When you work in nursing, everything depends on communication. It’s essential for identifying and tracking symptoms, understanding how a patient is coping emotionally, encouraging helpful actions or lifestyle changes, and helping patients and families take control of situations in which they may feel helpless.
Good communication can change patients’ outlooks and make them feel much more positive about the future, in addition to helping them achieve their health goals. As in every aspect of this profession, the goal is to keep getting better throughout your career, and there is always something new to learn. The strategies presented here will help you become the best nurse communicator you can be.
Develop your active listening skills
The first thing you need to understand about communication is that it is not all about talking. In fact, the most important thing you can do is listen attentively, and make sure your patients can see that. Don’t interrupt them, but use nods, small sounds and facial expressions to make it clear that you’re following what’s being said and that you care. If they’re happy to hold your hand, little squeezes every now and then can also help.
Eye contact is important but should not be constant. There may be some things they feel more comfortable saying when looking away, and autistic patients often struggle with eye contact. The aim is simply to be responsive and visibly empathetic.
Practice opening up conversations
Patients won’t necessarily start talking unprompted, so you may need to initiate the conversation. Asking big, general questions such as “How are you feeling now?” is usually better than inquiring about specific symptoms because it gives them room to talk about the things that are most important to them.
Be aware, however, that some people may have generic responses like “Fine, thanks” that they utter without thinking, potentially closing down the conversation. You will then need to probe a little further, but be sure to keep it gentle. The aim is to create a space in which they feel that no subject is off-limits but do not feel unduly pressured.
Accept and affirm
When patients talk to you, it’s important that they know you understand and accept what they have to say about their experiences. This doesn’t mean that you have to agree with them; it simply means that you’re affirming your recognition of their perspective.
If, for example, a psychiatric patient tells you that voices in his head are getting louder, you can acknowledge his experience without having to agree that the voices are real, and you can give him the sympathy he needs by recognizing that it’s a difficult thing to live with. This is an important part of the process of building trust and making patients feel that they don’t need to hold anything back.
Seek clarification
Even in conversations that feel generic and casual, details may emerge that are important to your clinical understanding of what’s happening to patients and what type of care they need. If anything comes up that requires further clarification, you will need to be ready to ask additional questions.
Never put pressure on patients or make them feel as if they’re bad at explaining. Instead, make it about you, with comments such as “I’m not sure I understood that properly,” which encourages them to go over things again in more detail. This also helps to build their confidence by making it clear that you care about what they have to say.
Encourage expansion
On a similar note, it is essential to keep patients talking when important subjects come up and encourage them to stay focused on particular topics. Comments such as “That’s really interesting,” or “Why do you think that might be happening?” work well in this situation because they send a clear signal that patients’ input is useful without creating a daunting sense of responsibility. They make patients feel that their ideas and perspectives are valued and that they can participate in their own care processes. You can back this up by providing affirmative signals as they speak further.
Recognize effort
When patients are making a useful contribution to their care, whether by sharing difficult things in conversations or sticking to exercise regimens or taking pills properly, it’s useful to acknowledge that in a positive way, encouraging them to stick with it. Direct compliments can feel patronizing, however, and as every patient struggles with different things, they may also seem ridiculous.
A better approach is to say, for example, “It’s a relief to work with someone who takes all their medication because a lot of my other patients don’t,” taking the emphasis off the patient in question but still making it clear that this behavior is valued.
Empower the patient
Being in need of medical or nursing care can be a dispiriting situation, making some patients feel helpless and vulnerable. You can help by creating opportunities for them to take control. When devising a treatment schedule, for example, you can invite input and ask what they think would be the best way to approach it, positioning yourself as a source of information and guidance rather than the arbiter of what will be done.
Without applying too much pressure for those patients who feel intimidated by being asked to take responsibility, this gives patients the chance to take ownership of key decisions. It reduces the risk of them blaming you if something goes wrong and can gradually build confidence when things go right.
Sum up the situation as you see it
As you draw toward the end of any important conversation with a patient, it’s a good idea to sum up the discussion you’ve had, again putting the focus on your understanding rather than on the patient’s ability to communicate. That way, if there has been a misunderstanding, it can be quickly corrected. It also gives the patient the chance to put things in perspective, get a clear grasp of any decisions made and know what to expect going forward. It also helps to provide closure if a discussion has been upsetting.
If you earn an online MSN AGPC, you’ll also learn how you can use such summaries in your records. They’re particularly important in gerontology, as this very practically oriented seven-week course from Spring Arbor University explains, because elderly patients may later become confused about what they’ve said.
Learn how to express doubt
If you feel that a patient has misunderstood a situation, especially in a context where this could cause harm (such as a patient who believes that vital pills are bad for them and wants to stop taking them), it’s still important to listen and accept the patient’s perspective, but you will need to be able to express doubt.
Simply telling patients that they’re wrong isn’t usually very productive. Instead, try to get them to think about the situation. You can do this by discussing the questions you might ask yourself if you found yourself in that situation, or by saying that you think a particular conclusion sounds a bit unconventional and you’d like to hear the reasons for it. You can also gently bring in your expertise by saying that you’re surprised to hear something because none of your other patients have experienced that.
Use humor and warmth
Talking about illness and injury can be depressing for anyone, and part of your job as a nurse is to help to alleviate the stress of these situations. You can do that to some extent simply by making patients feel valued, showing that you care about what they’re going through and what they have to say.
Humor is also a really useful tool. Where possible, encourage patients to see the funny side of things. A bit of self-deprecating humor can be a good way to introduce this as it doesn’t risk making them feel that you’re not taking their troubles seriously, and it gives you the chance to identify the type of humor they most easily engage with.
Know when to be silent
There are times in nursing when there isn’t really anything helpful you can say, or when patients just need a bit of time to process their feelings. Don’t try to force positivity on them if it’s not working, and don’t feel like you have to go away, either. You can do a lot of good simply by being there at someone’s side, showing them you care and that you’re available to talk when it feels right. Conversation isn’t always necessary to keep people from feeling alone.
In all these ways, a good nurse can help patients cope with their experiences and put them in a better position to enjoy optimal health. The focus is not on giving advice or making them feel that they need to have a particular reaction, but simply on offering support and encouraging them to lead the conversation. This can make a big difference to health outcomes and make patients feel much better about what they’re going through.