Nonverbal Communication in an Emergency Room

I was just an observer in the emergency room while everyone else was there because of some sort of serious medical issue. During my observations I tried to identify any emblems, adaptors, affect displays, eye gaze patterns, regulators, and illustrators and interpret why they might be occurring and what they mean. I also studied and interpreted the impact of the environment itself and what effect it might have had on the people in it. I took a seat toward the back of the room to get the largest possible view of the waiting room. The overall feeling was fairly comfortable and it was not intimidating.

The first thing I noticed was that the lighting in the waiting room was dimmer than the lighting in the rest of the hospital. It seemed like mood lighting to me and compared to the fluorescent lit rooms in the rest of the hospital it was more relaxing. The wall facing the outside was basically a wall of tinted windows looking into the parking lot. The windows were tinted to let in a comfortable amount of sunlight without it being too bright. I think the goal was to allow as much natural light in as possible. This would be a good idea in a waiting room because the windows can help reduce the feeling of being “stuck” there.

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There were a couple televisions mounted on the wall. Obviously, these were put there to help waiting patients and visitors pass the time. But I would also argue that the televisions were placed there to make the waiting room more familiar and comfortable like someone’s living room. The color of the wallpaper was a very dull, khaki, color. I think that color was picked because it is a neutral color that would not evoke any emotion. Another thing I took note of was how the seating arrangement was laid out. The room was a rectangle shape. The chairs lined the walls and outlined the shape of he room.

Other chairs were placed in the middle of the room around a couple of coffee tables. It didn’t seem to make sense at first. However, the more I stared at it, the more it made sense. The chairs seemed arranged to accommodate the different types of groups that would be sitting there. Some rows were long and straight without any other rows opposite them, which I thought would be suitable for somebody waiting alone and might not want to be facing any strangers and keep to themselves. Other rows were arranged to give you the option to sit face to face with someone.

There were also some rows that were arranged in a square facing each other but further apart, possibly so that if you wanted to talk to somebody you didn’t know, you had the option to do so, without it feeling obligated or awkward. At the end of the rectangle-shaped room, in the back left and right corners, were two additional areas. One was a “family consultation room” and the other area was the “children’s play area. ” These two environments differed from the rest of the waiting room. The children’s play area was in the corner and was made to be a fun environment.

There was a small, pink, round table with four matching chairs. The ceiling dropped down and was lower than the rest of the room as you entered the play area. I felt this made it cozier for children because the ceiling height was more in proportion to a smaller child’s height. The paint on the walls changed also. It had the same color wall as the rest of the waiting room but there was a big, blue, zigzag pattern that started half way up the wall and wrapped around the perimeter of the play area. It seemed appropriate because even without the label on the wall, the area was clearly a children’s play area.

The pattern also set a playful mood. The emergency room can be a stressful place and having to a specific place for children to feel comfortable in was a good idea. The second area was a “family consultation room. ” This was an additional room in the back right corner. This room is for families that have received devastating information about a patient in the emergency room. The room has a door but it was open and unoccupied at the times I was there. This room also had a different feel then the waiting room just outside. As you would imagine it had a very comforting feel.

The walls were a light blue color that seemed to be painted on with a sponge. This room also had a wall of windows but it had an optional pull-down shade to cover the windows if desired. The chairs in this room were different too. There were a set of two normal chairs, a couch and a two-seat bench. The couch had room for three people and the bench had room for two. The couch and bench were different from the seats in the other rooms because these did not have any dividers between the seats. I think the idea behind that was that the room was an area to be close with friends and family.

Having places to sit were you can be close to someone next to you was essential for the purpose of the room. After making notes about the environment I started making notes on everything I saw people doing, and taking note of the different types of people I was observing. I also intentionally put on headphones so that I would only be interpreting non verbal behaviors. Some of the emblems I saw were unique to the individual, while others were repeated among a lot of people. One that I saw a lot of people doing was to put an arm around the person sitting next to them.

Along that same line, people were holding each other’s hands, as well as putting a hand on somebody’s leg. The triage nurse that was calling new arrivals into triage rooms used her hands and body movement to direct people to come with her and to direct them into specific rooms. She would call out someone’s name and when that person acknowledged that they heard her she would invite them over with a wave of her hand. I also saw her point to one of the triage rooms without saying anything when a doctor walked into the waiting room. The doctor had come in and looked at her with a questioning facial expression.

She answered his non verbal question with a non verbal answer. She pointed to the second of two triage rooms. That was the answer the doctor was looking for because he entered the triage room without a word. Other conversational examples that were simpler were things such as a person shaking or nodding their head as a response to someone else talking to them. One woman was actually nodding and shaking her head in response to whoever she was talking to on her cell phone. There were a lot of adaptors throughout the entire room, visitors, patients and hospital staff alike.

A few of them were actually common throughout the room, not always simultaneous, but at some point or another they were repeated by others. One such adaptor was bouncing a leg up and down while talking or waiting. A couple of people also kept shifting in their chairs while talking. The two most common I saw with people’s hands were drumming their fingers on the arm rest, or rubbing their hands incessantly. One that I only saw once was a girl who every few minutes had to switch the position of her feet that were propped up on a coffee table in front of her.

She seemed to be doing it out of boredom or restlessness. I felt she was doing it too often for it to have been the result of her feet being uncomfortable from being in the same position for too long. Others that I noticed were small. A security guard that passed through a few times had the consistent habit of playing with his set of keys attached to his belt. I spotted one of the nurses at the information desk had a habit of tapping the end of her pen gently on her two front teeth while she was pausing to look up anything on her computer.

Most of the affect displays throughout the room were revealers, and very similar to each other, without much change from when I entered to when I left. The first thing I noticed was that nobody was smiling. The only smiles I noticed were fake smiles. The person smiling was forcing the smile. This occurred a lot within groups sitting together when they weren’t talking. A mother “smiled” at her son but her eyebrows were furrowed and pulled together, and her eyes remained unexpressive. The mother’s “smile” was a sign of reassurance and maybe it was interpreted by her son as a real smile, but the mother was clearly worried.

Most of the people in the room had blank expressions or just a slight frown. It seemed as if everyone was in deep thought and most people did not look thrilled to be there. Eye gaze patterns throughout the room varied quite a bit depending on the person's situation. A group that was sitting together in the area of chairs facing each other kept the most eye contact with each other while talking and seemed very comfortable with it. There was another group that was not as good at making eye contact. The group consisted of an elderly woman in a wheelchair along with a middle aged man and woman.

The man looked very agitated. He sat with his body positioned forward toward his companions, but his head was turned completely to the side so that he was looking out the windows. He had his elbow propped on the back of the chair next to him, his chin was resting in his hand and his fingers were covering his mouth. When one of the women talked to him his eyes darted to the one speaking to him but quickly went back to the windows as he answered. The women exchanged glances with each other that seemed to let the other know that they both picked up on his agitation and should probably let him be.

A few people’s gazes were all over the place. Those people seemed to be the ones that had nothing to do. They were sitting there without a magazine or anything to distract them. Another person sitting alone also mainly looked at their lap or the ground, occasionally locking eyes with a stranger sitting across from them and quickly looking away. The same thing happened to me with a girl sitting opposite of me. We kept making eye contact when I was looking around the room for examples. I’m pretty sure she was trying to figure out what I was doing.

I do think she did figure out that I was making some sort of observations and recording them because she started to avert her eyes more quickly the next two times we made eye contact. Regulators were hard to spot because, for the most part, nobody was talking to each other, with the exception of the two groups near me. In the corner what I noticed was, while the man was listening to the woman, he sat back in his chair, body turned towards her, and nodded his head. When it was his turn to speak, he did the opposite and sat up and leaned more towards her and looked around more.

The family was all fairly reserved while listening; hands in their laps, bodies turned towards the speaker, but were more animated with their hands and body shifting as they spoke. The illustrators I saw were mostly emphasizing or helping illustrate something somebody was saying. I watched one funny example play out between the two girls in front of me. I never heard what they were talking about but at one point they both put their arms out to their sides and touched the tip of their noses with their pointer fingers.

They were discussing either a field sobriety test given by a police officer or a balance test given by a doctor. Another example like this helping explain speech was a young man holding both of his closed fists together and snapping them apart while talking to a woman he was with. I determined he was explaining what had happened to his leg since he was in a wheelchair and his leg was wrapped. Those were the only specific illustrators I saw that seemed to have some type of meaning, where the most common thing was just random gesturing of people’s hands as they spoke.

This did not always seem to have any direct connection to what they were speaking about. The adaptors I saw had clear and similar messages with each other. One man came off as stressed and anxious because he was rubbing and squeezing his hands together very roughly without seeming to be aware of it. Fidgeting with his hands seemed to help him take away from the stress he was feeling. Similar to the man rubbing his hands was the girl shifting the position of her propped up feet. She was releasing energy through movement of her feet. It seemed as though she didn’t want to be sitting and would rather be moving around.

Most of the prescriptive interpretations I came up with for the behaviors observed came to me immediately as I saw them, as most of them seemed to convey a very clear message in my mind. Almost all of the emblems I saw were various people putting an arm around the person’s shoulder sitting next to them, holding their hand, or putting their hand on their leg. Touch is a powerful form communication. These all were ways of conveying to the other person that they were there for them, to comfort them and help them in this emotional time, and that everything would be alright. I didn’t have to do too much adjusting once I entered the room.

I didn’t stick out anymore than anybody else did as far as my clothing went. Since this is an emergency clinic, I assumed that none of these people planned to be here so there really was no particular style of dress. Also, the fact that I was there alone and not talking to anybody actually helped me blend in. There were plenty of people alone and keeping to themselves. The only time I felt like I wasn’t blending in was when the girl in front of me noticed I was writing about the room. That happened on the first day. The second day I went into the emergency waiting room, I wore a hat to better conceal my face and what my eyes were doing.

Overall I thought what I found was pretty interesting because I have been in this environment before, noticing most of these things, but the observations this time were put in a whole new perspective because I had to consciously interpret each one, instead of casually noting them. What I think was unique and interesting about this environment was the fact that, although everybody in the room could have easily been of a different ethnicity, gender, age, religion, or political affiliation than each other, they all still had a very similar communication style and seemed to convey the same general emotions.

The overall communication was mostly nonverbal simply for the fact that there was very little talking. However, the non verbal communication that was happening was easily interpreted by the people I was observing. There are few places you can go where the overall internal state of mind and emotions will be so universally contained within one room and made this an excellent location. This exercise made me realize how much and how effectively we communicate as humans without even talking.