Tuesday, July 29, 2008

Think About Who Might be Listening

Perhaps you were walking down a deserted hospital corridor, discussing in quiet tones the details of a patient’s care with a fellow RN. Maybe a similar discussion took place with one or more nurses during a regular shift change report. Whatever the situation, the absence of visibly obvious "listening ears" does not mean no one is hearing your words.

A neonatal intensive care physician, who was hospitalized for three months after being severely injured in a bicycle accident, learned a lesson during her recovery that is of value to all who are involved in patient care.

Because of her injuries, including fractures that required traction, the doctor was limited to lying flat on her back, unable to see much of what was going on around her. She was also intubated for a time, which temporarily curtailed her ability to speak. Despite the doctor’s limitations with verbal communication and visual observation, her sense of hearing was not compromised and she did plenty of listening, often hearing conversations not intended for her ears.

A dramatic example of what can happen when nurses let down their guard when discussing patient care occurred early in the physician’s recovery period. Her injuries were severe and required several surgeries in the days following her accident. Her condition stabilized but she still required intensive care. As she lay in the ICU she overheard a conversation coming from the nurses’ station questioning the care being given a patient: "Why are we continuing to (life) support her? Shouldn’t we let her go?"

The doctor, her thoughts muddled by the effects of narcotics and the anesthesia administered earlier in the day, was convinced that she was the patient the nurses were discussing. Overcome by anxiety, she summoned a nurse and, although it was near midnight, insisted that her husband be called. She urgently asked him, "Am I going to die?" He calmly reassured her that, although her injuries had been life threatening initially, she was improving and making progress every day and she needn’t worry about dying. Although the incident was at the forefront of her mind, it was weeks before she revealed that it was the nurses’ words that had prompted her to make that frantic phone call.

Her lengthy recovery period gave the doctor more than ample time to relive the upsetting incident and she realized that she, too, had probably conducted sensitive conversations within earshot of families and patients who overheard and misinterpreted her words. She vowed that she would, thereafter, be actively aware of what she says and where and how loudly she says it.

It is good to be reminded that we need to be vigilant about privacy when engaged in confidential conversations. As nurses we know the importance of patient privacy and that of reassuring patients and family rather than upsetting them, so why do we so often slip up?

The doctor mentioned here thinks we unwittingly fall into a sort of complacency. Nurses are busy, and dealing with the immediacy of life and death must come first. As a result, we may unintentionally allow the finding of an optimum time and place for such discussions to drop a few notches on the priority list. Perhaps we think that a certain noise level—one caused by respirators and monitors—will drown out our words. The doctor’s frightening experience should be the cliched wake-up call for all of us to be mindful that listeners, intentional or accidental, are everywhere whether or not we can see them.


Liza said...


Your blog posts are really interesting. I like this one because it's encouraging to see a healthcare professional advocating confidentiality and pointing out how it can be easy to slip up.

On a blogger's note, I would like to know if you would be interested in writing occassional guest blog posts for LydiasUniforms.com This is exactly the kind of material we would like to see on our blog.

If you are interested, e-mail me at lollila@lydiasuniforms.com for more info.


therapydoc said...

Probably talking about patients, just to talk, is never a good idea.

Glenna Murdock, RN said...

I certainly agree with therapydoc that patients should never be casually discussed (just to talk). I was referring to necessary conversations about the patient and his/her care. We are sometimes lulled into a sort of complacency that results in being less than vigilent in ensuring those conversations do not reach unintended ears.