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“Wisdom begins with the definition of terms.” ~ Socrates

T

he nurse-patient relationship will always remain pivotal to effective management of illness. Peplau (1952/1991) maintained that understanding was an essential component of the nurse-patient relationship. Consistent with Peplau’s assertion, Cleary, Edwards, and Meehan (1999) found that understandingsignificantly influenced nurse-patient interactions in acute psychiatric-mental health settings. Jackson and Stevenson (2000) cited understanding as a central theme

in their study about the reasons people with acute psychiatric illnesses need nurses. Although understanding is what patients want, studies suggest they do not experience it from nurses (Shattell, 2002; Thomas, Shattell, & Martin, 2002). Infact, one study revealed that the greatest understanding came from other patients (Thomas et al., 2002). In this article, we describe communication guidelines useful to nurses in facilitating patients’ experience of being understood.

JOURNAL OF PSYCHOSOCIAL NURSING, VOL. 43, NO. 10

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THE PROBLEM OF MISCOMMUNICATION Culture provides a prototype for examining the skills necessary tofacilitate understanding. A focus on cultural sensitivity and diversity training has raised awareness of the importance of clarifying individual meanings to facilitate understanding with patients who are clearly different. Even when nurses are acutely aware of possible differences in meanings, opportunities for misunderstanding and miscommunication abound. For example, in a study of non-Aboriginalhealth care providers and Aboriginal patients, Cass et al. (2002) found that health care providers did not even recognize their errors in understanding. Obviously, shared meanings of concepts is requisite to understanding (Cass et al., 2002). Shared meanings of concepts are particularly difficult when patients and providers speak different languages. In a study about the use of nurse-interpreters withSpanish-speaking patients, Elderkin-Thompson, Silver, and Waitzkinc (2001) found that approximately half of interpreter-mediated encounters had serious miscommunication problems affecting either the health care provider’s understanding of symptoms or the credibility of the patient’s concerns. In addition, Maltby (1999) found that interpreters often edit out important aspects of patientcommunication, clarifying that interpreting is “more than moving words from one language to another” (p. 250). People tend to think culture or diversity as concepts pertaining only to people from other countries or people who are clearly different (Evans & Severston, 2001). However, even within one culture, tremendous diversity exists. Ca30

nales (1997) indicated that one must avoid stereotyping based oncultures and recognize individual differences within cultures. Misunderstandings can compromise quality of care. An example from our clinical practice involved a foreign-born physician who asked a patient on an inpatient psychiatric unit, “How did you sleep last night?” The

Understanding can be facilitated by one overarching communication principle: Nurses may not comprehend what patients mean.patient replied, “I slept like a log.” The physician thought the patient was delusional (i.e., the patient thinks he is a log) and increased the patient’s antipsychotic medications. The physician, whose first language was not English, misinterpreted the patient’s response to his question, and rather than seeking clarification, accepted a concrete understanding of the phrase “slept like a log,”which resulted in treatment changes. Another example involved a newly admitted patient on an inpatient psychiatric unit who had locked himself in the bathroom while yelling, “It’s coming down. It’s coming down!” Because the patient was known to experience religious delusions, the nurses assumed the patient was talking about Jesus and the second coming of Christ, and administered several...