Give a running narrative of your care.

Next time you are watching a documentary on TV, lets say a wildlife documentary, or a history show, or (heaven forbid) a medical documentary, take a moment to pay attention to the voice over.

Seldom do you experience very long periods of silence. If there is not actual dialogue or conversations occurring in the scene, the narrator will be telling you what you are looking at. This often occurs even if what you are looking at is pretty self evident.

This is because watching something whilst listening to someone tell you what you are watching is a much more powerful form of communication.

Providing a running narrative or commentary is a useful habit to get into when delivering clinical care to your patients. This is for 2 important reasons:

  1. It really improves communication and understanding between you and your patient. It informs them of their care.
  2. It helps YOU focus on what exactly it is you are doing. It is really hard to be distracted thinking about the 13 other things you are currently multi-tasking when you are doing just one thing AND talking it through.

Often you will see nurses just move in and perform repetitive or simple interventions with only minimum (or no) communication with the patient. Or perhaps they perform the tasks whilst engaging in witty banter or casual conversation – which is absolutely fine, but often excludes the patient from understanding all those little things we are doing to them.

Even though it feels a little strange try to get in the habit of providing a running commentary as you perform even the simplest of interventions. This is a little different to giving an explanation, and I find it works best if I actually imagine I am talking myself through the task.

For example, if you are hanging a bag of saline you might talk it through something like this:

OK Dave, I’m just checking this bag of saline with Carol to make sure it is the right fluid and that the expiration date is not past.
Im just going to take it out of this protective bag, which, as you can see is always really difficult.
There. I’m just going to hang it on your IV pole whilst I open the giving set.
OK….Im just turning off this little roller clamp so the fluid doesn’t run through the tubing until I’m ready. I’m just going to spike the bag through this port here.
And now I squeeze this drip chamber to fill it to this mark here. Right. Now I can open the roller clamp and prime the fluid all the way down the tubing to remove any air bubbles. See? You might sometimes get tiny bubbles like this that are nothing  to worry about….

….and on you go. A running narrative expounding what you are doing as the patient experiences it. Sounds obvious. But when you start to pay attention, you realise just how many things we do without informing the person we are doing it to.

Don’t get me wrong. There are definitely times when it is appropriate to be quiet. To listen, or to let the power of an unhurried silence open up a space for deeper conversations.

And some procedures may not need to be talked through every single time. Perhaps just the first time you do them.
As you develop your running commentaries for each intervention, try to improve on them. What might your patients actually find interesting about these things that you are doing?
Become the David Attenborough of nursing narrative.

Other interventions that might benefit from a running narrative include.
Performing a physical assessment. Taking observations. Setting up and doing dressings. Performing 12-lead ECG. There are many more.

By adding running narrative your clinical actions, you are more focused, less likely to skip things or take shortcuts,  and less likely to make errors.

Also, things become much clearer for the patient, they feel more included in their care and have the opportunity to ask questions about the multitude of things happening to them. Things that we often consider small and run through on auto-pilot.
The very same things that may be incomprehensibly big for our patients.

So:

  • Tell them what you are going to do.
  • Then tell them what you are doing as you are doing it.
  • Next, tell them what you just did (in summary).
  • Finally, ask them if everything is OK (give them an opportunity to ask questions).

3 thoughts on “Give a running narrative of your care.

  1. This type of ‘thinking aloud’ is also a powerful teaching strategy as it helps expert nurses share their thinking with novice nurses.

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    1. I recently as a student on placement did this type of thing whilst preparing patients for cataract surgery. Not only did it give me a good repore with patients and help them to stay calm before their impending eye injection, it also helped my own nerves and gave me confidence and composure in what I was doing 🙂 (applying lignocaine drops etc..).

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