Hospital patient holding hand of family member

How to Approach Difficult Conversations with Patients

One nurse’s advice on preparing for those difficult conversations with patients and/or family members.

In my twenty years of healthcare, I have navigated my way through many difficult conversations – and not always with grace. Early in my career I was terrified of delicate interactions and felt inadequate to broach sensitive topics. It was during the ICU years of my career that I finally learned to embrace tough conversations and face them head-on with compassion leading me.  Below are a few lessons I have learned that you might find helpful as you prepare for your next difficult conversation with patients or their families.

Lessons I’ve Learned

  1. Build trust and rapport with patients and family before the time for the difficult conversation comes, this way they will know that you are coming from a place of caring.
  2. Anticipate family needs, how would they like to hear the news?
  3. Pray and ask for the right words and the right way to say them.  Religious or not, taking a few minutes to reflect before entering the room is an advantage.
  4. Re-humanize your objective medical mind and empathize before you walk into the room.
  5. Be aware of your posture, are you standing above them? Take a chair or squat down.
  6. Let the patient/family lead with verbal or nonverbal clues. It is important to be flexible and change your approach based on their response.
  7. The patient/family needs to be cared for in a holistic manner rather than the focus being just on the illness.
  8. Empathize but be honest and frank, use open questions and attempt for uninterrupted talk time. 
  9. Speak slowly and allow for silence.
  10. Invite others into the conversation if appropriate, consider including the Chaplin, social worker, family or caretaker.

If you do not feel comfortable in your ability to have these difficult conversations, do not be discouraged, start small by asking an open-ended question and just listen.  I would also suggest sitting in on conversations of senior members as they navigate the complexities of difficult conversations. 

Good luck and let compassion lead you in all your conversations.