Asserting Yourself When It Matters Most: Communication in a Health Crisis

Image by Paul Brennan from Pixabay

I can't remember how I learned my husband needed to be rushed to the hospital at 3 a.m. Nor do I remember how I found myself in the dead of night, standing at the nurses' station in our local emergency room explaining his sudden onset of unfamiliar symptoms. We were swooped behind a curtain in seconds, into another dimension - one that existed in crisis, a dimension of fear and cognitive overload. My thoughts swirled as I told myself to hold it together, to ask what I can: professionally, calmly, intelligently. Yet, regardless of my internal instructions, I could not formulate audible words to express the questions that strobed in and out of my thoughts. I will never let this happen again. And it does not have to happen to you either.

Health literacy and assertive communication are tools we can learn long before a crisis strikes. A bonus is that these skills are useful in managing other stressful scenarios in our lives too. These steps will help you with positive communication habits as well and provide tools to foster strategic thoughts in a pinch.

1. Learn Assertive Communication Beforehand and Practice Daily

Assertive communication is the ability to confidently ask for what we need while respecting the rights of others. It is not aggressive communication, but it is firm. In a crisis, insecurities creep up and adding stress, making cognitive overload likely. Practicing assertive communication daily can avoid this. The American Red Cross hosts several in-person and online First Aid classes for a small fee. The classes offer more than just bandaging and CPR training. Instructors also provide tips on communicating in an emergency and often offer guided role play to practice directing bystanders and E.R. personnel when needed. If a class is not workable now, The Mayo Clinic staff published a free, detailed article on managing stress through improving assertiveness. You can read it here. For now, it helps to be aware of their tops tips for effective communication:

· Use "I" statements and do not shy away from repeating yourself

· Use Diplomacy: Respect is efficient for both you and the hospital staff

· Practice saying, "No."

2. Have an Emergency "Script" Ready

Amelia Brenner is a Licensed Social Worker at Families Together in North Carolina. She empowers clients to advocate for themselves through "scripting." Before a health event, Brenner's clients create a script using clear, simple language that can be memorized and repeated easily. This script should include information about chronic illnesses, allergies to medications, preferences, or other pertinent details healthcare providers will need to know. In an emergency, practiced scripts are easier to repeat several times to the multitude of medical staff that will cycle by your loved one. For easy and quick accessibility, laminate the index card once completed.

3. Use Technology: Phone Apps and Printable Forms

A barrier to asking useful questions is that caregivers typically do not have enough medical knowledge or experience to form relevant inquiries, especially while hurried and distraught. The American Red Cross offers resources to help. Their free First Aid app is downloadable to any smartphone. The "Prepare," "Emergency" and "Quizzes" tabs provide educational information that can serve as prompts to spark questions that might otherwise be forgotten in a crisis. It would help to familiarize yourself with the app before you need it - the features are excellent, but navigation is not intuitive. Their website also provides downloadable forms and a caregiver's guide that includes a list of essential health questions. Take the time to print out the packet and fill in the details you can now. Place this with your laminated script and a pen for a complete emergency communications kit. Smartphones are also great tools in an emergency for notetaking and recording when needed but be sure to follow your state's privacy and recording laws.

4. Remain Empowered: Emergency Room Management Strategies

Brenner states that it is common for multiple hospital staff to repeat questions over-and-over again. Instead of becoming frustrated, Brenner says these are opportunities to gain more information. You can combat this by turning annoyances into opportunities. For each healthcare worker who enters the room, Brenner makes a point to ask their name, role, and what procedure they are performing - regardless of whether this information was explained earlier by other staff members. She said the more you ask, the more likely you are to receive information described in multiple ways, which will provide nuance and enhance your understanding of critical details. Next, treat forms as friends. Don't scoff at filling out paper documents when asked. Paper documents can act as essential guides if you're overwhelmed; copies remind you of information later on, and forms provide quiet moments to gather your thoughts. Brenner suggested using the "Is There Anything Else We Should Know" section included in many medical forms. If you have a request that has been dismissed or a specific preference, include it there, as staff are quicker to act on written documents.

5. Understand Communication Triggers

Elizabeth Beatty of New Lexington, OH, suffered an unexpected stroke at a young age. She remembers her family repeating, "But she's so young!" While her family's shell-shocked reaction is understandable, it effectively triggered E.R. staff to take over. Having no family advocate to lean on, Beatty experienced greater distress. She says it is vital to remain aware of your reactions and how medical professionals perceive you in an emergency. Mindful responses with explicit requests help staff identify you as a competent partner in your loved one's care. Beatty has since assigned her brother to advocate on her behalf in the future, given his past EMT experience. She's also coached him on her preferences, notating triggers that caused her distress, to ensure productive conversations with doctors, E.R. staff, and family in the future.

6. Assign a Delegate (a.k.a Advocate) Before my husband suffered a Pulmonary Embolism at 47 years old, we thought we were too young to discuss healthcare decisions and protocols. Having the conversation early means couples can agree on who is in charge before a crisis begins. In the E.R., my husband was conscious, though weak, so I did not know when it was time to take charge. Choosing a delegate beforehand and discussing situational nuances can help support confident communication and decision-making when it is needed most.

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