July 15 Blog

Do you trust me?

I'll be the first to admit I set the bar very high on healthcare and even higher on nurses and I think there is nothing wrong with that.  The people we are honored to serve are at their most vulnerable when admitted into the hospital. They are frightened, in pain, maybe confused or even angry and we have a responsibility to honor and acknowledge their experience with compassion, understanding, and kindness. 

IT'S NOT ABOUT US! IT REALLY IS ALL ABOUT THE PATIENT!!

There is a degree of gratitude healthcare professionals must connect with when engaging with patients and their families; "There but for the Grace of God go I" - John Bradford.  And this realization should spark deep compassion, empathy, grace and gratitude.

The experience of service we create for our patients, at the individual and organizational level, must be rooted in trust.  On first pass, patients trust we know what we are doing, they trust we will keep them safe and free of harm, they trustwe care about them as fellow human beings, they trust we will communicate with them openly, honestly and compassionately. 

But ... when that trust is broken, well that's a whole other kettle of fish. Maybe you can even relate to this on a personal level.  Have you had an experience with healthcare that left you feeling less trusting about a clinician or a facility?

Organizations and individuals must earn the respect and the trust of those they serve.  To earn trust there are 4 core elements:

  1. communication

  2. compassion

  3. consistency

  4. competence

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We make a lot of assumptions about communication, compassion, consistency, and competence that actually interferes with our capacity to build trusting relationships with our patients and their families.

Competence, for example, is often confused with training but it's so far from 'just training'.  Competence is when you demonstrate that you know what you're doing and why you are doing it.  For example, my brother was recently hospitalized and needed to have the bag changed on his new colostomy. 

When the nurse arrived, she had an ileostomy bag and when my brother pointed it out, the nurse notified the supervisor that my brother was refusing to let her change the bag.  When the supervisor confronted my brother, he explained that the nurse had the wrong equipment. The supervisor explained that she was new and didn't have much experience with colostomies (OK, so first, this should not be my brother's problem and I'm grateful that my brother knew the difference and could speak up for himself. How many patients aren't able to do that?).  

This novice nurse had a little bit of knowledge, but it was inaccurate.  Her communication to the supervisor did not reflect compassion and unfortunately she did not leave the impression that she was competent.

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Now, I am absolutely not throwing inexperienced nurses under the bus.  And this particular facility is not unlike any other facility where there is a mix of novice, advanced beginners, competent, proficient, and expert staff.  Diverse levels of experience among staff has many positive benefits, stimulating different ways of knowing and doing that can enhance critical thinking and even elevate the standard of care.  

However, many organizations (and individuals) miss out on creating an environment that supports professional growth and development in meaningful ways.  We stay stuck in teaching paradigms that allow us to check things off a list (a wicked long list) but don't really assure that knowledge has been translated into skill.  The 'Teach Back' method we use when educating parents / patients is something we must adopt with staff as well in order to establish performance expectations that are measurable and sustainable.

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Competency gaps impede consistency. Which basically means everyone just does their version of what they think is best which can be incredibly confusing for the patient / family (not to mention potentially unsafe). As Brené Brown says, "Clarity is Kindness". The inconsistency that many patients and families experience at the hands of healthcare professionals and organizations undermines their trust of the facility and the staff.

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And for babies, inconsistency keeps them on high alert, chronically stressed, never knowing what will happen next.

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We've such an amazing opportunity to take a step back and carefully examine our own cultures of care, what are the written policies and procedures and contrast them to the unwritten 'ways we do things here'.  Where are the inconsistencies?  Where are the opportunities to build trust? It's root cause analysis time and many of us know exactly what we need to do to change and it starts with cultivating TRUST.

I'm afraid, after 35+ years I still approach healthcare systems with caution, despite the multitudes of compassionate, competent trustworthy professionals I have encountered over the years, the paucity of consistency continues to make me wary.  Sad to say I am often pleasantly caught off guard when a healthcare professional is kind and compassionate to one of my family members or myself.  I wish I could rely on that experience to be a consistently reliable one.

Despite my 'en guard' approach however, I don't believe the system, with all its moving parts, is a lost cause. I am not giving up on the potential for healthcare at large to change and become aligned with Florence Nightingale's admonishment: 'The very first requirement in a hospital is that it should do the sick no harm' (check out Nightingale's Notes on Nursing for a comprehensive review of what constitutes nursing, it's as relevant today as it was back in the day).

Let's do this thing together .  All it takes is a little courage, like they say at TSA, if you see something, say something.  If you see something good, something to emulate - say something, recognize the individual and explore how you can make that good thing happen more often. An inch is a cinch, a yard is too hard.  We can transform the system one baby step at a time!

Do you trust me?

Take care and care well,

Mary

P.S.  If you are interested in learning more about transforming your culture of care, building competence and confidence in your staff, enhancing compassionate communication and delivering excellence in trauma-informed, age-appropriate care consistently reliable, Caring Essentials can help.

Using breakthrough, evidence-based strategies Caring Essentials helps you achieve clarity, build congruence, and challenges you, your colleagues, and your organization to become a center of excellence in trauma-informed neuroprotective care.

The babies and families are waiting!

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