What they didn’t teach you in nursing school Part 3: How to Listen, Not Assume
Stephen Covey in 7 Habits of Highly Effective People profoundly wrote, “Seek first to understand, then to be understood.”
I had a patient once whose health suffered from a lack of understanding by his healthcare professionals.
This older gentleman had a stroke. Even though he was in guarded condition, he was stable. He went around 11am to get a follow up CT scan of his brain. No changes. Good news, a stable patient who looked to be discharged to rehab shortly. This means he got 15 minute MD visits and shortened RN visits due to time constraints.
An added complication: He and his wife did not speak english. The wife was difficult to understand, but could communicate some.
After the CT scan, the wife began a 10 hour campaign to get the nurses and doctors to listen to her. “My husband is not well, come look!” After each visit by the nurses, nursing assistants, and physicians, she got a response: “He is stable, even though he had a stroke, his vitals are fine and neurologically he is the same.” With smiles, her only hope for her husband (her providers) left the room thinking, “He had a stroke, he won’t be normal, but he looks good for now.”
It was obvious that the wife did not understand what was going on. I went to get the translator phone (a two way phone used with patients where an interpreter can speak with both the nurse and patient) and waited 15 minutes for the correct interpreter. I gave the phone to the wife who was surprised to hear a familiar voice on the phone. Had she never used the phone in her husband’s 7 day hospital stay? Maybe not.
She began to tell me that ever since the CT scan, her husband has not spoken. His color doesn’t look typical for him. I called the physician who reluctantly ordered another CT. Fifteen minutes later we were running a code for this man due to respiratory distress and altered mental status. Turns out he had necrotic lungs due to untreated pneumonia. His stroke had progressed as well.
It is probable his stroke progressed on its own. It is also probable this patient aspirated unknowingly and did not show signs of respiratory distress until it was too late. It happens.
But, I couldn’t help but wonder: What would have happened had we listened to this caring wife instead of assuming we knew what she was saying? What if we had been proactive in addressing her concerns, instead of making decisions based on lab values and clinical tests.
May we always as health care providers seek first to understand.