Elucidation: Explain It – Part II

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This is the second installment in a series by Kaye Prather, RRT-NPS, AE-C discussing the importance of speaking to patients in a clear, easy to understand way.

Imagine that you are unwell: it’s not hard to do. When you are unwell, the key to a quality life is to stay well. This is very Zen. Your patients may not know or care much about Zen. Nevertheless, it’s logical: exercise and staying active are key to their quality of life. They’ve been through all kinds of tests, poked and prodded and medicated. Everyone seems to be speaking “clinicalese,” not English. They want to know what’s wrong and whether it can be fixed or if they have to learn to live with it. Your patient or a family member has Googled it, and that just brought up more questions. The main one is: how does all that apply to me? Someone says “educate,” and all they think of is more big words and “OMG, a test”—at least, that’s the way education is remembered from school.

So, how do you educate your patients and their families without using clinical terms or speaking in a patronizing way? You start by listening. Make some small talk. Ask them what they know and understand about their health to this point. By doing this, you get an idea of what they know from their perspective, which tells you three things: (1) What they know, so don’t waste your or their time by telling them what they already know; (2) You’ll get a good idea of what they don’t know or understand; and (3) You’ll pick up on whether they have a clinical understanding of their condition or not. With a few minutes spent in pleasant conversation, you’ve also assessed breathing (work of breathing, anxiety levels), what they already know and understand, and how much clinical knowledge they have.

More often than not, our patients don’t understand how the clinical information given to them affects them. When they don’t understand, they don’t know what they can do to help themselves: in short, they don’t comply. So, instead of educating them with the standard clinical information and terms, break it down. Elucidate, using an explanation that makes something clear. Use terms they use daily. Use analogies to explain the function and effects of their disease process, tests, procedures, and medications. Use everyday functions for comparisons. You can use something a patient relates to and something they have experienced. Then they will understand the concept and how it applies to them.

I have found there are four basic things that our patients need to understand to improve their quality of life. Previously, I addressed breathing. This will be the second subject, addressing activity and regular exercise.

Telling our patients to stay active is not always met with enthusiasm. Either they look at you like you’re an idiot for stating the obvious or like you’re crazy for telling someone who can’t breathe to be active and exercise. I’ll start with the obvious case: your patient is still in relatively good health and feels they are active. Find out what that means to them. If it does not include a basic aerobic exercise program, they will need to start one. The patient who feels they can’t exercise because they are unable to is a challenge. You will have to help them figure out what they can do, and then build on it. They will need to start slowly: it will not take much to increase their heart rate if they are out of shape, and they will not be able to do 20 minutes of non-stop exercise. Together you can find reasonable and safe goals. They will be surprised as to how fast they reach them when they work at it.

There are new standards and calculations for age for meeting aerobic outcomes. Since our patients are not in the best of health and start at various ages, I like the old standby of the heart rate at 20 beats over resting for 20 minutes. This is easy to understand and remember. The benefit we tell our patients about doing aerobic exercise is that with the increased heart rate, the body naturally starts breathing deeper, and increased circulation delivers that increase in oxygen to every muscle in their body. This builds muscle, and with an increase in their muscles, their body works more efficiently. When that happens, they can function better on less oxygen. Since they have less oxygen now, this will be good news. They will feel an increase in strength and stamina, which brings a much-needed improvement in quality of life.

I use the analogy of gas mileage. When they bought their car, it got 30 miles per gallon; as time went by, and if they did not service the car, the mileage slowly got less and less. Most your patients will understand this and realize they need to start exercising and making an effort to get out and about.

Conclusion: Patients are fearful and anxious while in the hospital. Getting home does not always bring peace of mind. Actually, it can bring on a whole new set of concerns. Listen to your patients. You will learn what they know and how anxious they are and the language they use. Answer their questions with analogies; use something common that they can relate to. You will find your own analogies based on your own life experience. Draw a picture, or if you can’t draw, find a picture. Use humor: a person who laughs, whether it is at you or themselves, lets go of the fear for a moment—maybe longer—with understanding. Above all, be honest.


kaye prather

Kaye Prather RRT-NPS, AE-C started her healthcare career late in life. She went back to school at age 49, graduating an accelerated program as valedictorian. During her career, she has in worked acute care, rehab, home care, pulmonary rehab and as a contract trainer.

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