, I felt disoriented and confused. This had been my first time walking into the hospital after 3 months of working from home. I had been issued my face shield 2 days prior, but this was the first time I wore it. PPE made facial recognition impossible, so every staff member I passed seemed unfamiliar.
Upon entering the patient’s room, I approached her bed. When I told her my name, she had trouble hearing me at first, but when she finally recognized my muffled voice, you could see the relief in her face. It dawned on me that this patient had every right to be “acting crazy and confused”; she probably thought she was on another planet with aliens who were difficult to understand and looked funny. I sat at her bedside, explained where she was and why she was there. She was most appreciative of the time I spent with her and I was able to phone the daughter and inform her that her mom really wants to go home, has been discharged, and she can come pick her up. I am happy to report that she was her usual, perky, stubborn (according to her daughter) self at home.
As an oncology nurse navigator, I am so fortunate in my role to have the ability to follow patients and their caregivers through their entire trajectory of their cancer journey. I am their constant, their advocate, their educator, and liaison to their entire treatment team. I am able to do this through communication whether in person or via the phone. So much of nursing is communication, and a large component of communication is listening.
Here are some tips on ensuring you are really listening to your cancer patients:
- Face the patient and maintain eye contact – Although this may be 6 feet away and with a mask on, your patient can still read you through your eyes. Do not scan the room, do not look down at your phone or your computer. If possible, pull up a chair and be at eye level.
- Be relaxed – Patients and their caregivers may be scared; this is their most vulnerable time. By showing you are relaxed and in a position to listen to their fears and concerns, then you can pick up on any barriers they may be facing during this journey.
- Give the patient/caregiver regular feedback – Pay attention to if they are saying one thing, but the tone of their voice says another. How many times have you heard, “I am fine” or “we are doing OK”, but you hear the shakiness in their voice? Mirror what they are saying by checking in on the emotions. For example, “You are telling me you are OK, but by the tone of your voice, you seem upset.”
- Paraphrase – Repeat what the patient/loved one has said to make sure they know you have heard them. You could say: “let’s see if I got this right” or “what you seem to be saying is…”
- Show you are listening attentively – Incline your head and make affirmative sounds.
- Don’t finish a patient’s sentence – Avoid jumping to conclusions until you have really let them finish what they are saying. Interruptions give them the impression you don’t have time to listen, and this may prevent them from sharing all they wanted to share.
- Use open questions – Ask questions such as: “tell me what you understand your diagnosis is” or “can you tell me about any other symptoms?”
Active Listening Brightened My Patient’s World, Thus Mine
Recently I cared for a new patient. While she was hospitalized for a post-surgical wound infection, I visited her daily alongside the oncology social worker. During our conversations, I picked up that her son was upset because her hair had been shaved. This set me in motion. I couldn’t change her diagnosis or her situation, but I could make a difference. I set out to get her a wig that matched her previous hair color and length. She was so excited and beamed as I helped her put the wig on her head. Had I not been listening, and I mean really listening to what my patient was saying, this moment would never have occurred. That wig meant the world to her.
Always listen carefully, as you may be surprised by what you hear.
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