Some people are just more skilled at (or creative about) it than others.
I am a very concrete thinker, and that comes across, sometimes too bluntly, in my communication style. Tact is not one of my finer skills...and that gets me in to hot water when I'm working with friends and families of laboring mothers.
We have a "three visitor" rule where I work...by policy, we allow only three people in the room during labor and birth. We're a major high risk referral unit...that floor is absolutely hoppin most of the time, and with a lot of our patients, it means we have to move fast at times...and there are a lot of us in the room doing it...so we can't exactly have everyone from Great Grandpa, down to big sis's latest newborn progeny in the room...either someone's gonna get trampled, or precious minutes are going to be lost that can mean the difference between a good or poor outcome. BIRTH IS NOT A SPECTATOR SPORT. For those whose hackles I raise when I say this, let me tell you that, at nearly every labor I have attended where a huge conglomeration of family and friends hung around during labor, most, if not all of the crowd were gone...vamoosed...as soon as Junior or Juniorette made his or her way past Mom's perineum...seriously...most people seem to just want to get a goggle at the emergence of this little alien from the mother's body, and then the show's over...they are out of the room before Mom is even out of stirrups (yes, they use them where I work, I hate it, but it's just how they do it), leaving her and her partner (if there is one...I have often see a family leave a mother totally alone) still dazed about what has happened to them. So, I don't think I'm being unreasonable when make that statement...because, more often than not, that's exactly how the onlookers are treating the situation.
It's also difficult to enforce this policy when Mom is sick. For example...when Mom has preeclampsia. The high blood pressures that a mother can experience with this illness can deprive her brain and nervous system of oxygen...when we treat a mother for preeclampsia, we're only buying time until we can effect a cure the only way that it can be effected...by ending the pregnancy (more specifically delivering the placenta, which is where current thought leads us to believe the problem originates, and of course, if the placenta is coming out, so is baby). In the mean time, Mom is at risk for seizures; so we keep the lights and noise down in the room, so as not to add to the problem of an already overstimulated nervous system. It doesn't help things when there are half-a-dozen or more family members, some of them with cranky toddlers in tow, coming in and out of the room, talking and laughing, eating, schmoozing, switching on the lights and television, and in general, acting like they are at a social event.
Over and over again I've explained to families, as gently as I can, why we need to keep the room clear of debris and extra bodies, so that, if need be, we can move fast...or so that we can keep Mom calm and resting. Things will quiet down for a while, and then, little by little, people tend to drift back in, and the noise level drifts back up. What gives? How many times can I explain things? How many signs do we have to post? Do they not believe that the risks I am pointing out to them exist? Maybe it's one of those "for other people not us" frames of mind. I can only guess. Anyone have any suggestions for Nurse Ratched here? I think I'm being nice when I explain. I try to be!
But those are my complaints. Patients and their families have legitimate complaints as well (doh). Sometimes they just aren't "meshing" with their nurse...or worse, the nurse is being a "b*&%$"...it's been known to happen...we all have our bad days (nights), and some of us seem to just hate our job, pure and simple (why these people stay in the job, I'll never be able to understand...I mean, nurses are among the most employable workers I know...there has to be something out there that they would rather do). There have been times on our floor when a Mother or family will ask (pleasantly or not so pleasantly) for another nurse; and we try to accommodate them...but it's not always easy...and sometimes we, probably because we've been asked in a way that we've allowed to get our defenses up, will allow ourselves to believe, and attempt to convince the family that, this just isn't possible (due to staffing, etc).
C. to the rescue...some people are just gifted in this way. Her advice to her Doula clients when a personality conflict (or worse) comes up...send someone out to the nurses station, ask to see the charge nurse, and with a smile and complicit sort of tone, say "I'm sorry to have to ask this, I know you are busy...but...this is so awkward...our nurse looks exactly like (my ex wife or, my abusive mother-in-law, etc.)
Of course, while C. is suggesting this, everyone in the room is roaring with laughter...but how could it not work? I'd move Heaven and Hell to relieve my laboring mother of her current nurse if I thought this was the situation.
Like I've said...some people (unfortunately, not me...I'm still [hopefully] evolving...are just plain gifted.
If only we could all be.
Showing posts with label Communication. Show all posts
Showing posts with label Communication. Show all posts
Tuesday, August 19, 2008
Communicate, Communicate, Communicate...
But do it well...do it honestly...and allow for the inevitable misunderstandings.
This I learned (or relearned, as I will forever continue to), a few days ago when I had the opportunity to attend a meeting of our local ICAN (International Cesarean Awareness Network) group. The group met in a room at the offices of the midwives I referred to in my last (and much too distant) post. I had the opportunity to spend time with one of the midwives.
My friend C. was with me. Ever the diplomat, C., after the meeting was over and we had a few moments to gab after the meeting ended, was able to gently approach the topic with the midwife. Interestingly enough, the news was just that...news to them. Even more "interesting" was her comment that the physician who they had been collaborating with was continuing to do so, long after the partners had decided that they no longer supported the collaboration.
So what is the solution? I'm not sure there is one that will make everyone happy. I'm more than a little frustrated that the collaborating physician doesn't seem to be more up front with his partners...a little passive aggressive perhaps? Who knows? Not an unheard of trait in the All-American-Male. The midwife feels that she and her partners have been as diplomatic as possible when transferring care...and I believe her...I've trusted her judgement and skills for years, and nothing has changed that for me; but a mother in labor and her family are not always in the most reasonable state of mind during a transfer...they don't always hear what is being said..and they are not always able to respond completely rationally...labor takes us out of the corporeal world and places us somewhere between earthly ground and some other plane; and perhaps that is where the misunderstandings began to originate...again, who knows?.
What I do know is this; that there are so many underlying prejudices, memories of past experiences, and motivations that lead us to understand or respond to a situation in whatever way we do, that trying to predict how any particular exchange of communication is going to turn out is, well, unpredictable. The only thing we can do is try very, very hard to listen when someone is speaking to us, and not let our own agenda ("I must have a vaginal [natural, unmedicated, monitor-free, {whatever}] birth", or, "If they wear scrubs, I'm not sure I can trust them") get in the way of what is being said. On the other hand, we can't let it (that agenda...and we all have one, to some extent) color what we are saying ("This is my decision, I'll do/say what I think is appropriate" - [despite the fact that life doesn't always cooperate with our plans]).
Do I think that this is what ultimately conspired? To some extent, yes; to just how much of an extent I can't know...I wasn't there, and I don't know all of the participants well. I'm glad though, that because of C.'s amazingly effective way of getting her point across without triggering the defenses of the person she is speaking to, that the midwives, their clients, and the physician in question just might be a little closer to forming a collaboration that can continue.
I know I said this once before...but, I can hope, can't I?
This I learned (or relearned, as I will forever continue to), a few days ago when I had the opportunity to attend a meeting of our local ICAN (International Cesarean Awareness Network) group. The group met in a room at the offices of the midwives I referred to in my last (and much too distant) post. I had the opportunity to spend time with one of the midwives.
My friend C. was with me. Ever the diplomat, C., after the meeting was over and we had a few moments to gab after the meeting ended, was able to gently approach the topic with the midwife. Interestingly enough, the news was just that...news to them. Even more "interesting" was her comment that the physician who they had been collaborating with was continuing to do so, long after the partners had decided that they no longer supported the collaboration.
So what is the solution? I'm not sure there is one that will make everyone happy. I'm more than a little frustrated that the collaborating physician doesn't seem to be more up front with his partners...a little passive aggressive perhaps? Who knows? Not an unheard of trait in the All-American-Male. The midwife feels that she and her partners have been as diplomatic as possible when transferring care...and I believe her...I've trusted her judgement and skills for years, and nothing has changed that for me; but a mother in labor and her family are not always in the most reasonable state of mind during a transfer...they don't always hear what is being said..and they are not always able to respond completely rationally...labor takes us out of the corporeal world and places us somewhere between earthly ground and some other plane; and perhaps that is where the misunderstandings began to originate...again, who knows?.
What I do know is this; that there are so many underlying prejudices, memories of past experiences, and motivations that lead us to understand or respond to a situation in whatever way we do, that trying to predict how any particular exchange of communication is going to turn out is, well, unpredictable. The only thing we can do is try very, very hard to listen when someone is speaking to us, and not let our own agenda ("I must have a vaginal [natural, unmedicated, monitor-free, {whatever}] birth", or, "If they wear scrubs, I'm not sure I can trust them") get in the way of what is being said. On the other hand, we can't let it (that agenda...and we all have one, to some extent) color what we are saying ("This is my decision, I'll do/say what I think is appropriate" - [despite the fact that life doesn't always cooperate with our plans]).
Do I think that this is what ultimately conspired? To some extent, yes; to just how much of an extent I can't know...I wasn't there, and I don't know all of the participants well. I'm glad though, that because of C.'s amazingly effective way of getting her point across without triggering the defenses of the person she is speaking to, that the midwives, their clients, and the physician in question just might be a little closer to forming a collaboration that can continue.
I know I said this once before...but, I can hope, can't I?
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