Communication—speaking, surfing, and smiling

AORN Journal, Oct, 1999 by Patricia C. Seifert

A word is not a crystal, transparent and unchanged; it is the skin of a living thought, and may vary greatly in color and content according to the circumstances and the time in which it is used."(1)

It may come as a surprise to readers of this column (except maybe the Past Presidents) that the President's Messages do not automatically roll off the brain of the writer. Authors are painfully aware how difficult it is at times to put their thoughts down in a meaningful way. (Attention! Aspiring authors: Do NOT let this deter you. Fortunately for all of us, there are editors who are willing to and capable of nudging us along toward our goal; believe me, they are all too familiar with the symptoms of "cantus writus.")

I have been (impatiently) waiting for the Muse, the mythical patron of writers, to return from her summer vacation to help me meet the Journal deadline. (Another factoid: President's Messages are written two months before publication. Thus, while I'm writing this, the leaves are green--or brown--crops are ripening, and the weather is hot and muggy. While you are reading this, you are admiring the red and yellow leaves, preparing for Oktoberfest, or grateful that cooler weather has finally returned.) It is not without irony that the subject of this President's Message is communication.

When writer's block occurs, I usually re-read my mail, looking for the undiscovered postcard from the Muse. (Okay, so sometimes I go to the movies.) What I found on the back page of the recently arrived Nurses in Business, Industry & Consulting (BIC) Specialty Assembly Newsletter was the Oliver Wendell Holmes quotation at the beginning of this column. Sue Taylor, RN, BA, BIC newsletter editor, used the quote to introduce her request for articles on topics of interest to BIC members. In this short quotation, Holmes succinctly captures one of the principles that both forms the foundation for successful communication and identifies some of its most persistent stumbling blocks.

WORDS AS VEHICLES

Words--written or spoken--convey thoughts. They are the vehicle for communicating ideas from one person to another. Holmes' reference to circumstantial and temporal factors that can vary the meaning of words is particularly relevant in this era of communication technology. Consider the many methods of communication at our disposal: voice mail, e-mail, faxes, cellular telephones, web sites, and chat rooms. Circumstantial factors related to these technologies include rules of etiquette associated with each technology. For example, e-mail writers should avoid the use of ALL CAPITAL LETTERS WHEN SENDING MESSAGES because it implies "shouting."(2) Fax senders and receivers need to respect confidentiality; and chat room participants are requested to limit their questions and responses to the designated topic.

Another consideration may be the reading level of patients who are encouraged to surf the Internet to find information, or patients' ability to gain access to this electronic information source. There also may be differences in patients' technical skills or comfort with the use of these communication tools. At this time, the computer chip is rapidly becoming the printing press of the future,(3) and we need to become familiar, and comfortable, with this technology if we are to serve our patients.

In addition to the staggering number of available communication mechanisms, we also need to be sensitive to the increasing number of diversity categories in today's society: gender (eg, "he said, she said"), generational (eg, one group loves technology, another fears it), cultural (eg, different perceptions of pain), and language (eg, Spanish, Vietnamese, Hindi). All these factors are reflective of the time in which we live and can be the source of anguish, emotional pain, or worse to patients and colleagues if they are not respected.

COMMUNICATING WITH MACHINES

In addition to communicating with people, we also must learn to interact with things: robots, information systems, and computer programs. Talking to machines requires a new skill set; how many of you have tried to tell a listserver that you want to "unsubscribe"--and you succeeded on the first attempt? Our ability to interact with these machines, devices, and electronic systems has become a necessary component of clinical competency, and our patient's safety may depend on our ability to engage in this form of "communication." Imagine the not-too-distant future, when telesurgery becomes more prevalent; surely our ability to talk to robots will make the difference between life and death.

NONVERBAL COMMUNICATION

Many of our communication patterns involve nonverbal or body language. We employ nonverbal communication when we smile, frown, or embrace someone. Therapeutic touch not only promotes relaxation, but also communicates concern. Art and music communicate ideas as well as emotion, and music therapy is commonly used to reduce anxiety in the perioperative setting. When language is a barrier, nonverbal communication often can help patients cope until a translator arrives.