Using analogy in nursing practice

This week’s Twitter chat (8pm-9pm UK time on Wednesday 20th June) explores the use of analogy as a tool within nursing practice. The chat will be led by Lizzie Ette (@busygirlizzie) – nurse lecturer at the University of Hull – whose blog below provides some context and questions related to this issue. You can join the chat by adding #ebnjc to your tweets.

The role of analogy in communication

The fundamental importance of effective communication in nursing is well-established (Delves-Yates, 2015; NMC, 2015). In nursing practice, spoken words are used extensively – notably, to exchange information, and to ‘do’ things (Draper, et al., 2013). Language helps us to gain patient cooperation, consent and understanding. Language helps us describe, explain, discuss and teach. Knowingly or otherwise, we frequently draw on what might be called ‘literary devices’ to help us achieve these rich linguistic communications, and analogy is one such device. Whereas metaphor and simile directly suggest that one thing is as or alike another, analogy enables us to draw parallels between things. Analogy is employed to compare one thing, usually something familiar, with another less familiar or unknown thing, and is most commonly used to help explain or clarify something (Oxford University Press, 2018).

As a driver, do you remember your first driving lesson? Do you remember how stressful it was? Did you leave the first lesson wondering if you will ever master it? There is just so much to think about – how will you ever be able to coordinate your hands and feet, at the same time as checking mirrors, be aware of other road users, negotiate a roundabout? I remember – vividly – but I also remember feeling thrilled when I passed my driving test. I find myself using this analogy with nursing students I teach, when they share with me their fears and anxieties related to their first placement, their first CPR situation, their first job as a qualified nurse. It helps me explore with them some of the concepts related to how we move from first trying at something, to successful mastery, or as Benner (1984) puts it, from novice to expert. Drawing parallels between something that is already known, or at least familiar to the student, may help them feel able to problem solve in anticipation of new events (Keefer & Landau, 2016). At least, this is my hope.

In working with patients, the ability to draw parallels in this way can be similarly supportive. The use of an analogy might help clarify or enhance understanding, and can be used to bridge the gap between what patients already know, and what they need to know (Elsberry & Sorensen, 1986). How often is the analogy that the heart is like a pump used in healthcare, for this reason? Building on this by adding that the heart is the pump in the central heating system, we can suggest that the circulatory system is the pipework, and that blockages in them causing similar disruptive and damaging events. When drafting this blog I took the opportunity to ask colleagues what analogies they found useful in patient interactions. A colleague cited the ‘heart as a pump’ concept, and adeptly took it a step further, suggesting that the heart, like the pump in the heating system, needs instruction from an electrical source to function optimally, somewhat like the heart and the source of electrical activity within it. This can be another useful feature of an analogy – it can offer the possibility of expanding and exploring it further. An example of another analogy used in healthcare is the bookshelf analogy, promoted by the Alzheimer’s Society (2018), which you can see on YouTube here. It helps illustrate the idea of memory loss affecting memory in specific ways, and introduces some relatively challenging concepts. But because of the parallels drawn with something familiar, these concepts can be grasped much more readily.

Like everything, however, the use of analogy has its limitations. Essentially, analogy can only be useful for our patient interaction if we know our patient well enough to be able to draw parallels with something that they are already familiar. This introduces significant scope for misunderstanding, as it is easy to assume that a patient is familiar with something when they are not. For example, it is easy to see that a non-driver will not fully appreciate the driving lesson analogy, and a person with no knowledge of how the central heating operates will struggle to draw any parallels with the function of the heart. Furthermore, as Gleeson et al. (2013) suggest, patients simply want verbal explanation with support from written documents given in a timely way. The use of an analogy might simply ‘muddy the water’ for them, introducing more concepts than are necessary, leading to greater misunderstanding. Indeed, Hayes (2000) warns that analogy can confuse rather than enlighten.

Despite the limitations, analogy can be used to create positive relationships between nurses and their patients. Whaley et al. (2013) found that when nurses used analogy during care interactions with their elderly patients, it improved patient ratings of the nurse, possibly because analogies are associated with those who are good at explaining. In this respect, when we want to explain something difficult, drawing parallels with something more familiar might facilitate a creative and enjoyable option.

Questions for the Twitter chat

Question 1: What analogies have you used in your own practice?

Question 2: How do you find your patients (or students) react to the use of analogy?

Question 3: If you have used analogy in clinical practice and found it helpful or unhelpful, what influenced this?

Question 4: Are there any other advantages or disadvantages to the use of analogy in nursing practice?

References

Alzheimer’s Society. (2018) Bookshelf analogy.  https://www.youtube.com/watch?v=WQ9uSR22qkI&t=5s[Accessed 10.6.18]

Benner, P. E. (1984) From novice to expert: excellence and power in clinical nursing practice. Menlo Park, California: Addison Wesley.

Delves-Yates, C. (2015) Essentials of nursing practice. Sage: London.

Draper, P, Wray, J & Burley, S. (2013) Exploring nurses’ use of language with older people. Nurs Older People, 25(9),18-23. doi: 10.7748/nop2013.11.25.9.18.e509.

Elsberry, N & Sorensen, M. (1986) Using analogies in patient teaching. The AmericanJournal of Nursing,86(10), 1171-1172

Gleeson, M., Meiser, B., Barlow-Stewart, K., Trainer, A., Tucker, K., Watts, K., Freidlander, M., & Kasparian, N. (2013) Communication and information needs of women diagnosed with ovarian cancer regarding treatment-focused genetic testing. Oncology Nursing Forum, 40(3), 275-283

Keefer, L. A. & Landau, M. J. (2016), Metaphor and analogy in everyday problem solving. WIREs Cogn Sci,7, 394-405. doi:10.1002/wcs.1407

Hayes, P. (2000) Analogy. Clarification or obfuscation? Clinical Nursing Research9(1), 3-5

Nursing & Midwifery Council. (2015).The code: Professional standards of practice and behaviour for nurses and midwives. London: NMC.

Oxford University Press (2018)English Oxford Living Dictionaries. https://en.oxforddictionaries.com/thesaurus/analogy[Accessed 10/6/18]

Whaley, B., Stone, A., Brady. S., & Whaley, R. (2014) Explaining diabetes: Studying the effects of using analogies to talk about illness. Journal of Diabetes Nursing18, 72–76

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