Elucidation: Explain it – Part III

It has been said that lung diseases are among the world’s most common medical conditions. Obstructive, restrictive, and sleep apnea have numerous causes. All of them affect the ability to breathe, increasing the work of breathing while impairing the exchange of oxygen and carbon dioxide. All of our patients have questions about these conditions. They and their families want to know how this will affect their lives and how they can “fix it.” Sadly, most of the diseases of the lungs cannot be “fixed.” They are debilitating diseases that continue to get worse over time. People who live with lung disease must learn to manage it, as well as to maintain or even create a new quality of life. Some are fortunate and qualify for transplants, which may (in time) give them back a more normal lifestyle. But even if a transplant is in their future, many will have to wait months or even years. They turn to us as Respiratory Therapists to answer questions and recommend possible actions to improve their quality of life. They expect us to teach in a few minutes what took us months or years to learn. That in itself would be difficult—adding to that, our patients are anxious and medicated. Their families, who are their best bet for recovery, are also anxious and confused.

More often than not, our patients don’t understand how the clinical information given to them affects them. So how do you educate your patients and their families without using clinical terms or talking in a patronizing way? You start by listening. Make some small talk. Ask them what they know and understand about their health up 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 you 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; (3) You’ll pick up whether they have a clinical understanding of their condition or not. In 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.

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 with the standard clinical information and terms, break it down. Provide 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, and the second topic addressed activity and regular exercise. Today I will discuss the need for a change in how they think about breathing and what it means. They have spent a lifetime not thinking about how, when, or what it means to breathe. They have never thought how the body processes oxygen or its need for oxygen. To improve their quality of life, they need to start thinking about and understanding oxygen consumption.

Many of you refer to this as oxygen conservation; I do not like that term. One definition of conservation is preservation. This sounds like you are teaching them to protect themselves and is just as likely a cause for them to sit down and forget everything you’ve told them about being active. Teaching them oxygen consumption, what it means, and how it applies to them gives them tools to manage their lives.

So, where do you start? Explain that the body is a machine, and like machines, it runs on fuel. Oxygen is the body’s main fuel. Everything it does consumes oxygen. Each blink of an eyelid, swallow, or heartbeat, and the act of breathing, uses oxygen. When their lungs are not working fully the way they used to or should, knowing how oxygen is used will help them manage. I refer to driving a car. Most of your patients have driven or ridden in a car. I start with a scenario: “When you start your car, you don’t have to step on the gas, and yet the car sits there and idles. This is like you sitting, and all is fine—you feel pretty good, and you’re not out of breath. When you get up and walk to the kitchen or do other activity, you find you start getting out of breath. When you’re in that idling car and want to back out of the driveway, what do you have to do? Yep, you step on the gas and give that car more gas so it will go. You need more oxygen to get up and walk, to move around. Now you’re driving, and you come to a hill: you’ll need to give it more gas to maintain your speed to go up that hill. You are the same, in that when you want to do more, to be more active, you need more oxygen.” This is something your patient relates to. Understanding this concept sets a basis for managing their lives. They will use this to plan their activities of the day and to set their expectations.

Conclusion: They will be able to use some of the breathing techniques you have explained to them. The breathing techniques, along with understanding the body’s need for oxygen, will empower them. They’ve given up much of their power and independence; now they’re getting some back, with the ability to manage their activities. Choosing when and how they consume oxygen will build strength and confidence. By listening to your patients, you’ll learn what they know, how anxious they are, and the language they use. Explain their questions with analogies. Use something common that they can relate to—you’ll find your analogies based on your life experience. Draw a picture, and if you can’t draw, find one. Use humor: a person who laughs, whether it is at you or themselves, lets go of fear for a moment and maybe longer, with understanding. In short, be honest. Don’t lie. Don’t avoid. When you don’t know the answer, tell them that. When you say you’ll get back to them with an answer, do it.


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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