Dr. Patricia Benner, a well-known and respected nursing theorist, introduced the concept that expert nurses develop skills and understanding of patient care over time.1 She identified nursing practice as a continuum, from novice to expert.1 In this column, I often use real experiences from my practice to highlight the kinds of communication challenges we face as nurses. In spite of my many experiences handling difficult conversations, my supposed expert status, I am a novice with each patient. Truly we all are.

What was my take away? I had no idea that my attentiveness, my being too nice had triggered anxiety about what the subtext of my interaction suggested. When I asked her if I could return to the original question, I expected her to tell me that her doctor had said something new or that she read something on the Internet. Instead, she had tuned into my attentiveness and interpreted it as having another meaning. It would be impossible to predict how each conversation or each action may be interpreted. But this experience reminded me to ask not just about my instructions or about symptoms, but about more hidden concerns. “Is there anything else you are wondering about? What else is on your mind right now?” Maybe then Cynthia would have initiated a conversation before she had worked up her anxiety.

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There are many nuances to communication challenges. Even being too nice may be misinterpreted and perceived as a negative. Next time, I can inquire more openly. With Cynthia, my focus was specific: her pain was the highest order of care, but inadvertently my attention to it triggered an alternate explanation to her. Now, when I am faced with a question that comes out of nowhere I start by clarifying what I have communicated in words, and actions.

Ann Brady is the symptom management care coordinator at the Cancer Center, Huntington Hospital, Pasadena, California. 


1. Benner P. From novice to expert. Am J Nurs. 1982;82(3):402-407. doi: 10.2307/3462928.