by Charly Miller, EMT-P

Emergency Crisis - both traumatic and medical - causes patients to become hypersuggestible to all perceived stimuli. Additionally, Emergency Crisis brutally rips away a patient's sense of control. Both of these conditions can be positively affected by providing a patient with explanations of everything that occurs to and around them.

Explanations Restore A Patient's Sense of Control

Every patient has the right to an explanation of what's being done to them and what's going on around them. After all, it's "their emergency." Explaining our every action demonstrates that we respect the patient's rights. Feeling respected helps return the patient's sense of control.

Explaining things also shows that we care about the patient - otherwise, why would we take the time to explain things? What patients - and care providers - don't realize, is that explanations take little-to-no time at all. We can explain things as we prepare equipment, perform other tasks, and perform the acts we're explaining. We're all (unfortunately) accustomed to not receiving explanations without aggressively asking for them. So, when we take the time to explain things, we significantly demonstrate care for our patient, and positively influence our patient's condition.

Explanations Can Be Positive-Outcome-Suggestions

Everything we need to do has a purpose. And every purpose can be explained - simply and in English (or whatever other language you and your patient are speaking). If positively phrased, an explanation becomes a positive suggestion. Remember how susceptible the emergency patient is to suggestion? We can effectively use that susceptibility to suggestion by providing positive explanations to achieve positive patient responses.

Obviously, if negatively phrased, explanations can just as easily become negative patient suggestions. Avoid negative-sounding words:

• Instead of "pain" or "hurt," use the word "discomfort."
  This gives the phrase, "more comfortable," a greater and more positive impact when you use it.
• Instead of "no" or "not," find ways of phrasing things so that you say the same thing by using the words, "yes" and "will" instead.
• Instead of, "This will stop your nausea," use "This will make your tummy (stomach) feel much more comfortable."
• Instead of "This will make you feel much less anxious," use "This will make you feel much calmer" or "more relaxed."
• Instead of "This will help you feel less confused," use "This will help your thinking become much clearer."

This sounds more complicated than it actually is. It only takes a little practice to become more proficient at positively phrasing your explanations and directions.

If you're apprehensive about using suggestive explanations, remember:

Positive explanation suggestions are simply a way of greatly enhancing the positive outcomes that we honestly expect, anyway.

Additionally, suggestion has a much stronger effect when it accompanies a physical action. So every time we positively explain an action - before and during its performance - we encourage a more rapid positive patient response to our actions.

"This is oxygen. It will..."

Often, when administering oxygen, the most a care provider says while applying the cannula or mask is, "This is oxygen." Rarely is the reason for oxygen administration explained. Rarely is Oxygen identified as a drug - and all patients have an innate belief in drugs to help them feel better! Oxygen administration is a marvelous opportunity to give your hypersuggestible emergency patient a positive-suggestion explanation.

"I'm going to give you some oxygen. Oxygen is a wonderful drug that will...

• alleviate your chest discomfort and help you feel much more comfortable."
• soothe you and help you feel much calmer."
• soothe you and help you feel much more relaxed."
• relax the muscles around your injury so that you feel much more comfortable."
• calm your stomach and help you feel much more comfortable."
• help your thinking to become much clearer."
• help you breathe much, much easier - you'll soon feel much more comfortable."

Obviously, "much more comfortable" is a magic phrase, and cannot be used too often.

Did I lie when using any of these oxygen positive-suggestion-explanations? No! Oxygen can, and will accomplish all these things. But if we accompany its administration with positive-suggestion-explanations, oxygen will provide all forms of patient comfort much faster and with greater effect.

To demonstrate the effectiveness of positive-suggestion-explanations, I'm going to admit to something awful.

When I worked for Denver's Paramedic Division, our ambulances required a toggle-switch to actually "turn on" the oxygen system. We could plug-in the oxygen tubing, turn on the flow meter, and hear a "hiss" as the oxygen that remained in the system's line was administered. But if we didn't switch the toggle on, once the line was bled dry no more oxygen was delivered.

During the nine years that I worked there, I occasionally forgot to turn on the toggle switch. Thankfully, if the patient had a nonrebreather mask on, I rapidly noticed a deflated bag and turned the oxygen on. But if the patient wore a nasal cannula, I wouldn't always notice that I hadn't activated the system - until I went to turn it off and found it already off!

I always follow-up my positive-suggestion-oxygen-explanations with, "Now that you've had some oxygen, you're feeling much more comfortable, aren't you?" So, by accident, I learned that even with the oxygen off, my patients consistently reported receiving relief from "oxygen administration."

I believed they were getting oxygen. They believed they were getting oxygen. And since I had explained - suggested - to them how much more comfortable the oxygen would make them, they felt much better without actually receiving any oxygen at all! The power of belief and the power of positive suggestion in the emergency setting cannot be underestimated.

Even seemingly complex actions and effects can be achieved faster with simple explanation - positive suggestion. And any medical process or treatment effect can be explained in English. Which is good, because we should never, ever use medical terminology when speaking to our patients.

Nitroglycerin, for example:

"This little pill (spray, paste, patch) is a drug called, 'nitroglycerin.' It doesn't explode or anything, but, it will make your blood vessels larger, so that they deliver more blood and oxygen to your heart. This will calm the irritated portion of your heart and help you feel much more comfortable!"

All of these things are true. Everything we need to do has a purpose that can be explained. And if we positively explain these purposes, our patients respond more positively, feel respected, feel less loss of control, and get better faster.

Lastly, after you've made positive-suggestion-explanations of the things you do to and for your patient, you need to follow them up - reinforce the positive-suggestion-explanation effect - by learning how the patient is responding.

Avoid questioning the patient about their condition in a negative way. In times of emergency, it's much easier to adopt a negative attitude than embrace a positive attitude. So we need to encourage and suggest a positive attitude at every opportunity.

Instead of asking your patient, "Are you feeling better?": Suggest to the patient that they're feeling better, and see if they argue about it.

"You're feeling better, now - aren't you?!"

A patient who isn't feeling better will tell you so, at which time you should provide more positive suggestion for positive response. But when your patient is feeling better, by reinforcing his improvement with recognition, you encourage him to feel even better than before!

"That oxygen has really helped your breathing, hasn't it?!"...

• "Yes. Now that you mention it, I am breathing easier."
  "Great. The more oxygen you get, the better your breathing will become. So I'm going to keep giving it to you."
• "No. I'm still ... having to work awfully hard!"
  "Well, lets give it some more time. Oxygen is a drug that works wonders with breathing. I'll turn it up a little for you, and your breathing will become much easier soon."

"Since you've had that nitroglycerin, your chest feels much better, doesn't it?"

• "Yes. Now that you mention it, I'm not nearly as tight as I was before."
  "Fabulous! Nitroglycerin and oxygen are wonderful drugs, aren't they? Since your blood pressure is so good, I'll give you another Nitroglycerin to make you completely comfortable. And I'll keep you on the oxygen so that you continue to get better and better."
• "No, it doesn't. I still have that squeezing pain in my chest."
  "Not a problem! Sometimes it takes two doses. I'll give you a second one now, and keep the oxygen going. Nitroglycerin and oxygen are wonderful drugs. You'll feel much better now."

Like the power of belief, there's no limit to the wonders that can be achieved when using positive-suggestion-explanations! Especially when positive-suggestion-explanations are reinforced by following-up with positive-response-suggestions.

In Part Six of the "Foundation of Patient Communication" we briefly discussed the subject of giving patients a "choice" about what happens during their emergency response. Giving patients "choices" restores their sense of control, improves their condition, improves their response to treatment, even improves their prognosis. But, do we give a patient the choice of whether or not they are spinally immobilized? Do we give a patient the choice of whether or not they get an IV? They have a right to refuse such things - don't they?

In Part Eight we'll explore the techniques and secrets of "patient choices" in more depth.

Reference
(1) Patient Communication For First Responders and EMS Personnel - The First Hour of Trauma: by Dr. Donald Trent Jacobs, published by Brady, Upper Saddle River, New Jersey, 1991. Dr. Jacobs attributes this quote to someone named, J. D. Hadfield.

Email Charly at: c-d-miller@neb.rr.com
Those are hyphens/dashes between the "c" and "d" and "miller"