I remember sitting with her, holding her hand, telling her the same information over and over again. Finally, she lifted her head and said, I hear what you are saying. Within five minutes, she asked me the same question again.
You would assume the scene I am describing is one of tragedy. It is not. It is about an interaction in a health care setting and it is about the ability of a human being to hear and process information when stressed.
Fight or flight, or the acute stress syndrome, is a common happening when a human being perceives a threat. I am sure to my Anatomy and Physiology professors’ dismay the following would make them cringe. I like to envision little people running around pulling the levers to activate the systems of moving blood to our muscles, away from the brain. With the chemical reaction within the body the brain’s functionality becomes limited. Some researchers have shown that this physiological state gives human beings in essence the brain of a lizard. That is right: When we are stressed, we think with the brain of a lizard. Learn from me, your significant other does not appreciate you pointing out that they have a lizard brain during a spirited discussion.
Having consciousness that the acute stress syndrome reaction is an influencer when talking with families is the first step in awareness of the filters that families might be hearing the information you are trying to share with them. The second filter is fear. You could argue that fear causes the reaction of fight or flight and you would be correct. Fear is the trigger; the reaction is what you must deal with first.
In a family’s mind are a million whirling thoughts when they are concerned about the one they love. They are looking for clues that will either support their fears, or alleviate them. It really is that simple.
Early in my career, when I would meet with families, I was professional and factual. I would give them the clear clinical picture and what the team thought would be the course direction with always the qualifier of potentials. I was puzzled that they would not remember what I said, except for the parts that supported their fears. One burly rancher put it into perspective for me one day. He said, “Why don’t you ask me what I am worried about instead of telling me what you think I need to know?”
From that day forward, I changed how I spoke with families. I now work on how to be present to them, actively listening instead of actively talking. I put aside my phone, pager or other device so I am able to be all theirs for the moment. I take deep breaths to clear my lizard mind from the day. I remind myself of their loved one’s story. If I do not know it, I ask them to tell me about their loved one. Knowing the story opens up the ability to be empathetic. Furthermore, talking about the loved one brings a centering and grounding that creates a mutual connection. It sets the stage to ask the most important question that can be asked, “Tell me what you want to know first. What are you worried about?”
Tell me what you want to know first? What are you worried about …? Most families will let out their breath and a flood of thoughts, worries and questions flow out. Some families will ask, what are you worried about? I have learned when they ask that of the provider, they are looking for validation of their worries. I usually say something like, most likely the same things you are thinking about. Let’s talk about them together.
I then answer them as openly and with transparency of the information or knowledge that I know as of this moment. What I have learned is that in the absence of asking the question of what they are worried about, the worries grow larger and the fear becomes stronger. That then triggers further the acute stress syndrome, or the fight or flight reaction.
In follow-up conversations I have with families, I bring the questions back around early on in the conversation: 1. Tell me what you want to know. 2. What are you worrying about for your loved one? By discussing together, the worries or fear, it allows a partnership to develop and dialogue on the best course of care with everyone working together for their loved one.
I recently experienced being on the family side. I was the designated care support for my elderly father as only one family member could be present due to COVID restrictions. I was isolated and alone. My stress level was over the top. One provider brought me off the ledge by asking, “What are you worrying about for your father?” I took a breath and said “everything.” He laughed and then we talked together about “everything”.
We are, as one recent political figure said, “in the halftime of COVID.” People are tired, frustrated and wanting this pandemic to be over. Add to that the restrictions for prevention and containment that have been put into place potentially fosters worries to become stronger and turn into fears. Healthcare, and especially long-term care, have been working hard to communicate in new ways with those they serve and support.
Yet, I find the question, “What are you worrying about for your loved one?” remarkably absent in conversations. Many conflicts, family dissatisfaction and difficult issues can be worked through by open dialogue and authentic answers. We must use courageous leadership and be willing to ask the question repeatedly to assure we are listening with both head and heart to those we serve. It is going to be critical as we face COVID, part two, during these coming months.
Martie L. Moore, MAOM, RN, CPHQ, has been an executive healthcare leader for more than 20 years. She has served on advisory boards for the National Pressure Ulcer Advisory Panel and the American Nurses Association, and she currently serves on the Dean’s Advisory Board at the University of Central Florida College of Nursing and Sigma. She recently was honored by Saint’s Martin’s University with an honorary doctorate degree for her service and accomplishments in advancing healthcare.