Good Communication Strategies While Wearing PPE

Good Communication Strategies While Wearing PPE

Nursing & Allied Health
Oct 26, 2020
Beth Sandy, CRNP
Lung cancer care providers have traditionally relied on facial gestures to show empathy. With face coverings now the norm, empathy can actually be shown through improved processes.
Beth Sandy, CRNP
Beth Sandy, CRNP

Communication while wearing personal protective equipment (PPE) is a challenge, especially in the field of oncology, where the information being communicated between patients and their providers is often critical and life altering. Historically, prior to the COVID-19 pandemic, oncology providers were accustomed to face-to-face visits without PPE covering our or our patients’ faces, and we could rely on facial expressions and nonverbal cues. In thoracic oncology, PPE is especially important because our patients often have a frequent cough, significant mucus, or heavy breathing, making people around them concerned about whether the patient is displaying COVID-19 symptoms, as well as about increased risk of exposure due to the aerosolizing nature of a frequent cough. Now, a frightened frown, a comforting smile, an angry smirk, or a painful wince are often muted by the facial coverings we are wearing, making our ability to effectively communicate with our patients, and for them to communicate with us, very difficult.

Complicating the communication aspect is the fact that, given the poor prognosis of lung cancers in general, the way we deliver information to our patients is rehearsed and practiced to be as thoughtful and compassionate as possible. How can we, as thoracic oncology providers, demonstrate effective, compassionate, and understandable communication while donning restrictive and concealing PPE?

Practicing New Scripts, Enhancing Paperwork Can Make a Difference

Kham Kidia, MD, and Amrapali Maitra, MD, two internal medicine residents, wrote a blog post about this topic on the KEVINMD website.1 In their post, they outlined some behaviors that they observed while practicing inpatient care during the pandemic, as well as their suggestions to improve communication, which contain many pearls for our everyday practice. The Table summarizes some of their recommendations, with some additions gained from my personal experiences. 

Although there is no perfect way to communicate with patients while wearing PPE, there are strategies that we, as thoracic oncology providers, can institute to improve our message. This is a tenuous and frightening time for both patients and providers, and any way to facilitate compassionate communication should be considered to provide the best care to our patients.
 

Table. [AW1] Suggestions to Improve Patient Communication During the COVID-19 Pandemic1

Make Use of Technology

  • Collect pre-visit data electronically as much as possible.
  • Send appointment reminders.
  • Conduct a phone call prior to a patient visit or prior to entering a hospital room to ally yourself with the patient.

Have Sensitive Conversations in Person

  • Human presence for serious conversations should be utilized as much as possible. In thoracic oncology, this is a common occurrence, and having these conversations over telehealth has been very difficult and lacks the proper emotional support for both the provider and the patient (let alone a child in the background who may be overhearing a conversation).

Make Good Eye Contact

  • We are relying on eye contact, as most of the rest of the face is covered.
  • Try to sit at eye level rather than hovering over patients.
  • Make good eye contact and try to soften your gaze by raising eyebrows or tilting your head slightly.

Speak Loudly but Gently

  • Masks muffle our voices, and many elderly patients already have hearing loss. Also, there is no lip reading with a mask on.
  • Do not yell, but try using a louder voice without the harsh tone.

Consider Physical Contact

  • Patients may feel terrified by people entering their room in full hazmat suits. If you feel comfortable and are wearing the appropriate PPE for the circumstance (whether the patient is COVID-19 positive or negative), consider leaning in a little closer to show that you are not afraid of them.
  • Take their hand. Stigma is a part of every pandemic. Body language and physical contact can go a long way to put a patient at ease.

Improve the Message/Put a Face on the Care

  • Make sure your name tag and photo ID are on display. Make sure information about the care team is well printed and in a place where the patient can see it.
  • If feasible, use photos of family and loved ones to decorate a room.

Practice

  • Consider practicing what you are going to say to a patient while wearing PPE with a colleague to see if they can hear you and if they feel you are conveying compassion.

Reference:
Kidia K, Maitra A. Connecting through PPE: patient communication during COVID-19. https://www.kevinmd.com/blog/2020/05/connecting-through-ppe-patient-com…. Accessed July 13, 2020.
 

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About the Authors

Beth Sandy, CRNP

Beth Sandy, CRNP

Ms. Sandy is a thoracic medical oncology nurse practitioner at Abramson Cancer Center, University of Pennsylvania.