Thursday, January 24, 2013

The Nurse Listens

Today on the Facebook page for Nurse Keith Coaching, I posted a question about listening that really got me thinking. Listening is a skill that all nurses need to develop and hone over the course of their career. But what does it really mean to listen well, and what if we think about listening metaphorically rather than literally?
Facebook is often a great place to stir up a conversation, so here's the text of what I posted: 
"Nurses, when we listen to a patient's lungs, heart and belly with our stethoscopes, what do you feel is the deeper metaphoric meaning of that action? "
 A follower of my page then responded:
"Please elaborate."
To which I responded:
"What I mean is, are we always simply just listening for heart sounds, belly sounds and respirations? Or are our nursing actions sometimes imbued with a deeper meaning? Are we 'listening' metaphorically to our patients? Are we trying to 'hear' what's deep inside of them? Are we promoting patient-nurse intimacy and connection through our ministrations?"
While this may sound quite metaphorical (and indeed it is), I feel that these sorts of questions are quite worthy of our sincerely curious inquiry.

We often hear about different levels of listening, and there are many models put forth by experts in communication regarding the ways in which we engage--or fail to engage--in true active listening. In one model, we may be listening at a very high level of engagement, meaning that we're hearing the words spoken by the speaker, listening for the feelings beneath the words, and assessing and interpreting body language, tone of voice and facial expressions to more fully understand the speaker's intention, subtext, and underlying emotional state.

When we listen at such a deep level, we are also using our intuition and feeling nature to gather data about the speaker that doesn't get communicated through the voice or body. Yes, it may sound esoteric, but many sensitive people do this all the time--perhaps without even knowing it. 

On the other hand, when we're listening at a very low level of engagement, we're distracted, thinking about what to say next, going over our shopping list in our head while the other person is talking, or otherwise disengaging from the speaker's words. In this type of scenario, we drop in and out of the conversation, sometimes finding ourselves embarrassed by the information we seemingly missed. At this point, we may try to cover for our previous distraction by asking a question that has already been answered by the speaker while we were daydreaming. At a low level of listening, we're not fully present, and while we may notice body language, tone of voice or facial expressions, we don't really bother to interpret them other than in the most superficial manner. 

So, when you put that stethoscope to a patient's chest, what are you really doing? Today, I listened to my client's lungs, heart and belly, and I'll admit straightaway that I was performing a mechanical task, ready to record his vitals, check his lung sounds and move on to something else. I interacted with my client, but my interactions were surface level. Yes, I was acting as a nurse, but strictly as a nurse. There were no intuitive abilities at play (of which I was conscious). It was just task-oriented nursing work that had to be done.

I asked the question about the metaphoric meaning of listening to our clients' bodies as a way to open a door to a more mythopoetic, subtle notion of what it means to listen. I don't pretend to have the answers, and perhaps it's more of a rhetorical question than an inquiry to which I expect discrete responses.

As nurses, we can think like artists, we can think like poets, or we can think like novelists, anthropologists or detectives. We function at many levels--often simultaneously--and sometimes our intuition--if highly developed--speaks to us even when we're not "trying" to be intuitive or empathic.

I'm sure there are countless stories of nurses who walk into a hospital room or a patient's home, and there's an immediate sense that something is wrong. One person might define it as "weird vibes" or that the "energy was off" in the home or room. A sensitive nurse might pick up on very subtle changes that have not even yet manifested in identifiable physical symptoms.

Aside from some intuitive "sixth" sense of what's going on with a patient, sometimes it just feels good to raise your invisible antennae and see your patient from the perspective of deep curiosity and a sincere desire to know them--to really know them. That's the subtle aspect of nursing that we can neither quantify nor qualify.

I know what you're thinking: I live in Santa Fe, one of the hearts of esoteric, New Age America. It's true. And while I'll admit that there are more healers, psychics and intuitives in my adopted city than you can shake a stethoscope at, I'll also wager that there are sensitive, intuitive and tuned-in nurses everywhere. You don't need to be a self-identified psychic healer to know when something is wrong. Many nurses are indeed nurses because they see, hear and feel differently than others. And then there are nurses who'll say I'm just crazy. So be it.

All of this is to say that there are levels at which we operate on the conscious plane, and there are levels at which we operate on a very different plane--be it the intuitive, the esoteric, or Carl Jung's collective unconscious.

For me, there's more to nursing than meets the eye. In fact, there's more to being human than meets the eye. However, in my busy and task-filled day-to-day life, I probably miss 90% of the subtle stuff that I might otherwise pick up on if I were to really pay attention and allow my intuition room to be unshackled from my left brain's domineering ways.

So, dear Reader, let's go back to that original question that I posted on Facebook today:
"Nurses, when we listen to a patient's lungs, heart and belly with our stethoscopes, what do you feel is the deeper metaphoric meaning of that action? "
If you have a thought or an observation to share, please share it here as a comment. I'd love to know what you think (and feel). It behooves us all to occasionally pause for the cause of intuition, insight, and the vast unknown worlds and sensations of which we are generally so blissfully unaware.


Leslie D. said...

Effective listening in the context of a patient encounter requires a degree of intentionality. Taking pause and making the choice to be present prior to entering a patient's room ensures that high level of engagement.

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Great point, Leslie. Intention is really an important part of the equation. Thanks for reading, and I greatly appreciate the comment!

Beth Boynton, RN, MS said...

Thanks for a great post giving us lots to think about re: listening! I think the example of listening to lung sounds is wonderful b/c it is a great opportunity for us to have that deeper moment with our patients that goes beyond the assessment. We can tell them what we hear and explain what it means, offer a chance to ask questions, reassure what we will do about any abnormalities, teach about C&DB. Plus the touch itself can be very meaningful, i think. Placing a hand on our patient's shoulder and warming the stethoscope, saying "Hi" and listening to the "Hi" back are all powerful moments where metaphorically we are listening...(acknowledging, being with, respecting our patients as human beings not just clinical objects may fit in with your meaning of metaphoric listening???)


Elizabeth Scala said...

This is a beautiful post. I love your original question and find it one that does require some inner reflection. If we weren't really listening to your question- do we miss the meaning and deeper point? If we are distracted when we read something- even as brief as a post on social media- we miss the point.

I absolutely love your points regarding the challenges nurses face every day with being distracted and tasks with multiple things at one time.

For me, "listening" is being fully present, in the moment, and hearing a person on a mind-body-emotion-spirit-energy level... more of feeling than hearing.

Thanks for offering such words to ponder. I loved this and will think about it as I journal today. Have a healthy day,
Elizabeth Scala

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Beth and Elizabeth,

Thanks so much for the kind, thoughtful and insightful comments. I really appreciate you taking the time to read and chime in.

This is a topic worth exploring more. Maybe we can write a group blog post or do a podcast about it!


GRC - Greg said...

As you note so well, Keith, listening and engagement go hand in hand. Experience can build our ability to hear and understand from a gut level, but skilled folks in Psych understand that we miss and misunderstand far more than we get, even the best clinicians do, in all our interactions. Humans are seriously complex animals, yet our ability to communicate relatively limited in comparison. As a result, we need to seek as much clarification, as often as possible, if we want to understand anyone else. The effort also reflects and clearly displays respect and caring that greatly enhance rapport and cooperation. Wins all around! And you can have some fun at the same time, AND get paid for the whole fascinating process!

Keith "Nurse Keith" Carlson, RN, BSN, NC-BC said...

Great point, Greg. Yes, there is so much we can easily miss, and our complexity can sometimes make it as frustrating as it is enriching and fascinating.

Here's to deep listening--and understanding!