Through a Face Mask

Put aside the exasperating debate about whether individuals should wear a face mask to protect themselves and others against the spread of the COVID-19 virus (Centers for Disease Control and Prevention, 2020). Wearing a face mask has become a cause célèbre, with implications of safety for oneself and others, trust in science, and being in defiance of or in lockstep with healthcare authority figures.

Clinical providers have long worn face masks, particularly those who practice in the operating room or postanesthesia care unit or those caring for patients who are immunocompromised or have infectious disease. Clinicians also always wear face masks based on particular clinical procedures. In addition, because of religious, spiritual, or cultural practices, individuals may cover their faces. With the COVID-19 pandemic and face mask policies in any clinical environment, all providers and patients are wearing face masks. Those wearing face masks in public or uncontrolled spaces, including a wide array of essential workers, go far beyond just healthcare workers. Therefore, to address a universal challenge for all of us who are now wearing face masks, let’s focus on communicating clearly through them.

When we wear face masks in oncology clinical practice, how are we communicating with patients when we hang that second bag of IV hydration, when we teach them to anticipate a rash after starting a checkpoint inhibitor, or when we hear about their fatigue that is particularly wearying? Through face masks, do we take in crucial information when patients attempt to tell us they are anxious, confused, or afraid? All of us have had moments of frustration when communicating through a face mask, but there are ways to improve our communication.

Who better to provide guidance than actors and master communicators in the theater world? We have much to learn about communication techniques from actors. Actors, through training and development of their craft, pronounce words with intentional enunciation, articulate concepts from a prescribed script, and mobilize diaphragmatic support to project their voices so that they are playing to the back of the house. Actors are skilled in communicating via body language—sans voice—to convey the grand gesture, the purposeful stance, an effective touch (for us, through gloves, of course), and the energy of genuine concern. Most important in the actor’s communication toolbox is the ability to really listen to fellow actors during a performance—to best connect, convey emotion, and, ultimately, nail a performance. Frankly, the actor’s toolbox of communication techniques, especially the act of listening, is not that much different from the clinician’s toolbox.

The challenges of communicating emotion through a face mask were described in a June 2020 New York Times article (Fortin, 2020). Those interviewed for the article lamented about how face masks make the ability to convey a smile moot or awkward, prompting alternate ways to communicate positivity. According to those interviewed for the article, being creative when communicating includes attention to nonverbal cues, particularly using your eyes, which have been long considered the window to the soul (Fortin, 2020). Through face masks, direct eye contact can still establish intent, clarity, connection, and compassion.

A repertoire company is an ensemble group of actors, singers, dancers, and other performers who are collectively prepared and can competently perform a group of plays, songs, or operas (The Free Dictionary, 2020). As clinical oncology nurses, we perform in a repertoire company, too. Even through face masks, we can be prepared to communicate clearly, competently, and compassionately with patients and their caregivers, making authentic and supportive connections.

About the Author(s)

Ellen Carr, PhD, RN, AOCN^®, is an oncology communications consultant in San Diego, CA. Carr can be reached at CJONEditor@ons.org.