Engaging Patients in Dialogue: A Partnership

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By Megan M. Krischke, contributor

August 26, 2011 - “Communicating clearly with patients is a cornerstone to providing safe, quality and effective care,” remarked Fé Ermitaño, RN, BSN, project manager for the patient experience at Virginia Mason Medical Center (VMMC) in Seattle. “We aim to provide patient-centered care, so I tell the nurses that we are to engage our patients in a partnership and a dialogue and that we should be a conduit through which patients can bring their concerns.”

Improved Nurse Patient Communication
Fé Ermitaño, RN, BSN, project manager for the patient experience at Virginia Mason Medical Center encourages nurses to have honest and transparent communication with patients.

Clear communication with patients is of utmost importance to Erica Dickson, RN, BSN, CCRP, oncology research manager for Poudre Valley Health Systems (PVHS) in Fort Collins, Colo..  Dickson leads a team of nurses and other professionals who offer oncology patients opportunities to participate in clinical trials and then works with these patients to coordinate their care.

“My job is to make sure patients have the time and the information to make their decision. ‘No’ is as good an answer as ‘yes’,” explained Dickson. “Often patients tend to take anything the doctor says as prescriptive. So if a doctor informs a patient that there is a clinical trial that could be a good option for them, what the patient may be hearing is the physician saying that they should participate in the trial. The nurse’s job is to start a new conversation; to say this is a choice and it is totally voluntary.”
She notes that nurses should be aware of potential barriers to communication such as illiteracy or the patient experiencing stress from learning of a new diagnosis.

“We need to be aware that reading isn’t always a helpful way for a patient to receive information,” Dickson said.

Ermitaño adds that the pressure of having more to do than time to do it and issues related to cultural diversity can also complicate a nurse’s ability to communicate clearly.
“When working with a patient of another culture, or even if a nurse just senses his or her communication is not being well received, I encourage nurses to try to mirror the emotions and behavior of the patient.  If a patient isn’t making eye contact, there may be a cultural reason for that,” she remarked. “Nurses who work with a diverse population could consider seeking out diversity training.”

She also warns against using medical jargon when speaking to, or even around, patients.

“When they don’t understand the lingo, not only is our ability to communicate limited, patients can also feel alienated. Early in my career a physician was discussing with me the patient’s condition and within ear shot of that patient used the acronym SOB to refer to shortness of breath. The patient, however, thought the physician was insulting him,” related Ermitaño. “This very sweet patient was hurt that the physician saw him in such a poor light.”

“I consider it a sign that we are communicating well when the patient is able to state back to us the fundamental information about the study in which we are inviting them to participate,” stated Dickson. “I also see a patient’s willingness to ask questions as a sign that they are comfortable relating to the nurse and that they are engaged in the conversation.”

Ermitaño also sees active listening and asking patients to say in their own words what you have just explained as key communication techniques, as well as paying attention to physical clues such as eye contact and nodding.  She adds that it can help to declare your intention; to tell a patient why you are asking them a particular question because it builds trust and gives them a better understanding of what kind of information you seeking.

“If I’m not making progress with the patient I try to go back and say, ‘I don’t think we are communicating clearly. Is there something I’m not doing or explaining well?’ and have the patient direct me on what kinds of communication are helpful for him or her,” she explained. “At VMMC, patients wear yellow slippers, so we talk about putting yourself in their yellow slippers. When a nurse puts his or herself into the patients’ yellow slippers it is easier to overcome any communication barriers.”

“Patients need to feel from us that they are really our focus when we are with them.  Nurses need to multitask, but they shouldn’t do it while they are with patients,” stated Dickson. “Also, whenever we can, we should offer patients choices.  I don’t think patients have as many choices as we might assume. Just approaching and asking if it is a good time for a blood draw is a positive way to interact with a patient.”


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