Communicating with staff

Many NESB students express concern about not understanding the instructions that are given to them by the nursing staff and are worried about the possibility of making mistakes.

Read these two quotes from a NESB student and a supervisor about the clinical experience.

Student: I was having difficulty coming up with the correct words during problem solving sessions with my Clinical Instructor. This made me anxious. The Instructor was stereotyping me as having insufficient knowledge .. the real issue was that it took longer for me … to come up with the correct words to express the thought.

Supervisor: I find the students need more time to compensate for their slowness and repetition. If they are given this extra time they usually meet the required point by the end of the placement . Knowledge-wise they are often better students … it’s the cultural and language stuff that needs the extra time.

From: Stewart, M et al (1996) International students in the clinical practicum: Problems with English language proficiency, cross cultural communication and racism. The University of Sydney

Do you find that it takes longer to 'come up with the correct words' to express thoughts?

Do you agree with the supervisor that it is 'the cultural and language stuff that needs the extra time'?

Please join in the online discussion to comment on these questions. You will probably find that other students share your concerns!

*In interactions with staff you may sometimes not be quite sure what they mean. It is important that you clarify meaning to check your understanding of what has been said and also that you can demonstrate your understanding to the staff member.

Clarifying meaning

Some ways to clarify meanings and check your understanding include:

1. Asking for repetition:

• Pardon?
• What did you say?
• Would you mind repeating that?
• I’m sorry, I didn’t catch what you said.
• Could you say that again slowly please?
• Could you repeat that please?

2. Asking clarification questions:

Eg A nurse might say to you:

'We'll need some more supplies of Betadine today'.

Your clarification questions could include:

• We'll need some more what?
• What did you say we'll need today?
• Did you say 'Betadine' ?
• What does 'Betadine' mean?
• Did you say 'Betadine' or 'Pethidine'?
• Do you mean that we'll need to collect some supplies from the locked cupboard or order some more from the Pharmacy?

Demonstrating your understanding

Sometimes your supervisor will not be quite sure whether or not you have understood what has been said, especially if you just smile and nod in response to an instruction. In this case you need to demonstrate that you have understood by:

    1. Repetition of key words

    2. Confirmation Statements - where you paraphrase information or put what someone says into your own words

    3. Expansion Statements - where you add information to what has already been said

    4. Elaboration Questions - where you ask for more information

For example, imagine your supervisor might say:

‘Could you ring the kitchen and order a low-fat, low-salt diet for Mrs. Green?’

1.You could respond with a repetition of key words:

'...a low-fat, low-salt diet'     OR

2. You could respond with a confirmation statement:

OK. I'll call the kitchen and ask if Mrs. Green can have meals  that are low-salt and low-fat                              OR

3.You could respond with an expansion statement:

Yes, Mrs. Green said that she needed to lose some weight before her next operation. I’ll ring the kitchen now         OR

4. You could respond with an elaboration question:

Dealing with implicit instructions

In undertaking your first clinical placement, you are entering a professional community where language is used in a particular way. Socio-linguists note that in professional communities there are likely to be more examples of ‘implicitness’ in conversations. This is when something is not explicitly (clearly) stated but rather implied or suggested. For example, in the clinical setting, staff members sometimes use 'ellipsis' in their conversations with students. 'Ellipsis' is where some words are left out of a sentence and the student may be required to mentally ‘fill in’ the missing words such as in the following example:

Doctor to patient, on rounds with student nurse, looking at the patient.

Doctor: We’re going to have to do some more blood tests today.

Doctor to nursing student 10 minutes later.

Doctor: Have you got those path. forms ready for Mr Lee?

*Here the doctor抯 original statement addressed to the patient was actually a cue for the nursing student to get the pathology request forms prepared. This cue serves as an 'implicit' instruction to the student.

'Implicit' instructions are those instructions which are not clearly stated but rather are implied or suggested. They sometimes cause problems for NESB students because they are not recognized as instructions and so no action is taken. Supervisers then think that the student is reluctant to perform nursing duties or perhaps doesn't understand what has to be done for the patient, when in fact the student just hasn't realised that she/he was being asked to do something. To recognise implicit instructions, you will need to 'read between the lines' of what is said and 'fill in the gaps' of what is not said! 

For example, look at the following 'implicit' instructions and see if you can  work out what the nurse is actually asking the student to do:

1.Nurse to Student: Mrs. Georgiou’s legs are still quite swollen and painful, but she’s agreed to start ambulating tomorrow morning with your assistance.

2. Nurse to Student: Mr. O’Neil is complaining of severe pain and asking for his analgesics even though they’re not due for another hour and a half. It might be an idea to contact Dr. Riccardi and see what we can do for him?

Note that the sentence constructions for implicit instructions often include the use of modals  such as: you could, you might, you had better, you needn't or it's time something happened. See if you can listen out for implicit instructions on your placement and note how they are expressed.