Language,Simulation,and Human Connectedness: Thoughts During the 2020 Pandemic

Language illuminates meaning, which powers understanding, knowledge, and thus provides a framework for presence and choice. The author in this article explores nursing practice and delves into some thoughts on current nursing practice preparation strategies, which are often referred to as simulation. Simulation, or any teaching-learning strategy, needs to embody the human experience and therefore needs to include attention to language. With the events of the COVID 19 virus, the circumstances on which nurses practice such as being with patients while masked, being with persons while caring for an increased volume of patients in isolation, being with persons who are experiencing limited or no visitation, or being with persons while sheltering at home, simulation offers learning opportunities to transform practices during these experiences. It is the central premise of this article that the current circumstances have elevated the importance of language and being with persons. The author shares some considerations regarding language and nursing theoretical frameworks as necessary components to illuminate simulation and preparation for engaging with persons in their healthcare experiences.

The article begins with thoughts on the essences of language. Language is defined as an “audible articulation and systematic means of transmitting ideas, feelings with having an understood meaning” (Merriam-Webster Dictionary, n.d.). Language is thus the communication of information, thoughts, and feelings through a system of particular signals like sounds, voice, written symbols, or gestures. McWhorter (2004) articulated a view that all languages continually transform. This transformation includes the meaning of words, sounds, movements, silences, and grammatical elements. Consider the words shelter in place. The term is meant to convey a set of restrictions that are typically detailed out in the protocols of a city or state. When these words were first referenced within the general lexicon, they equated to mitigating looming nuclear threat. The terminology has grown to incorporate sheltering and protecting from tornados, chemical spills, protection with active shootings, and general safety promotion. In 2020, the current usage has expanded to include recommendations to shelter in place to promote social distancing with the pandemic outbreak of COVID-19. Although specifics have changed, the current term shelter in place quickly gets to the point of staying indoors to enhance protection. This examplifies that language abounds with mysteries of different dialects and wonderful bundles of dynamic themes that are knit together through a collection of established and emerging customs. Language is one of the many wonders of being human. Of note it is truly amazing that persons can communicate with the commonality and understandings to the degree accomplished.

In an effort to gain additional insights within the nursing literature, an abbreviated literature review was conducted to seek out the emphasis of articles that focused on language. This nursing literature was found to feature the topic of disciplinary language, and the nursing literature also discussed reducing language barriers. As an example of disciplinary language in an article by Allen, Chapman, O’Connor, and Francis (2007), the authors describe communication within the nursing discipline as having a common language, an intermediate language (clinical pathways), and an elite specialist language most often found within the confines of complex tertiary care. All components of language are designated as integral to professional accountability. Disciplinary language is described to encompass a conundrum in that the demarcation of where common language finishes and where exclusive language begins is illusive (Allen et al., 2007). The illusive nature of this proposed conundrum represents a challenge in the facilitation of accurately communicating with patients. The conclusion of this particular article summarizes that working with patients to find a common understanding possesses a unique challenge and nurses need to take the lead to facilitate understanding that encompasses “quality care and consumer choice” (Allen et al., 2007, p. 47).

In addition to disciplinary-centric language, another element frequently cited within the nursing literature focuses on the topic of language barriers. Language barriers describe difficulties of exchanging information and most frequently refer to linguistic differences between persons with different language backgrounds or dialects. The literature on overcoming barriers focuses on rudimentary suggestions such as work with an interpreter or technologically provided interpreting services and “greet each person individually, communicate directly with the patient, consider the situation and speak in shorter sentences, at the conclusion of a conversation review if patient needs anything else, and summarize the conversation” (Squires, 2018, p. 23).

Describing and explicating disciplinary language as detailed by Allen et al. (2007) and attending to language barriers as exemplified by Squires (2018) do not emphasize the importance of theory, language, and being with persons. Nursing as a science has its own unique phenomenon of concern and is propelled by different theoretical perspectives. These different theoretical perspectives harness knowledge and correspondingly use specific language that aims to enhance quality of life and health of persons. For instance, in Peplau’s (1997) theory of interpersonal relations, there is a need for human connectedness. Human connectedness forms the structure of nurse-patient relationships with the concept of the patient as a partner in the nursing process. The structure of the partnership and language that illustrates the partnership formulates what is known as the nurse-patient relationship. The nurse-patient relationship consists of phases and progress over time. The phases are described as orientation, working, and termination phase. Each phase promotes the needs of the patient as a primary focus of language and nursing interventions to maintain the dignity of the patient (Peplau, 1997). The theory also defines various roles in which the nurse serves in the relationship; the phases are labelled as stranger, resource, teacher, leader, surrogate, or counselor (Peplau, 1952/1991). The phases and roles focus the language to achieve expectations of patients and nurses, while pursing the provision of health services.

Another theoretical perspective providing insight into the importance of language is the humanbecoming paradigm. Parse (2002) noted that accuracy and clarity are essential to convey meanings. It is thus an essential disciplinary accountability to use words as they are either defined by a “dictionary or defined by a discipline-specific theoretical perspective” (Parse, 2002, p. 183). The clarity and knowledge of a theoretical-based discipline drives the approach when engaging in a nurse-person process. For example, living the art of humanbecoming arises from the ontology and is unique to humanbecoming. True presence is an unfolding “a bearing witness and being with others in their changing pattern preferences attuned to the rhythms, hopes, and dreams as shown in the sounds and silences, the visions and blindnesses available with the illimitable mystery of humanuniverse” (Parse, 2014, p. 93). The nurse prepares and invites a discussion to focus on what is important for the person in the moment, and the meaning surfaces offering new insights. Meanings are illuminated by the choice of words, sounds, silences, and movements. The nurse is guided by the person and does not have a preexisting checklist to complete. This attentiveness with the proper language forms at the theoretical level. Thus, language is more than a series of words, silences, and motion. It provides the building blocks of understanding in how the words, silences, and motions are cocreated.

Whatever disciplinary theoretical framework the language utilized reflects values and assumptions. Language thus serves as the fulcrum upon which to guide the preparation of nurses to enter into interpersonal relationships or to bear witness to others through true presence. Both teaching-learning and healthcare organizations have initiated clinical simulation and practice for the purpose of building skills and confidence for what is labeled real-life clinical experiences. Simulation and practice develop technical proficiency through practice and repetition of psychomotor skills, access to experts who oversee learning context, while providing a safe and secure environment (Cant & Cooper, 2009). The simulation literature did not center on the element of being with or engaging with persons as a primary focus. Simulation should be considered anew and serve as a tool to demonstrate the importance of being with persons and bearing witness to their experiences. This honors human dignity and is consistent with nursing’s mission as a distinct contribution to the “betterment of humankind” (Parse, 2014, p. ix).

Being with persons and bearing witness to health, choices, and the opportunities and restrictions that arise in being with persons has undergone significant transformations with the COVID 19 pandemic. The elements of social distancing, masking, decreased or prohibition of visitors, increase of virtual communications with patients, and working remotely bring to the forefront the need to utilize and think about language and being with persons differently. Words, movements, and silences, in essence all the aspects of language that matter, require attention to the circumstances, which will prepare nurses for a disciplinary-centered paradigm at the point where healthcare is delivered. Although it might seem an unaffordable luxury during these times to center on the experiences of persons, it is essential to preserve dignity. The focus on the experience of persons as a paramount endeavor provides mechanisms for decreasing safety issues and increasing person satisfaction and prevents later reconciliation and service recovery. Listed below are opportunities to enlist simulation elements to create opportunities for meaningfully engaging and being with persons.

According to Dieckmann et al. (2020), simulation provides the opportunity to learn “at the individual level and it has an integral part to play in systems testing” (p. 17). This benefit centers on the assumption that participants within the simulation experience can provide valued feedback on enhancements to continually focus on improving the experiences for persons who are being served by healthcare organization. Language and the practice offered through simulation serve as an important bridge that promote being with persons, opportunities to promote human connections, and risk mitigation during these times. These opportunities hinge on attention to language and an overarching knowledge base to illuminate meaning and transform care. This approach honors persons and the various important connectednesses of family and community as the primary focus and outcome.