10 nurses tell how they prepare for hard patient conversations

Ten nurses discuss how they prepare for difficult conversations with patients.

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Note: The following responses were edited for length and clarity.

Question: How do you prepare mentally and emotionally to have a difficult conversation with a patient?

Trish Celano, RN. Senior Vice President, Associate Chief Clinical Officer and Chief Nursing Executive at AdventHealth (Altamonte Springs, Fla.): In a difficult conversation, I always tried to make it personal. What if it was my dad getting this news? What questions would I have as a patient or as a daughter? You don't really have to train yourself to think this way because we've all been a patient, a family member, a friend. We can put ourselves in their shoes. There is not only emotional weight, but financial stress.

Another thing I learned was to hold back and go at the pace of the patient and family. You owe it to that person not to rush through things. Consider the impact and what they may be thinking. No matter what, it's going to be a blur for them; we need to empathize with their mindset. To that family, this is everything.

I almost always brought a chaplain into the conversation, if possible. Just having a chaplain hold their hand or talk to them made them feel less alone. Heartfelt physical, emotional and spiritual support is never more important than when someone is processing life-changing news.

Jeanell Rasmussen. Vice President of Patient Care Services and Chief Nursing Officer at Harrison Medical Center (Bremerton, Wash.): Mental preparation is key. Taking a few minutes to center myself, reflect and prepare has been helpful in ensuring I will be fully present for the conversation. Though I gather relevant facts in advance, I also question assumptions and create an openness to listen and understand the patient's perspective and experience. I identify other resources or support that might be applicable to the situation, either during the conversation or to offer in follow-ups. It is not so much about having the answer, but rather providing an opportunity to listen and engage with the patient based on where they are and how we can support them moving forward.

Becca Smith, RN. Learning Specialist in the Neuroscience Trauma Unit at Primary Children's Hospital (Salt Lake City): I try to prepare for any hard conversation — with a patient, co-worker or family — by trying to put myself in their shoes to see it from their mindset. I want to understand their perspective. Why would a reasonable person do this or think this way? It helps me know how to approach what I need for them to understand my perspective as well. This way, we can meet in middle ground and move toward a common goal.

Michelle James. Executive Director of Providence Nursing Institute (Renton, Wash.): In preparing for a difficult conversation with a patient or a caregiver, I prepare with facts and then go into the conversation with a compassionate heart and also do my best to be present in the moment. I have learned it is OK to cry with a patient, caregiver and the family.

Tammy Richards, RN. Assistant Vice President of Professional Practice and Learning at Intermountain Healthcare (Salt Lake City): I make sure I am clear on the intent of the message, and I ensure I have all the relevant information and details. The most important part of preparing is caring enough to reflect on how that message will be perceived. The conversations always go better when I make eye contact and genuinely listen to their response.

Lee Woodman, RN. Staff Nurse, Behavioral Health at Shasta Regional Medical Center (Redding, Calif.): I take a few moments to do some deep breathing and calm myself. I think about what I'm going to say. I envision possible responses/reactions the patient may have and anticipate how I will deal with them for the best possible outcome.

Karen Hatley, RN. Patient Educator in the Maternity Education Center at Atrium Health Pineville (Charlotte, N.C.): I evaluate my thoughts and emotions on the situation. I take a deep breath and try to leave my personal opinions in the hallway. Once I step into that patient's room to have a hard conversation, I strive to put myself into their shoes. I want to fully be there for that patient and family regardless of whatever else is on my mind that day.

Kelli Hohenstein, RN. Chief Nurse Officer at Dallas Regional Medical Center (Mesquite, Texas): I always approach patients with an open mind and a willingness to listen. Most patients just want to be heard and understood.

Lorraine McDonald, RN. Psychiatric Staff Nurse in the Center for Behavioral Health at Shasta Regional Medical Center (Redding, Calif.): I prepare by reminding myself that being honest with a patient or family member is always best and the ultimate truthful outcome is going to be worth any momentary discomfort.

Rose Price, RN. Clinical Supervisor in the Cardiovascular Intensive Care Unit at Atrium Health Pineville (Charlotte, N.C.): I try to be honest and express empathy when preparing for a difficult conversation with a patient. I always envision myself in their place and try to see the situation through their eyes. The conversation may be difficult because that patient may be experiencing distress, grief or pain. I try to genuinely connect with patients so that I may understand them better and help them work through their difficult situation. I believe that if I focus on the patient's needs rather than my own, I can navigate through any type of conversation with compassion and grace.

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