Talking About Health; Why Health Communication Matters

How do nurses cope with the emotions of caring for terminal patients?

March 26, 2010 GUEST POST by Jason Bankert

It is the common belief that nurses are the care givers and thus are more compassionate than physicians who are often perceived as hard and emotionless. The Intensive Care Unit (ICU) can be emotionally draining as many patients are in critical condition or are terminal. The care of terminally ill patients is called end of life care or EOLC. How do health care professionals, such as physicians and nurses cope with the emotional burden of terminal illness in the ICU and how do there perception, treatment and communication involving terminal ill patients differ? These different perspectives impact physician-nurse collaboration as well as their satisfaction with the quality of EOLC (Hamric and Blackhall 2007).

In a recent study conducted in the ICUs of a rural hospital in Southwestern Virginia and an urban hospital in Eastern Virginia, investigators examined these questions to provide an insight on how these different perspectives on EOLC ultimately impacts patient care and what interventions can be taken to reduce moral distress and improve physician-nurse collaboration (Hamric and Blackhall 2007). The study, based on survey responses, showed that RNs experience more moral distress during EOLC than do physicians, even though both groups identify the situation as morally distressful (such as aggressive treatment as requested from a family member when both groups feel the treatment is unnecessary (Hamric and Blackhall 2007). As a result, these nurses are less content with their environment or the perception of the quality of care given to the terminal patient. This higher emotional burden on nurses may be the result of their job. It is the nurses who provide the majority of the bedside care during EOLC and are in contact with the patient more often than physicians. Also, nurses lack finally authority over the treatment options implemented by physicians. Even though nurses may disagree with the way physicians communicate prognosis and diagnosis, they feel that they have no say in the final decisions regarding patient treatment during EOLC.

The emotional environment is more important for nurses who are in contact with the patient more often than physicians, providing most of the daily beside care tasks (Hamric and Blackhall 2007). Therefore, it is necessary to improve this environment to ultimately improve the overall quality of patient care. The best care in the ICU occurs when nurses are active participants in diagnosis and treatment decisions and are active in communicating with patients and families alongside physicians (Hamric and Blackhall 2007). In order to provide a environment where nurses can be proactive in the patient care, special attention and policy needs to be implemented to increase physician awareness of the extra emotional burden experienced by nurses and respect their input in regards to EOLC. Equally important is the improvement of physician-nurse collaboration. This may be accomplished by promoting open communication about the different perspectives of EOLC through team meetings, individual meetings with chief staff members and conferences involving staff and specialists from other institutions.

Hamric, A. B., L.J. Blackhall. (2007). Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate. Critical Care Medicine, 35, 422-429. Retrieved from: http://www.ncbi.nlm.nih.gov/pubmed/17205001

Why is belly fat bad for your health?

March 17, 2011

I guess we would have to be living under a rock not to have heard health messages about belly fat. What I remember hearing the most is something like, “Belly fat is bad for you.” or “You want to concentrate on that belly fat.” And what I really got out of the messages had to do more with how we look–that belly fat is not attractive–than how it relates to health. I had seen a number of programs addressing how to get rid of belly fat [ http://www.meandjorge.com/] but never really made a connection with why in terms of health. Until the other day…

I can’t even say what program was on as I was making a meal but I heard them say that belly fat is especially harmful for our health because it is fat that works it way between and around our organs. That it literally does harm by wrapping our kidneys, liver, and intestines in fat… that was a rather horrifying image. The program went on to say that one cannot have belly fat liposuctioned away…because it is wrapping and twisting its way through our insides. The fat that can be liposuctioned away is just beneath the skin… [see this for a discussion, http://blog.healia.com/00488/belly-fat-damages-blood-vessels-could-cause-cardiovascular-problems]

To me, this is an example of one of those messages that needs to be clearer. I especially think that men are being shown as at risk for having belly fat…but the emphasis is too often placed on how the men look and not on what is really happening inside their bodies when the pounds add up around their middles…

Or will it be Pennsylvania trout that will be the canary in the mine for Marcellus shale?

February 22, 2011

There appears to be no shortage of articles about concerns relating to the environment and Marcellus shale drilling in Pennsylvania[e.g., http://blogs.wvgazette.com/watchdog/2011/02/16/is-the-marcellus-boom-a-good-idea/]. Fewer concrete examples exist of action in this area. One exception is the organization, Trout Unlimited. The organization is partnering with the State, where loss of funding and the economy has contributed to challenges in efforts to collect data regarding water quality in the State’s streams [http://www.tu.org/conservation/eastern-conservation/marcellus-shale-project].

Volunteers will be trained to collect water samples. That is an important first step. It is less clear what happens next. Where will the samples be evaluated? How will data be stored? It is important to plan for consistency and to identify now any problems related to evaluating the water samples. If we fail to plan now, then the findings will be suspect later. So certification of the folks collecting the water samples is important. But we don’t want their hard work and training to be lost in warehouses where samples stockpile with no one to evaluate and track them. We also don’t want results to be discounted because the assessment of samples isn’t consistent or valid…

How are asking these questions relating to health like a sleigh ride…?

February 13, 2011

Seven Springs… A horse drawn sleigh ride… There is something very spiritual about riding through falling snow deep into the woods. And it can almost seem as if you’re floating right into the horizon…

Questions about health and health care can be like that… They go beyond the focus on illness or disease. They often go to the horizon of working in health care… Nurses working with doctors… “What’s that like?” And doctors talking to patients.

Have you ever thought about what it would be like yourself to be a doctor? Imagine asking a doctor, “Does talking to patients make you nervous?” What about asking patients, “Do you have trouble making ends meet?” Or, “Do you need financial help?”

In each of these cases, the way the question gets asked makes it hard to imagine that anyone could answer them honestly…

Why would anyone become a doctor if he or she gets nervous thinking about talking to patients? Perhaps that isn’t the best way to think about it. Why wouldn’t anyone get nervous at the thought of talking to someone about something so important and so personal as their health?

If you were a doctor, how would you go about talking to your patients in ways that respect their religious beliefs? What about breaking bad news, like a cancer diagnosis–wouldn’t that make you nervous? Every conversation is a little bit like going forth into a snowstorm…counting on someone to guide the way but preparing to make the most of the trip…

What did Dr. Oz say about genes and health, and what did his guest doctor say about viruses causing cancer that left me talking to the TV–and not in a happy voice?

February 4, 2011

Aieeeeeeeee. Dr. Oz had some visiting doctors on his show again today. As they were wrapping up some of the discussion, Dr. Oz said, “Genes load the gun… The environment pulls the trigger… I want you to remember that.” What?! We have discussed the importance of family health history in this forum before. So the role of genetics is one that is an important topic when talking about health.

But I wonder how many viewers really got the idea that it was family health history they should be thinking about with his expression–“Genes load the gun.” This is an old metaphor for the role of genes for health and has not been very effective. Add to that, the conversation that Dr. Oz was having about genetic mutations on the show. It all got mushed together…

“The environment pulls the trigger.. I want you to remember that.” Really? What does it mean? Again, the meaning of environment in this metaphor has many interpretations. Environment for most people is about where they live, the climate, the neighborhood, pollution… those things all matter when it comes to our health and interact with our family health history. But environment includes our personal behavior and our social environment–friends, family, and culture. What we eat, for example, is part of the ‘environment’ that our genes live in… But I am not confident that this meaning is clear when talking about genes and health with this metaphor…

Then there was the conversation about viruses–that cause cancer. HPV was one of the two examples discussed. I think that this also was not a good way to discuss the issue. If I have cervical cancer, you cannot ‘catch’ it from me. Cervical cancer is not a virus that can be passed from one woman to another. Cervical cancer is often caused by the lesions that form from genital warts caused by HPV–the humanpapilloma virus. So there is a virus that causes a condition that may be the cause of cancer…and not just cervical cancer but also penile cancer and throat cancer and head and neck cancers… So we may pass a virus between us that leads to genital warts that sometimes do not heal and may cause some changes in our cells and become cancer…

So let’s focus on understanding that increases our health literacy and not shorthand expressions that don’t… And let’s look toward spring and the daffodils that will replace the frozen icy tundra in my woods today…

What didn’t Oprah know about drug use and sperm quality and women’s health that Pam Grier told her?

February 3, 2011

Wild horses… well, not exactly. More like tame pets… A few images from our fall camping trip to Assateague…where ‘wild’ horses live on the beach, walking among the campers and even sharing our water and facilities…

And then, there was Oprah’s show today… [http://www.oprah.com/oprahshow/The-Original-Foxy-Brown/4]

Pam Grier talked about her life–today and during the period of time when she had starring roles in such shows as Foxy Brown. She also talked about relationships she has had, including with Richard Pryor.

As the Oprah show revealed, “After a gynecologist visit, Pam says she discovered Richard’s vices were affecting her too. She writes candidly about the experience with the hope of informing women who may be at risk. “There was an epidemic of a lot of people doing cocaine,” she says. “And it accumulated in the body and often in the prostate gland. It would come out during your sexual activity and [end up] inside a woman.”

Pam’s doctor cautioned her about the dangers of having unprotected sex with Richard. “[The cocaine] could harm the woman’s internal organs,” she says. “So I had to tell Richard, ‘You’re going to have to wear a raincoat—a condom.’ And he had an issue with that, and I said, ‘Well, it’s my life. You have to understand.’ So I chose me.”

Oprah said, “I did not know that–” in response to the revelation about the drugs ending up inside the woman… We have discussed such matters before http://whyhealthcommunication.com/whc_blog/wp-admin/post.php?post=295&action=edit

We can’t talk about ‘women’s reproductive health without talking about men’s reproductive health… and we can’t talk about men’s health without talking about women’s health…

What do stories about Amy Chua and ‘tiger moms’ have to do with communicating about health?

January 30, 2010

I have been surprised by one of the media’s most used excerpts to discuss Amy Chua’s book, ‘Battle hymn of the tiger mother.’ The example is about one of the author’s children saying that she hated math. The mother then decided to make quizes and drill the daughter, which improved her skills, and in a short period of time, the daughter like math.. even loved math. My own daughter reached an age where she, too, told me she hated math. I feel lucky that I had a friend and colleague who was studying how students learn math. She had reached the conclusion that girls and boys learn math differently.

Martha Carr “studies first-graders, and has found that girls use different strategies and have different motivations to do math. ‘Boys,’ Carr says, ‘tend to use memory to retrieve sums and are motivated by a sense of competition to get the answer fast, even if they sacrifice accuracy. Girls care less about speed than accuracy and more often rely on “manipulatives” — counting on their fingers or a counting board. Girls will use manipulatives even when they might be able to retrieve [the answer],’ says Carr. ‘They need an added push that boys don’t need to start using cognitive strategies.’ That’s important because while using manipulatives is an excellent strategy when students first learn math, it slows them down as problems get more difficult. In fact, in a study that followed students from second grade through fourth grade, Carr found that becoming fluent, and therefore faster, at basic math is directly linked to math performance. The study also found that girls were less fluent than boys. ‘If we make sure all children are fluent [in math facts], we will eliminate most gender differences,’ she says. http://www.apa.org/monitor/2010/07-08/gender-gap.aspx

Because I had heard Martha present some of her research findings, when my daughter decided she didn’t like math, I looked for a female tutor to balance her male classroom teacher’s approach. It didn’t take the tutor long–several weeks–before my daughter decided that she again liked math because she was performing well again and feeling more confident about it. She went on to become her high school’s ‘physics student of the year’–an award that would be unlikely to be earned by someone who didn’t like math and felt anxious about it. Today, she is a high school science teacher… So, yes, I believe we really do need to listen to our children’s reports about difficulties experienced in the classroom at the earliest ages possible and see if there is a way to improve their experiences…

I talked about math anxiety in March of 2010 http://whyhealthcommunication.com/whc_blog/wp-admin/post.php?post=162&action=edit. I emphasized the importance of having math skills to be able to make health decisions. These range from simple decisons such as how to calculate when to take a medication that you should take three times a day to deciding whether the research about benefits for a specific treatment add up to a longer life or a more quality life as each of us would define it.

I haven’t read Chua’s book and am unlikely to do so. It was interesting to note, however, that another book on this topic was written a number of years ago and comes up on the search at Amazon for ‘tiger mother’… The title includes ‘tiger mother’ and ‘dragon father’ and introduces a philosophy for raising children that may have some parallels to Chua’s underlying philosophy but apparently did not include the ‘mean mom’ actions that Chua used to actualize the approach… http://www.amazon.com/Confucian-Disciplined-Respectful-Children-ebook/dp/B004J4VYYO/ref=sr_1_2?s=books&ie=UTF8&qid=1296407014&sr=1-2 It really is in the communication process that these differences come to light…

What did Dr. OZ say about stress today?

January 24, 2011

Dr. Oz talked about heart attacks on his show today. He emphasized things we can do to manage our risk for ourselves. He talked about the risk for women as well as men. One of the issues that he emphasized was ‘stress.’ He noted that stress is a big contributor to heart disease. He has talked about this in terms of our diet before http://whyhealthcommunication.com/whc_blog/?p=328 I have talked about Dr. Oz referring to stress before on this blog .http://whyhealthcommunication.com/whc_blog/?p=236

This time, I want to applaud the very concrete suggestions that Dr. Oz gave us for handling stress. He said, “Have two social conversations each day.” And, “Have one social outing each week.” This is very useful for us. How often do we find ourselves stressed with feelings that there is ‘no wait out.’ Then we talk to a friend or a colleague about a new movie coming out, or our passion for a sport, or our love for our children. Even five minutes, and some of that stress melts away. And, yes, as impossible as it seems when we feel stressed, having a social outing–a walk at the city park or in the mall when it is too cold outdoors, lunch at Subway’s or each other’s home, or going to see that new movie–everything looks and feels different afterward. So thumbs up to Dr. Oz for concrete ideas that we all can do to manage our stress…

What did Michelle Obama have to say about WalMart today?

January 20, 2011

Michelle Obama spoke today standing in front of fresh produce at a WalMart. She talked about the initiative that WalMart will undertake to make healthy food more accessible.

http://www.youtube.com/watch?v=TwMsh8vaYvE

WalMart will reduce the sodium in their products and get rid of products with trans fats. They will lower the prices for fresh fruits and vegetables. In short, they will work to make it possible for more of us to afford to eat healthy… Let’s hope it is a model that others follow…

Is there really any reason to believe that communication about health causes discrimination?

January 19, 2011

Yes. And we are hearing about it again as the Congress considers health care reform…yet again.

Insurance discrimination… Parents are worried once more as Congress talks about health care reform and it seems as if some conditions might not be eligible for care. It is hard to understand why a conditon that someone is born with might be ruled out for care, while a condition that has direct links to our personal behavior would be covered… We don’t want to find ourselves playing a ‘blame’ game… but resources are limited. We have somepersonal responsibility. Society has some responsibility. We have to consider both.

Employment discrimination… A subtle thing can happen, subtle because it is hidden from view. As costs for health care increase, as medical knowledge grows, will there be some conditions that rule us out of consideration for employment?? Will some genetic conditions linked to risk from some diseases lead some employers to require testing for those genes? What do the innovators of ’23 and me’ think about these issues?

http://www.youtube.com/watch?v=F7UHBBHhoj0&feature=related

Social discrimination. We have years of evidence to support that naming or labeling health conditions can lead to stigmatizing behavior toward people who have been labeled…avoidance and more.

Reproductive discrimination… Yes. How we talk about health can cause discrimination…