NURSE (by Kathrynn Thompson)

I recently was talking to one of our nurses about how to best care for an end of life patient. We discussed how difficult and sad it can be when one of our patients is dying.  Intervening with patient and family emotions can be one of the most challenging things we do as nurses. And handling our own emotions is a vital part of our self- care.  So how do you respond to a patient’s  emotion? We need to understand their perspective/ feelings/ attitudes in a non-judgmental manner. The NURSE MNEMONIC can be a helpful guide.

• N=Naming: Start by naming the emotion your patient is experiencing (“It sounds like you are afraid the cancer is coming back”)  Then use reflective statements, naming, restating and summarizing as ways to begin to accept and respond to the patient’s emotions.  Observe the patient’s nonverbal cues that can help you determine the emotion. Use statements beginning with “I wonder”, “Sounds like” rather than telling the patient how they feel.
• U=Understanding: Validate the patient’s feelings and do not give premature reassurance. Use active listening and silence to further explore what the experience means to the patient.  You might say, “I think I’m understanding you to say …” or  “ I cannot imagine what it is like to…”
• R=Respecting: Your response can be a verbal and/or nonverbal response. Acknowledge and respect your patient’s emotions. Strong emotions in your patients can bring up strong emotions in the nurse. Acknowledge your patient’s good coping skills to show your respect .
• S=Supporting: Acknowledge the patient’s efforts to cope. Express concern and willingness to help. You could say, “I will be with you during this illness” (if it is true) or “ I will be with you while you are here and I will make sure the unit you are going to understands your concerns”. Reinforce that you are in this relationship with the patient and that will continue (if it is true).
• E=Exploring: Be empathetic. Connect yourself with the patient, “ I sense how upset you are because the doctor was not able to do more with the surgery”.

Remember your words and your compassionate presence are powerful nursing interventions.

References:

• Barclay, J.S., Blackhill,L.J. & Tulsky, J.A. (2007). Communication strategies and cultural issues in the delivery of bad news. Journal of Palliative Medicine, 10(1), 958-977.
• Boyd, D., Merkh, K., Rutledge, D.N. & Randall, V. (2011). Nurses’ perceptions and experience with end-of-life communication and care. Oncology Nursing Forum, 38(3), 229-239.
• Svarovsky, T. (2013). Having a difficult conversations: the advanced practioner’s role. Journal of Advanced Oncology, 4(1), 47-52.