Communication Advice for Nursing Students
Avoid communication mishaps (and maybe even catastrophes) by avoiding common errors in communication. Use of loaded terms, ways of talking about brain death, and the hazards of not explaining what you are doing are discussed. I've seen new and experienced health care providers make these mistakes. Add your own in the comments!
We all make communication mistakes. As a hospital-based nurse for over 30 years, I've certainly made my share, and witnessed many more. Along the way, I've picked up a few tips that I hope are helpful to students and new nurses.
1. Avoid loaded language.
Terms like "brain damage" and "life support" are riddled with emotion and unfavorable connotations for the lay person. Although it may seem counter-intuitive, there are times when "medicalspeak" is more effective for communication. It reframes concepts, sidestepping the emotion associated with certain terms in the vernacular. Think about what "life support" really means to us: vasopressors to maintain BP? A ventilator? Cardipulmonary bypass or ECMO? Then consider what it means to a layperson: impending death? Permanent dependence on a machine? A vegetative state? Hopelessness? Using medical terms for interventions is clearer and promotes understanding rather than distress.
2. Death is death.
Don't say "brain death" to families and loved ones when you mean death. The term "brain death" is not clear to laypersons; they might think it is reversible or different from "real death" somehow. "Brain death" is death. Humans do not live apart from a brain, although the heart may still beat. You and I understand this, of course, but laypersons often do not.
Do not use euphemisms either. People need to hear words such as "death" and "died," not "passed on" or "expired." Do not risk miscommunicating about death by using polite terms. Families deserve and need clarity from health care providers in time of crisis. We can be compassionate while communicating clearly. Cultivate this skill in your nursing practice. Find people whose communication skills you admire and learn from them.
3. EVERYONE in a hospital room is stressed.
To patients and families, a hospital stay represents a crisis, and people in crisis have limited cognitive capacity. Their recall and processing are impaired. They may not communicate well with each other. This is why they will forget what you told them yesterday and you will have to tell one family member the same thing you told another family member. They aren't being difficult, they are in crisis. Antagonism from a busy nurse only escalates the crisis, so try to be patient, and use written resources to help provide answers to the common questions (location of bathrooms, visiting hours, etc.) Help the family identify a spokesperson who can act as the #1 go-to person for questions, and refer them to the spokesperson for daily updates. Don't allow yourself to get overwhelmed with inquiries from many people; politely deflect questions to the spokesperson or written materials.
4. Tell people what you're doing.
When you enter a patient's room, say, "Mrs. Jones, I have your atenolol, lovastatin, and IV antibiotic, carbepenem. Let's do the oral pills first, then I'll work on your IV medication." If someone interrupts you, say, "I'm giving medication (or whatever you're doing), and will be with you shortly." If you give the impression that you're not doing an important task, it's much easier for someone to interrupt. And don't forget that assessment and monitoring are also important. Nurses seem to forget that these essential responsibilities that are a huge part of our role save lives, prevent complications and promote healing.
5. Finally, know that you, like everyone else, will make communication errors.
If appropriate, admit the error and apologize. Rephrase what you said in a better way, and move on. You will show that you are human, that you care about communicating skillfully, and that you intend to make things right. And you will gain the respect of colleagues, patients and families.
Although we all make communication missteps, communication is rarely, if ever, overdone in health care settings. Clear communication prevents errors. Try to default to more explaining, more clarifying, and more communicating, not less. You will find it makes you a safer and more effective nurse. Happy communicating!Last edit by Joe V on Jul 10, '13
About Teresag_CNS, PhD, CNS
I am a PhD-prepared clinical nurse specialist with 30+ years of ICU, teaching, and research experience. Gerontology and acute care are my areas of clinical expertise. Research interest: safety and quality of care in intensive care units. I have a passion for undergraduate teaching.
Joined: Feb '09; Posts: 199; Likes: 403
independent wound care expert, educator; from US
Specialty: 34 year(s) of experience in ICU, trauma, gerontology, woundsJul 10, '13Excellent advice! It's so hard as a nursing student to know what's appropriate. Having just graduated I'm still learning and it's good to know this information. Thanks!Jul 10, '13Great advice, thanks so much for posting this! As a student (and an introvert) communication is something I know I need to work on and I'll definitely keep these tips in mind.Jul 14, '13#1 is great advice (well, they all are). My father in law was in the ICU on Friday on a ventilator and a family member asked what a ventilator was. Before I could describe it, another one piped up "he's on life support". Well, she flipped out! I was able to calm her down and explain that the ventilator was helping him breath and he was actually breathing 70% on his own and only requiring the ventilator for the other 30%. By the next day, we were able to get him completely off the ventilator...yay
Had she just thought "he's on life support", the whole family would have thought he was about to pass away. While he's not out of the woods yet, he's now alert and can speak again. I think the biggest part of communicating with patients is keeping a calm demeanor. You can't sugar coat things, but the way the words are conveyed go a long wayJul 18, '13I agree that this story is really cool.Last edit by TheCommuter on Jul 18, '13 : Reason: TOSJul 28, '13I am starting nursing school in August and plan to always remember that being in the hospital is a crisis to the patient and their families. Most patients and families are scared and feel helpless.
My father had stage 4 lung cancer and had an aortic aneurysm. After surgery he was placed on a vent. His body started to shut down and we were told he probably wouldn’t make it. We were struggling with the news and the decision of taking him off the vent and getting hospice. I never left my father's side and one night he was struggling with the vent and had a look of panic in his eyes. (I'll never forget that look) I went to the nurses’ station and told a nurse that my father was awake and struggling and had that look of panic on his face. The nurse looked annoyed and snapped, "There isn't anything I can do. I can't give him anything else for pain, it will kill him." Her words left me feeling completely helpless to help my father. I turned and went back to his room and he was still struggling and had "that look" on his face. His vent alarm kept going off and the nurse came in to check it. As she was checking my father, she apologized to me for the way she spoke to me. She ended up calling respiratory and they changed the filter on the vent. After my father calmed down and rested peacefully the rest of the night.
My point is that communication is key and it is not only the choice of words, but also your tone and body language. We need to remember that the hospital environment is not the "norm" for the patients and their families. The nurse that night may have been having a bad night, but I was having a worse night; I was losing my father. I am learning that nurses struggle with the limited time they have with their patients. I feel it is so important to take what little time there is and to communicate with kindness, compassion and empathy to your patients and their families.Jul 28, '13Teresag_CNS, thank you for the great article!Jul 29, '13Thanks for sharing that meaningful story, reg4fun69. I'm sorry you had a bad experience with a nurse, but glad she apologized and it does seem like it was a learning experience for you, which is good, of course. Best wishes in your nursing studies!
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