8 Tips for Tough Conversations with Patients

Have you ever stumbled through a difficult conversation with a patient? We all have! Here are eight tips to keep you moving right through your next hard conversation. Nurses Announcements Archive

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  • Workforce Development Columnist
    Specializes in Workforce Development, Education, Advancement.

Informing patients of abnormal assessment findings or lab values can be hard. On the one hand, you want to be honest and forthcoming, yet, you don't want to cause unnecessary stress or alarm for the patient. How do you go about delivering this information in a seamless manner that meets all of the above?

Here are a few tips you can put into practice today that will help you when discussing tough conversations with your patients.

Pay Attention to Tone

When you're talking to your patient about their test results, they're likely hanging on every word. And, it's not just the words you use, but the way you use them that they interpret. The tone of your voice communicates what you're feeling when you speak.

Tone can be changed by other factors, such as how you're feeling that day or other things on your mind. You might not be good at understanding your own tone of voice when you speak. Whatever the reason, be sure that your words are correct and your tone is conversational and caring.

Speak Clearly, Not Loudly

Have you ever witnessed a conversation where someone didn't understand the information being given, and instead of changing the message, the speaker started talker louder? Unfortunately, we've all done this. When communication starts to get off track, you might naturally change your tone and volume without even knowing it.

The next time you're having a difficult conversation with a patient, be sure to speak slowly and clearly. Keep the volume of your voice at a moderate level.

Avoid Acronyms or Big Medical Words

You talk fluent nurse, but your patients don't. Try to avoid acronyms and big medical words whenever possible. If you must use either, be ready to explain what they mean in simple terms.

Know Your Audience

This is one of the best communication tips for any type of communication. It doesn't matter if you're giving a lecture to nurses or talking to a patient - you should always know your audience. This means you might need to ask a few questions to gauge the patient's current level of understanding of their disease process.

This can come in handy if the patient is a health care provider too. Remember that just because the patient is a nurse, doctor, or another clinician - they still need to be taught about their illness. And, they may have family or other caregivers with them, who need to understand the information so that they can support the patient.

Stop Talking and Listen

You might think that you need to tell the patient everything before you stop to assess where they are in the journey of understanding, but this might not be the best strategy.

Try to pause after small bits of information and allow a little silence to enter the space between you and your patient. This gives them the opportunity to express understanding or ask questions. Listening is one of the best communication skills to know what your patient is understanding. And, you might also connect with them on a different level if you use active listening.

Use Reflection to Gauge Understanding

Also known as the "teach-back method," reflection gives your patient the opportunity to demonstrate to you what they've learned. To use this method, ask the patient to restate, in their own words, what you taught them. This allows you to check their level of understanding of the information you provided.

Remember Your Body Language Speaks Too

You walk past the nurse's station and notice a coworker talking to a family member. Your co-worker has their arms crossed over their chest, and they're looking down the hall at another nurse. You later hear them tell the unit manager they have no idea why the family member expressed concern about their communication skills. You silently replay the scene you saw earlier and thing to yourself - "it was your body language."

Always strive to match your body language, words, and the intent of the conversation. If you want your patient to open up - you need to mimic this through your words and behaviors. Keep your arms down to your side or in your lap to show that you are open to receiving feedback. Maintain good posture and eye contact. Pay attention to the expression on your face, and smile, when appropriate.

Assess For Communication Needs

I recently witnessed an interaction between a registration staff member and a non-English speaking patient. First, the registrar increased the volume of her voice when she thought the patient wasn't understanding. Then, her tone changed, until she finally realized the patient didn't speak English.

She quickly got on the phone with an interpreter, but while waiting to get this process started, the registration staff working with this patient ignored them. She didn't engage with the patient at all. In fact, she actually turned her back to the patient and even told another staff member, "They don't understand, so I'm just not talking to them."

While the patient didn't understand the words, they certainly understood the body language and the message being sent by the staff member turning their back on them. Once the patient heard the interpreter speak their native tongue, everything about them changed - they smiled, their body language relaxed, and they maintained eye contact with the interpreter on the video call.

This was an excellent example of what not to do when you have a patient with special communication needs. Remain open when communicating with patients so that you can recognize these needs. If a patient doesn't understand you, change your approach and then consider if there are special needs that you're not meeting.

No matter how good your communication skills are, you can always improve. Challenge yourself to consider using just one of these tips the next time you're in a difficult conversation with a patient.

Do you have other tips? Place your thoughts in the comments below, we would love to hear them.

Kitiger, RN

1,834 Posts

Specializes in Private Duty Pediatrics.

You said, "The next time you're having a difficult conversation with a patient, be sure to speak slowly and clearly. Keep the volume of your voice at a moderate level." That is so true. I'd like to give a little more detail.

If the patient is hard of hearing, be sure he/she can see your face. (Don't stand in front of a window.) Speak more slowly, giving time for the person to run your words through their computer/brain. ("Did she say fast? Last? Cast?")

It's easy to miss the first few words of the next sentence, while trying to decode the first sentence.

If they ask you to repeat, speak clearly, but not necessarily louder. Speaking louder can actually make it sound more garbled. If they still don't get it, try using a synonym. The word 'rapid', for instance, is easier to hear and decode than the word 'fast'.

I have found that - when asked - people do these things well for the first 3 or 4 sentences, and then they revert back to their usual pattern of speech. Try to be mindful of this tendency, and keep your speech clear.

Often, the person will not keep asking you to speak clearly. They will give up and smile & nod, and you will finish, thinking that they got it. Once you leave the room, the patient will turn to their visitor and say, "What did she say?"

Workforce Development Columnist

Melissa Mills, BSN

126 Articles; 367 Posts

Specializes in Workforce Development, Education, Advancement.

Kitiger - Excellent points!!!! Thanks for sharing!

Melissa

tina hobbs

2 Posts

I wanted to also chime in on the last paragraph by Kitiger. My mother was hard of hearing and we had told the oncologist that she wasn't understanding. Mom was sitting next to the physician and he increased the volume of his speech, but did not move closer to Mom, nor did he ask her if she understood. When I called her on the phone the next day to see how she was feeling it was very obvious that she did not understand. When I said, "Mom, don't you remember he said...." she said to me, "Oh, I couldn't understand half of what he said." It's especially important to ensure that you are engaged with the hard of hearing and/or elderly patient. They will simply smile and nod and give false reassurance to the provider that they understand.

Thanks so much Melissa, for reminding us about how our communication skills matter!

Tina

Workforce Development Columnist

Melissa Mills, BSN

126 Articles; 367 Posts

Specializes in Workforce Development, Education, Advancement.
I wanted to also chime in on the last paragraph by Kitiger. My mother was hard of hearing and we had told the oncologist that she wasn't understanding. Mom was sitting next to the physician and he increased the volume of his speech, but did not move closer to Mom, nor did he ask her if she understood. When I called her on the phone the next day to see how she was feeling it was very obvious that she did not understand. When I said, "Mom, don't you remember he said...." she said to me, "Oh, I couldn't understand half of what he said." It's especially important to ensure that you are engaged with the hard of hearing and/or elderly patient. They will simply smile and nod and give false reassurance to the provider that they understand.

Thanks so much Melissa, for reminding us about how our communication skills matter!

Tina

Tina - You are welcome! Thanks for comments and example. I think real-life examples always sink it better. Your story reminded me of one other tip - look at the patient! How many times are we busy doing 15 other things that we forget to be fully engaged and look at them. This allows us to assess their body language too - so, if you see that puzzled look or blank stare - you know you need to dig deeper to see where the disconnection might be.

Thanks again! ~Melissa

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