Listening to patients is necessary but harder than we think
John, a patient in a nursing home with mild dementia is angry and it’s escalating. He is pacing in front of the nurse’s station and verbalizing his unhappiness in front of several staff members.
He voices multiple complaints – his clothing has been lost in the laundry and he can’t reach his wife on the phone. At first, it appears that the nursing staff is ignoring him, perhaps hoping that he will vent and go away. This makes him even madder.
Finally, after he begins to make vague threats a nurse responds as follows: “John if you don’t calm down soon and stop acting like a child, you will need to take a PRN Ativan.” This condescending remark gives John the idea that no one cares about his concerns and he unleashes a verbal barrage of swearing and activity that causes complete chaos around the nurse’s station.
The nursing supervisor, Jane, is called in to assess the situation. Her concern is that the nursing staff did not listen to John’s initial complaints and allowed the incident to escalate to this point but she also understands that in some cases, nurses may not even hear a patient simply due to the existing environment of information overload. Other patients could be talking at the nurse’s station, the phone is ringing, alarms are going off and one nurse is concentrating on charting her medication into the computer and feels she can’t be interrupted. There is often a lot of going on and a lot of background noise.
In some cases, we may just be wrapped up in our own personal concerns and not focused on others at all and other times we exhibit an insulated form of listening where we tune out any topics we would rather not deal with. Or a person could be acting as a pseudo-listener pretending to listen but actually thinking about something else entirely. In many studies, active listening actually ranks first in required communication skills and is the key component in interpersonal communication.
In this case, the supervisor realizing that John just wants to be heard and invites John to come with her to her office to discuss his concerns. By doing this she removes him from the hallway to a quiet spot where he can have her undivided attention.
Here she can employ both relational and task-oriented listening skills. Relational skills focus on being nonjudgmental and supportive, while task-oriented listening will focus on getting John’s concerns met. Both styles of listening are important.
First, she wants to hear what John’s concerns are so she will pay attention to what he says and make sure she understands the message. One way she can do this is by paraphrasing – providing feedback for clarification. For example, she can say “John, are you asking for assistance in retrieving your belongings and contacting your wife?” By asking short questions, she confirms that she understands John’s concerns. He tells her that his wife had instructed him to call at 10 am and he is now worried that she is not answering the phone so he is anxious. He then says he hasn’t had any clean clothes for 2 days. Now that she understanding his concerns she can prepare a satisfactory response.
She may suggest that they go down to the laundry room together and see if John and the staff can identify his lost clothing where they find them clean and folded, but set to the side. She also helps John call his wife. John, whose vision is poor, had simply been dialing the wrong number and he is relieved to talk to her. He is now satisfied that his concerns were taken seriously because Jane has used the correct listening tools to support him.
To reiterate, first, she agreed that there was a problem and demonstrated that she took his concerns seriously. She then offered to help by taking him down to the laundry area to actively look for his belongings which also successfully diverted his anger. She addressed the problem in the “here and now” thus relieving his anxiety immediately and he got the reassurance he needed that his wife was safe.
Jane viewed this not only as an appropriate level of support for John but also as an opportunity to teach the staff how to deal with problematic issues on the unit. She led by example.
It is important to note in this case that she was also not critical of her staff because she understands the pressures on the unit. From here, she can now employ her analytical listening skills to understanding the different perspectives on the unit and get to the core of the problem. Once she can break down the issues, she can help create an atmosphere in the unit where a nurse can more easily meet the challenges that careful listening requires.
