Communicating with patients and families

Communication ► Communication is the very heart of the nurse- patient relationship  Nurses often must communicate with patients and families when they are stressed and dealing with intensely difficult situations- not an easy job  Failure to communicate effectively can jeopardize the nurse’s credibility with the patient and family

Doctors vs. nurses ► Patients expect doctors to speak in fancy medical terminology… ► Patients expect that nurses will speak so that they can understand what is being said ► Patients expect that doctors may be aloof and distant… ► Patients expect that nurses will demonstrate caring and empathy in their demeanor

Impressions are everything It doesn’t matter to families that the nursing staff may have performed the most advanced lifesaving techniques for the patient… if the nursing staff comes across as cold and distant, the patient and family will not feel cared for.

Non-verbal communication ► Don’t underestimate the power of non-verbal communication! ► Watch for nonverbal cues that don’t match what the person is saying-  Patient says “I’m fine” but is holding on to the side rails with a death grip and rocking in pain  Nurse says “I’m here to help you” while rolling her eyes and scowling

Touch ► Be very careful when using touch to communicate ► Touching a patient who has neuropathy can be very painful, especially hands and feet ► Certain cultures forbid men and women to touch, while other cultures frown upon shaking hands ► Warn patients before you touch them, and describe what to expect- “this will feel tight around your arm” ► Also be careful with gestures- what is acceptable to one culture may be offensive to another

Be honest ► Don’t lie to patients- if what you are going to do will hurt, say so!  Patients (especially kids) really resent hearing phrases like “it’s just a little poke” before a shot- it’s going to hurt and they know it.  When the nurse does this, the patient loses trust in the nurse and then disregards everything else that the nurse has to say.

Giving news over the phone ► Sometimes nurses have to inform family members that someone has been injured or has died ► Make sure that you have the correct person on the other end of the line! ► Introduce yourself and keep the conversation simple while conveying your message ► Try to keep the conversation short- extensive explanations can usually wait until the family comes to the hospital ► If the family asks if the patient has died, be honest but wait to give details in person

Bad day before work? ► Bad day? Leave it at home! ► Even if you have had a horrible day before coming to work, you must leave your bad mood at the door to be caring and professional when working with your patients! ► Sound tough??? It is!!!

Putting a good face on… ► Shortly after I started working on an oncology unit at a metro Detroit hospital, a very good friend was diagnosed with a very malignant brain cancer. ► My husband and I saw him over the weekend, and found out that he would probably die in the next year or two. ► When I went to work on Monday, I had to care for a patient with cancer that had spread to her brain- she was having seizures and could no longer talk. Seeing her, I could only imagine that my friend would soon be in the same state.

Putting a good face on… ► Even though I was in turmoil over my friend’s cancer diagnosis, I still had to be a professional, caring nurse for my patient and her family. ► Yes, it was terribly difficult! ► I knew that it would be painful to continue working on the oncology unit after that, so I soon transferred to a supervisory position instead in the hospital. ► My friend died 2 years later.

Putting a good face on… ► No matter how you may be feeling inside, you always must put forth a professional, caring demeanor for patients and their families ► You will sometimes see horrible-looking wounds or experience nasty smells when working with patients- you absolutely cannot let the patient know how you really feel about it. ► Sometimes nurses have to put on Oscar-winning performances to hide negative feelings- but it’s part of being a professional, respectful, and empathetic caregiver

If it’s really bad… ► Some chapstick or Vick’s Vapo-Rub under the nose will sometimes help mask nasty smells ► If you feel faint, excuse yourself politely and go sit down in another room until you feel better. ► Surgical masks don’t do anything to disguise smells- it will only make the patient feel bad and very self-conscious about the odor

If it’s really bad… ► When I am working with a really nasty wound or smell, I try to block it out of my mind by concentrating on something else- usually a conversation with the patient. ► I focus on talking with the patient as I am doing the dressing change (or whatever) and that helps the time pass more quickly. It also takes the patient’s mind off of the wound and what I am doing.

If it’s really bad… ► If a wound is particularly bad, I try not to think about it too much while I am doing the dressing change… ► When I am all done, then I will go into the bathroom or someplace else away from patients and vent a bit. You might find it helpful to go talk it over with a classmate or co-worker in a conference room afterward.

As you get started… ► Listen. You may hear someone talking, but are you listening? Too often nurses don’t listen to what a patient or family member is saying, but instead are busy forming a response. ► Maintain eye contact. When you are listening, be sure to observe body gestures for signs of contradiction to what he or she is saying verbally. ► Speak with the family members as well as the patient. Try to encourage family interaction and questions, especially if a family member is the primary caregiver for the patient.

As you get started… ► Don't be judgmental. Listen attentively but don’t show excessive emotion to what the patient or family members is saying. Don't ever say that the person's idea is silly. Respond gently instead- suggest that there may be another way to address the issue and the new approach may work better. ► Listen carefully. You can learn much from a patient who is willing to share how he or she addresses and copes with chronic illness or difficult situations. Listening can be a tremendous educational experience, especially when starting a nursing career.

As you get started… ► Speak clearly. This will also help you speak more slowly, making it easier for patients and families to understand you. ► Skip the medical terminology. This only confuses patients and families. Use terms that are easy to understand. ► Allow periodic moments of silence. Silence provides an opportunity for the patients and families to mull over information that formulate new questions for the nurse ► Respect cultural differences. Use caution with touch and humor.