Ep 57: An ED RN Talks To Patients
Sources:
2022 study: Gabay G, Gere A, Zemel G, Moskowitz H. Personalized Communication with Patients at the Emergency Department-An Experimental Design Study. J Pers Med. 2022 Sep 20;12(10):1542. doi: 10.3390/jpm12101542. PMID: 36294684; PMCID: PMC9605307.
Agency for Healthcare Research and Quality TeamSTEPPS Program
2014 study: Swayden KJ, Anderson KK, Connelly LM, Moran JS, McMahon JK, Arnold PM. Effect of sitting vs. standing on perception of provider time at bedside: a pilot study. Patient Educ Couns. 2012 Feb;86(2):166-71. doi: 10.1016/j.pec.2011.05.024. Epub 2011 Jun 30. PMID: 21719234.
2018 study: Sobczak K, Leoniuk K, Janaszczyk A. Delivering bad news: patient's perspective and opinions. Patient Prefer Adherence. 2018 Nov 12;12:2397-2404. doi: 10.2147/PPA.S183106. PMID: 30519005; PMCID: PMC6239094.
Preamble:
Welcome to It’s An ED RN, on today’s episode we’re going to talk about talking to patients. A good interaction with a patient can make your day, as surely as a poor interaction with a patient can ruin it. And although we as individuals are not responsible for the behavior of other individuals, there are some evidence-based ways we can shape our communication to improve the chances that our words and actions will be perceived in the way in which they were intended.
I’m your host, an ED RN and I hope you’ll stick around to listen;
Intro Song
Episode 57: An ED RN Talks to Patients
Welcome:
Welcome to my podcast, It’s An ED RN
I am your host, an ED RN and today we are talking about:
Talking;
Talking to patients;
Talking to patients and not having it be the most soul-sucking experience;
If you’re new to the show:
Introductions:
Nurse x13yrs
MedSurg, ICU, House Supe
5yrs Admin
Back to bedside in ED
How to talk to patients
ANA:
“Clear communication helps patients feel understood and valued. Reliable one-on-one time with their nursing team helps promote patient trust and deepens their understanding of the process. To build a strong rapport with patients, nurses should:
Allow patients to speak so they don't feel rushed or ignored.
Express compassion through verbal and nonverbal cues like eye contact and body language.
Ask open-ended questions to avoid steering the conversation.
Paraphrase in a way that demonstrates interest and respect.”
AMA:
Center the patient (thank you for being patient, what can I do for you);
Avoid blaming (change can be hard; what has worked for you in the past”);
Encourage disclosure (“what do you think is going on?”);
Solicit the patient’s point of view (“tell me more about that”)
Prebunk false information (“there’s been some misinformation be spread, but here’s what we know”)
This 2022 study tried out different messages with ED patients to see how they performed:
This was mostly done to raise patient satisfaction scores 🫠
The study had patients fill out surveys
These answers categorized them into three groups
Physicians could then focus on that category of “patient mindset drivers”
Essentially, it’s complicated;
AHRQ TeamSTEPPS Program
Extensive training modules on communication;
We’ve known since 2014 that sitting instead of standing leads to patients perceiving you spent longer with them than you did;
This 2018 study found the greatest barriers to effective communication with patients among doctors was:
Lack of soft skills;
Paternalistic viewpoint;
Anyone can be paternalistic, btw;
An ED RN shares anecdotal soft skills:
But first…
IMPORTANT
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Talking to Patients Key Concepts;
Rid yourself of judgment;
You are not better than they are just because you’ve mostly been lucky;
If hard work and a strong moral compass were all it took, bitch I’d be a millionaire;
Homelessness and drug addiction are a feature of late-stage capitalism, google it;
Know your role;
Empathize, don’t maternalize;
You are not mother, you are licensed goddamn professional;
The Transtheoretical Model stages of change (learn this)
Communicate clearly and honestly;
Yes, you’re going to wait a long time;
Yes, it’s going to hurt;
No, I can’t do that but here’s what I can offer you;
Specific actions and phrases: Triage, boarding patients;
Verbal communication skillz;
“Hi (patient’s name); what brings you into the emergency department today?”
Open-ended
Confirms you got the right person
Let them talk
“I’m sorry that happened to you”
Shows empathy
Puts patient at ease
“What are you hoping to get out of your visit today?”
Allows you to get to the point while centering the patient
“Thank you for telling me”
You’re a literal stranger and they just told you something very intimate, so thank them
“It is a long time to wait and I wish the system was better”
Makes clear that you have no control over a shitty situation
We are not fixing the current state of healthcare today
Non-verbal communication skillz;
Eye contact
Turn toward patient
Sit if you can
Specific action, phrases: Trauma, EMS arrival;
Verbal communication:
“Hi (patient’s name); for your safety, a lot is going to happen very quickly, but we will tell you before we do each thing”
Sets expectations for the patient
Sets expectation for every provider standing around the patient
“Yes, it’s going to hurt for about (this long), and then it will be over”
Sometimes fear and anxiety is experienced as physical pain, so decrease the unknown whenever you can
“You don’t need to apologize to me; I’m happy to help you”
Response when pt says sorry for needing something, like pain medicine or shitting themselves or just generally existing
“Excuse me, why are you yelling?”
Open ended
Calls out the specific behavior
Indicates that the specific behavior is not the expected behavior
“I would like to help you with that, provided you lower your voice”
Follow up to previous
Non-verbal communication skillz:
Warm blanket therapy
Every patient deserves to be dry, normothermic and safe
Eye contact, no rolling
Slow, even breaths, no sighing
Hands in front, not crossed, open and toward the patient
To summarize:
Tips and Tricks:
Tip #1: Know your role. You are not mother, you are not father, you are one person trying to understand how you can help another person by performing within your scope.
Tip #2: People are people. So, why should it be that you and I get along so awfully? Depeche Mode had it right, we’re all just doing our best out here and sometimes our best is gawd awful. So what.
Tip #3: Don’t take it personally. Study projection, like really study it. Patients will say the meanest things, they’ll pick apart your physical appearance, they’ll blame you for systemic failures and you know why? Projection. They don’t know you, they have no authority to assign you value based on your looks or job performance. It’s probs projection.
Trick: Turn to wonder. I wonder what happened in this person’s life that they are this way.
Closing:
I hope you’ve enjoyed this episode; if so, leave a review, find me on socials and tell your nurse friends to listen;
Talking to patients is hard because talking to people is hard, but the more you practice evidence-based methods for verbal and non-verbal communication, the better those interactions can be.
Thank you for listening and have a safe shift.
