Wednesday, October 9, 2013

Lessons from Elements of Style - Part 2

Thank you all for your positive responses to my Elements of Style series!  I really appreciate all of your comments.  If you didn’t get a chance to read part one, here’s the link.

This week’s quote is one that I feel I have a pretty good handle on. 

Direct and vigorous.  Now those are two words that I would love someone to use when describing my writing. 

The difference between active and passive voice really clicked for me when I became a nurse.  It’s one of my responsibilities to record everything that happens to each one of my patients.  There are multiple reasons for that.  One is to communicate with other nurses, therapists, doctors, etc what is going on with the patients.  Another is to keep record of anything out of the ordinary that might happen.  A third is to cover myself if I ever get accused of anything by the patient or a family member.

But when charting, I’m not allowed to use anyone’s names, or refer to myself.  A lot of it has to do with legality, but it also has to do with subjectiveness vs objectiveness.  It forces me to remove my own personal feelings and focus only on exactly what happens.

Here’s an example of a VERY HYPOTHETICAL situation vs how I would chart it.

Real situation (active)

Let’s say that I walk into a patient’s room (we’ll call her Krista.)  She tells me that her stomach hurts and that she wants something for diarrhea.    I decide that before I give her a medication, I want to see if it’s something more serious.  So then I feel her abdomen, testing to see if there’s a specific area that hurts more than others.  She starts yelling because it hurts after I press the lower right area of her abdomen.  I check her vital signs and notice her temperature is a little high.  I’m concerned that this could be appendicitis.  So I call the doctor and get an order to send her to the hospital.

Now here’s the passive/nursing charting version (passive):

Patient complained of pain at approx. 1930, requested PRN medication for diarrhea.  Abdomen was palpated and rebound pain noted in the right lower quadrant.  Pain radiating to lower extremities and to back.  Vital signs were checked and temperature was 100.3.  Dr. Smith called and order to send patient to hospital was received.  Resident left facility at 2000.

See where although I did all of the actions, I’m not mentioned once in the charting?  When I do something, I change the sentence around so that the patient is receiving the action, but I don’t state that I’m the one doing it. Active is when something is acting.  Passive is when it's being acted upon.

Active: I palpated her abdomen and noted that she had rebound pain.
Passive: Abdomen was palpated and noted to have rebound pain.

Whenever I have a question about active vs passive, I just ask myself: Do I sound like I’m trying to write out legal documentation?

How about you?  Do you have difficulties with active v passive voice?  What do you look for to make your writing direct and vigorous?