There are lots of conversation topics in healthcare that fall into the “Bad News” category. It can be that an orthopedic surgery didn’t accomplish what was planned. Or a patient who had a private room needs to be moved into one with a roommate. Or the labs that were drawn on a child clotted and need to be drawn again. And of course, there are the tough conversations that surround profound illness and death. Often, we as nurses, find ourselves in the Bad News Aftermath: The 12 hours of your shift that happen after the bad news has been communicated.
Discussing bad news with patients and families can be uncomfortable and challenging. It can also be an ongoing need. The only way to make it a little easier is by learning some proven techniques and keeping a few principles in your back pocket.
An article published by CA: The Cancer Journal for Clinicians is chock full of helpful strategies for having those difficult conversations, including what not to do.
Let’s start there.
What not to do
A wise nurse once told me, “You’re not the awkward one in the situation. The situation is awkward.” When we use ineffective communication behaviors, it’s usually because we’re uncomfortable. That’s natural. But being aware of a few things to avoid when talking to a patient who has received bad news can help you steer clear of these pitfalls.
|Behavior||What It Sounds Like|
|Blocking||Your patient says, “I’m afraid I might die.”You say, “Don’t worry about that right now.” Or you change the subject.|
|Lecturing||Giving lots of information without stopping to ask what the patient has understood so far, if there are any questions, or asking how they’re doing emotionally.|
|Collusion||Your patient doesn’t ask if the prognosis is poor and you don’t broach the subject either.|
|Premature Reassurance||“You’re going to be fine.” “We’re going to make you better.”|
Helpful strategies that work
The NURSE Pneumonic
|Naming||Identifying an emotion, even if just to yourself, can help you empathize with what the patient is feeling. Or say, “It sounds like you’re angry” or “Sometimes people feel angry.”|
|Understanding||“I understand that you’re concerned about how your chemo treatments will affect your family.”|
|Respecting||Can be verbal or nonverbal; the intent is to validate a patient’s feelings and find an area where they might receive praise. “The way you’re expressing your emotions is a very healthy way to cope.”|
|Supporting||“We will stick with you during your treatment.” “You’re doing a great job taking all of this information in.”|
|Exploring||Ask open ended questions like, “What are you thinking about?” or “You said you’re at the end of your rope … tell me more about that.”|
You can read the full article here for even more tips and useful conversational tools.
How well do you feel you communicate during difficult conversations? What has worked for you? What is most challenging? Share with me and our Scrubbed In readers — because you are the true experts!