As a nurse, you’re not only there to treat your patients, but as the conduit of information to their families. A patient’s family relies on you to keep them abreast of their loved one’s condition, but this part of your job isn’t always easy.
Sometimes families are distraught, emotions are high, the prognosis isn’t good, or there are difficult decisions to be made. These situations can make communication challenging and delicate. But nurses are renowned for their empathy, and this is where you put your compassion to purpose. These are the moments when you provide a different, but in many ways equally important, kind of care: communication.
You’re the expert in the room when it comes to your patient’s biology, but remember you may not be the expert when it comes to their history, perspective, or many other life circumstances. Letting the family into the conversation will not only help you better relate to your patient–it may also uncover crucial information the patient hasn’t shared, either because they didn’t think to, didn’t want to, or are incapacitated.
Here are some good guidelines to keep lines of communications open without crossing lines you shouldn’t. Let’s start with some basic practices to get off on the right foot with your patient’s family:
Family Communication Table Setting
Your relationship with a patient’s family starts the first time you’re all in one room, so use this opportunity to make a connection and a warm impression. This starts with a few very simple acts of etiquette that might seem obvious but may be missed in the dealings of your shift:
- Make eye contact.
- Introduce yourself and your role.
- Introduce any other hospital staff in your company.
- Ask family to introduce themselves and their relationship to the patient. If you can’t remember this information easily, write it down.
- Invite family members to write questions on the white board (if available) for clinicians.
Through these simple introductory acts, you establish trust, create a baseline for communication, and put the family at ease. To them, you’re the gatekeeper for information and action. Let them know the gate is open.
Practice Active Communication
When speaking with family members, whether the patient is present or not, be active about communicating. Communicating means actively initiating conversation and also facilitating an open and ongoing discussion. There are a few practical ways to accomplish this.
The first is to try to ask open-ended questions. Instead of a question that can be answered with a “yes” or “no,” phrase your questions to leave room for a longer answer. This can be particularly helpful when asking about a patient’s history as might be relevant to their current condition.
You should also be actively forthcoming with the information you give. Patients are eager for updates – offer them in a timely fashion when you can. Remember that relief from uncertainty is a form of kindness, even when the news is difficult.
Important Note: As you communicate with patients’ families, be sure to remain in compliance with HIPAA (the Health Insurance Portability and Accountability Act). Never disclose anything that falls under HIPAA protection to family, either in front of the patient or in private conversation, without the patient’s consent.
Empathetic Communication Skills
Empathy is a word that is thrown around often and at times incorrectly – but in this case, let’s stick to the definition of empathy as it pertains to healthcare. Empathy means imagining or attempting to understand someone else’s experience as if it were your own; it means identifying with your patient and their families. Even though it sounds conceptual, there are real ways you can apply empathy to your discussions with a patient’s family:
- Try to put yourself in the family’s shoes and understand their experience.
- Look for similarities in your perspectives when there’s a difference of opinion.
- Acknowledge the family’s feelings, and make sure they feel “heard.”
- Avoid medical language that is difficult to understand; speak in layman’s terms.
- Give complete information and be ready to break it down further if asked.
- Be a good listener, and respond to all reasonable family requests with action.
- Try to help family members articulate their questions and concerns.
When you exhibit empathy to a family, you create an implicit sense of trust. Following up on a conversation, either with additional information or action, will demonstrate that your respect and concern for a family continues beyond the conversation. And if you’re unable to fulfill a family member’s request, explain the rationale and what action will be taken instead.
Perform Bedside Shift Reports
Although not universally adopted, at least not yet, many in healthcare are advocating for a bedside handoff during nurse-to-nurse shift change. (Read our post about nurse shift changes for more on this.) Not only is this practice proven to improve the accuracy of the information exchange between nurses, but including the patient and their family helps keep everyone informed and gives others the opportunity to ask questions. You might even find out something new during this exercise.
Take the opportunity during the bedside report to introduce the incoming nurse, if they haven’t met the family yet. Then exchange the patient information at the bedside, within earshot of the patient and, if the patient has indicated it’s their wish, the family. Allow for interruptions and questions from family members during the handoff.
One 2018 study showed that implementation of the bedside report increases both patient safety and patient and nurse satisfaction. When performing a bedside report, always be sure to safeguard HIPAA guidelines. Check with your patient about who they want in the room, and ask family to step outside as needed.
In the Event of an Angry Confrontation…
Dealing with an angry family member is a skill – some would say an art form. So, we’ll spend a little more time talking about why relative outbursts happen, how to deal with them, and equally important, how not to deal with them.
Healthcare facilities are hotbeds of emotion. The stakes are often very high, medically, and many patients and families are living in a place of fear. Sometimes this fear turns to anger. And sometimes that anger will be directed at you. This is unpleasant, possibly alarming, often unfair, and can be upsetting for you – except you can’t allow yourself to become upset.
First of all, there may be ways to head an outburst off at the pass, just by being observant and watching for early signs of agitation in body language. If a patient’s family member becomes agitated, you might notice early signs. Common body language for someone who is unsettled include fidgeting, a clenched jaw, furrowed brows, or curt speech. If you notice these things, a simple “just checking in to see how you’re doing,” or “is everyone comfortable?” is a proactive way to offer someone a chance to voice an issue before it bubbles over.
Of course, you’re very busy so watching for subtle signs might not always fit into your schedule, and you may not notice someone becoming upset until it’s too late. The first thing to do when a patient’s family member loses their temper is stop what you’re doing. When an aggrieved person sees you continuing to go about your business, they may feel ignored, which could escalate their anger. If the person is yelling, you may interject and calmly ask them to lower their voice – you’re listening.
Then do just that. Listen patiently. Let them say whatever they have to say, even if it takes a while. Don’t just passively stand – maintain eye contact and remember what they’re saying, because you’ll want to repeat some of it back to them afterward. Consider that the person yelling at you is more afraid than angry, and likely acting out due to feelings of powerlessness and panic.
Once they have stopped and are expecting an answer, be sure to respond calmly, with respect and empathy. Don’t allow someone else’s anger to manipulate you into becoming defensive or angry in return. Tell them that you understand they must be upset, and that you can see their point. Use the person’s name in addressing them, and paraphrase their own concern back to them so they know you heard what they had to say. In most cases, this will be enough to get you both back into the same calm headspace to figure out what’s next.
How you resolve the actual situation beyond the confrontation depends on what’s upsetting the family member. If it’s reasonable and something you can take action to resolve, then do so. Often, it’s waiting that upsets a family. Explain what’s taking so long, if you can, and see if there’s a way to shorten a waiting period, or at least offer a realistic expectation of timing. Maybe their loved one is in a lot of pain and they don’t see anyone addressing it. Or, if the family has strong feelings or concerns about a treatment, try to arrange for the doctor or clinician to visit the room to hear their concerns and explain the courses of action being taken.
The worst-case scenario is that the situation gets out of control, and a relative or friend of the patient becomes verbally abusive or threatens you physically. This is what security is for. If you feel in any danger whatsoever, separate yourself from the situation and have the person removed.
Some Things to Keep in Mind…
First, in dealing with a patient’s family, whether there are difficulties or not, it’s important to always keep a few things front of mind. In prioritizing inclusion and collaboration with a family, remember that HIPAA comes first. As mentioned above, you should never share sensitive patient information to family members without first getting the patient’s consent.
Second, when a family member is emotional, or even just demanding, do what you can to help, but safeguard your time as well. It might become apparent to someone that when they make your job more difficult, they get what they want. If the requests are within reason, you should accommodate, but you can’t ethically prioritize one patient over another. Don’t allow yourself to be manipulated into a situation where a family is trying to monopolize you.
Finally, and importantly, always document any significant interaction with a family member soon after the fact, so you have a record of the exchange. This can be helpful for you to keep track of things, but in some cases, it might be necessary for you to have for purposes of liability.
As with anything, dealing with your patients’ families and relatives becomes easier the more you do it. Rely on your soft skills as a nurse and a few hard rules, and you’ll be fine.
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