Communication Tips – Difficult Conversations

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Who You’ll Hear

Kati Kleber, MSN RN – Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.

What You’ll Learn

• What is a difficult converstation
• Support for patients and families
• Tips for difficult conversations

Communication Tips – Difficult Conversations Show Notes

• What’s a difficult conversation?
  • Speaking with them one-on-one after the physician has told them this is a terminal situation
  • Telling them something went wrong
  • Telling them their loved one died when they weren’t there
  • Telling them their surgery is cancelled, something very serious now needs to happen, the small issue is now a very large and life changing one
• The moment when time just stands still
  • Have you ever had a serious moment in your life when time just feels slow, irrelevant, or you just don’t even know how to be in your own skin because everything from that moment forward will be different? That’s what your patients and their loved ones experience – it’s shock in a sense… their whole world just… stops.
    • Makes sense they may not be the best communicators, remember things correctly, need things re-explained, make weird decisions, or ask odd questions
    • Recall this feeling to your active memory when interacting with people experiencing it so you can better understand how to empathize and communicate with them
• Patients / families
  • Bring in support if needed
    • Chaplains are a phenomenal resource, as they are trained to be with people experiencing trauma
    • Chaplains can spend time with your patients/families to be present and process tough news/make challenging decisions (not give them the answer, but help talk them through their thoughts and priorities non-judgmentally) while you’re busy doing the practical nursing care stuff
  • Anticipate questions and prepare appropriately 
  • Don’t take emotional responses personally – be the emotionally mature one
    • Tree standing firm, letting their negative thoughts rustle through your leaves but not unearthing you
• Be direct, kind, empathetic, and honest
  • Many times they want a definitive answer that you can’t provide
  • Don’t beat around the bush; pull the band-aid
• Don’t provide false hope out of a personal need to provide positivity
• Validate feelings, use reflective listening

More Resources for Communication Tips – Difficult Conversations:

• Email list sign up
• Breakthrough ICU – Fresh RN Course
• Communication Tips – Patients and Their Support Systems – Fresh RN Podcast
• Comfort Care Conversations