The Usual Post-Biopsy Vitals: A Handoff Between Interventional Radiology and an Oncology Floor, Read Through Watzlawick's Five Axioms
Student Name
American College of Education
NUR5123: Relationships Through Communication
Module 1 Assignment
Instructor Name
July 6, 2027
The Event
The setting is the interventional radiology department of a composite 350-bed hospital, which has four procedure rooms and a nine-bay area where patients are prepared and recovered. Inpatients who have procedures return to their own units once they meet recovery criteria, and the interventional radiology nurse gives report to the receiving nurse by phone.
On a Tuesday afternoon, a 64-year-old composite patient with metastatic colon cancer had a CT-guided biopsy of a liver lesion. He had been receiving a prophylactic dose of heparin, held that morning, and his platelet count was at the low end of normal. He recovered for an hour in interventional radiology without problems. At 1440 the interventional radiology nurse called the oncology unit. The receiving nurse answered while preparing a chemotherapy infusion for another patient. The report lasted just under two minutes. It included the procedure, the patient's stable vital signs and the instruction to follow the usual post-biopsy vitals and keep him on bed rest for four hours. The receiving nurse said she knew the routine.
On the oncology unit, the usual post-procedure routine meant vital signs every four hours. In interventional radiology, the usual post-biopsy vitals meant every 15 minutes for an hour, every 30 minutes for two hours and hourly for four hours. The patient's next vital signs were taken at 1800, when his blood pressure had fallen to 88/50 and his heart rate had risen to 118. A CT scan showed a hematoma beneath the liver capsule. He received two units of blood and recovered without surgery. Bleeding after image-guided liver biopsy is uncommon, occurring in fewer than 2% of cases overall in one scoping review, but it is known to be more likely in inpatients and those with abnormal coagulation (Midia et al., 2019).
The next morning the interventional radiology nurse manager called the oncology nurse manager and said the patient had not been monitored as ordered. The oncology manager replied that the order was never communicated and that interventional radiology routinely sends patients back with instructions nobody on the floor can find. The call ended with both managers promising to escalate the matter.
The Theory
Watzlawick et al. (1967) approached communication as behavior within a relationship rather than as the transfer of a message from sender to receiver. They proposed five axioms. First, one cannot not communicate: every behavior in an interaction, including silence, conveys something. Second, every communication has a content aspect and a relationship aspect, and the relationship aspect tells the receiver how to take the content. Third, the nature of a relationship depends on how the participants punctuate the sequence of exchanges, that is, where each believes the chain of cause and effect begins. Fourth, people communicate both digitally, through words with agreed meanings, and analogically, through tone, pace, posture and context. Fifth, exchanges are either symmetrical, in which each party mirrors the other's behavior, or complementary, in which one party's behavior fits with and completes the other's.
The theory is useful for this event because the failure was not simply missing information. Both nurses were competent, and each believed the other had understood. The theory also has a limit worth stating: it was developed from the study of families and therapy rather than of workplaces, and it says little about the organizational pressures, such as staffing and workload, that shape conversations between busy clinicians. The analysis below therefore treats those pressures as part of the context in which the axioms operate.
Applying the Five Axioms
One cannot not communicate. The receiving nurse's brief reply, that she knew the routine, and her failure to ask a question were themselves messages: they told the interventional radiology nurse that the instruction had been received and understood. The interventional radiology nurse's brisk, two-minute call also communicated something, that this was a routine transfer, not a patient needing close watching.
Content and relationship. The content was a monitoring schedule. The relationship aspect was more complicated. The phrase the usual post-biopsy vitals assumed a shared routine and a relationship in which the floor nurse would know interventional radiology's standards. The floor nurse's reply defended her competence on the relationship level; asking what the usual vitals were would have felt like admitting ignorance to a specialist. The content failed because the relationship made asking the clarifying question feel like a loss of face.
Punctuation. The two managers punctuated the same sequence differently. The interventional radiology manager began the story at 1440, when an order was given and not followed. The oncology manager began it years earlier, with a pattern of vague instructions from interventional radiology, and saw the missed vital signs as the predictable result. Each account was internally consistent, and each placed the cause on the other side. Watzlawick et al. (1967) describe exactly this kind of disagreement about punctuation as the root of many relationship struggles.
Digital and analog. The words of the report were accurate but ambiguous; the digital message contained no numbers. The analog message, a hurried call answered while the receiver was preparing chemotherapy, signaled that both parties were busy and the exchange should be short.
Symmetry and complementarity. The managers' call was a symmetrical escalation: each met the other's accusation with an accusation of the same weight, and each promised to go over the other's head. Neither took the complementary role of listener that might have allowed the exchange to move toward a shared account.
What the Analysis Means for Nurse Leaders
Three conclusions follow for the leaders of both units. First, the handoff failed on the relationship level as much as the content level, so a fix that addresses only content, such as a new form, will be incomplete unless it also makes clarifying questions normal. A structured handoff that requires the receiving nurse to read back the monitoring schedule, which Module 2 will develop, does both, because it turns a question into a routine step instead of a confession.
Second, the managers' argument shows that punctuation disputes cannot be settled by establishing who started it. A review of nursing handoff research found barriers in eight categories, including communication, environment and the absence of standardized processes, and noted that most studies were of modest quality (Riesenberg et al., 2010), which suggests that handoff failures usually have several contributing causes rather than a single one. The two managers will be more productive if they describe the event together as a system failure, with contributions from both units, than if they continue to argue about where it began.
Third, the leaders' own behavior sets the relationship level for their staff. If the managers escalate symmetrically, nurses on both units will learn that the other department is an opponent. The interventional radiology manager has since asked to meet the oncology manager in person, with the event timeline on the table and no one else present, as the first step in rebuilding the relationship on which every handoff between the two units depends.
References
Midia, M., Odedra, D., Shuster, A., Midia, R., & Muir, J. (2019). Predictors of bleeding complications following percutaneous image-guided liver biopsy: A scoping review. Diagnostic and Interventional Radiology, 25(1), 71-80. https://doi.org/10.5152/dir.2018.17525
Riesenberg, L. A., Leitzsch, J., & Cunningham, J. M. (2010). Nursing handoffs: A systematic review of the literature. American Journal of Nursing, 110(4), 24-34. https://doi.org/10.1097/01.NAJ.0000370154.79857.09
Watzlawick, P., Beavin, J. H., & Jackson, D. D. (1967). Pragmatics of human communication: A study of interactional patterns, pathologies, and paradoxes. W. W. Norton.
How this NUR 5123 Module 1 example is structured
NUR 5123 Module 1 typically analyzes a communication event through a named communication theory; your classroom's instructions decide whether the event must be one you witnessed and how much of the theory must be applied. This example describes the event factually, explains the theory from its primary source, applies each of its axioms to specific moments in the event, and ends with conclusions for leadership practice.
NUR5123 Module 1 questions, answered
What does NUR5123 Module 1 usually ask for?
NUR5123 Module 1 typically asks you to describe a communication event from practice and analyze it with a named communication theory, ending with what the analysis means for your practice or leadership. Your classroom's instructions decide the theory and length.
Which communication theory should I use?
Use a theory from your course materials that fits the event. Transmission models suit events where information was lost; relational theories such as Watzlawick's axioms suit events where the relationship between people shaped what was heard.
How do I keep the event description objective?
Describe what was said and done, with times, before any interpretation. Save judgments for the analysis section, where the theory explains why each moment went the way it did.
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