How to respond to patients’ emotions
When emotions like stress, frustration, anger, or grief arise during conversations with your patients and their families, you shouldn’t ignore them. Instead, you can use six specific skills to respond to and address them.
The acronym N.N.U.R.S.E. summarizes six essential skills you should use when addressing patients' emotions. The key is to have more options so that you can use a combination of these skills, or try different solutions, depending on the situation. In this lesson, you will learn these six skills and how to use them.
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There are specific and definable skills that can help you communicate with your patients. Every clinician should be able to build trust, adapt their communication to patients of different backgrounds, and structure difficult conversations. Mastering these skills will make you a better clinician.
Transcript
Responding to emotions in difficult patient conversations
[0:00]
It’s only natural that intense emotions will arise in our difficult conversations with patients and their families. After all, the topic of conversation usually represents a major source of stress, frustration, or grief for them. And yet my sense is that it is the prospect of this emotion which actually causes many of us to shy away from these conversations. Maybe we each have one or two ways of responding to emotion that seem to work most of the time, but maybe not all the time, or perhaps when emotion arises in these conversations, we just ignore it. Maybe we are afraid of emotion because we don’t know what to do with it.
Six skills for responding to patients’ emotions
[0:41]
The irony is that there is good evidence to show that the key element that determines how our patients and their families feel about us after difficult conversations is the way we respond to their emotions. In this video, I want to share with you six skills for responding to emotion, corresponding to the acronym NNURSE. Depending on the specific situation and the person involved, they will each be more or less useful. The key is to have a few different options so that if one strategy doesn’t work, you’ve got a few options to try something else. Let me show you what I mean.
Responding to anger by naming the underlying emotion
[1:13]
Skill #1: Name the emotion. When we name the emotion, it is useful to consider what is the emotion behind the emotion that we can see. This is especially important if the emotion you can see is anger. “You seem angry” often doesn’t go down so well. “Angry? Of course I’m angry.” But if we look behind the anger, what we often find is either fear, grief, or pain. “You must be feeling really scared right now.” “Yeah. Yeah, I am.”
Normalizing patients’ emotions
[1:46]
Skill #2: Normalizing for the population. This involves voicing a recognition that what the patient may be experiencing right now would be similar to what almost anyone might be feeling under the same circumstances. “You know, most people would probably feel pretty stressed hearing that news.” “Really? So I’m not weird for feeling this way?” “Absolutely not.” Normalizing increases the psychological safety of the conversation by acknowledging that these emotions are only natural and that the other person is not unusual or defective for feeling them.
Understanding patients’ emotions and acknowledging family support
[2:21]
Skill #3: Understanding the driver. This involves recognizing the circumstances behind the emotion and again frames the emotion as the natural consequence of this. “Given what you went through with your son and now with your daughter being unwell as well, I can only imagine how worried you must be feeling right now.”
Acknowledging family caregivers’ efforts
[2:43]
Skill #4: Respect, praise, and appreciation. This involves recognizing the other person’s efforts in some way. “It sounds like you’ve been an incredible support to your mom, especially over the last few years. I’d say she’s been really lucky to have you.”
Supportive statements for patients and families
[2:59]
Skill #5: The supportive statement. This means stating openly that your intentions are aligned with the other person’s and that you will be there for them when they need you. “The most important thing to me right now is that we find out what is making your daughter unwell, that we do everything we can to help get her better, and that we support you through that whole process.”
Exploring patients’ emotions with open questions
[3:23]
Skill #6: Explore. This means asking an open question about how they might be feeling. “That’s a lot to take on. How are you feeling about it?” Just a tip. I would avoid asking these kinds of questions to overtly angry people. “How are you feeling?” This often doesn’t go down so well. “How am I feeling? How do you think I’m feeling?” In this kind of situation, you are probably much better off using one of the other skills.
Using silence to communicate empathy
[3:48]
One last thing. In the workshops I run, I see a lot of healthcare workers making great use of these skills, but then all their hard work goes to waste because they keep talking. Please don’t do this. Once you have demonstrated your empathy, stop talking. Let silence do its work. It may feel uncomfortable for you, but silence is the key that actually allows your empathetic statement to really have its effect.