Running head: TL: VC IN N 1

Tread Lightly: Verbal Communication in Nursing

Tristen Reid
Louisiana State University

Author's Note
This paper was prepared for English 2001, taught by Professor Coco. It is a research
paper on verbal communication for first-year nursing students.
Running head: TL: VC IN N 2

Tread Lightly: Verbal Communication in Nursing

Preface:
I would rate the focus a 2 because I stated in the introduction everything that would be
addressed in the rest of the paper and kept referring to my purpose in writing the paper. A 1 for
organization, because I think my last body paragraph could use better organization but I'm not
sure of the best way for that yet. A 1 for development because I think my transitional phrases
could be improved. A 2 for audience awareness because I think I take an informational tone
which is ideal for 1 st year nursing students.
In terms of focus, I think I did well. You can see this when I wrapped up my first body
paragraph and reminded the reader of the reason for writing this paper. "Ultimately, learning to
communicate bad news in nursing requires reflection, self-awareness, and practice." Three
concerns that I have would be my use/lack of use of transitions, organization for my third body
paragraph, and advice for improving the development of the paper as a whole.

Introduction:
According to the book Patient Safety and Quality, "a study of incidents reported by

surgeons found communication breakdowns were a contributing factor in 43 percent of

incidents" (Friesen, 2008). So, if miscommunication is involved for almost half of the incidents

in healthcare, it is important to identify the undermining problems and educate healthcare

providers on how to eliminate miscommunication-related errors. Nurses often play the role of

"the middle-man" of information between the patient, their families, other doctors, specialists,

and hospital personnel. This is why it is extremely important for nurses to know how to

communicate in every situation that may arise.

Overview of genres:
Running head: TL: VC IN N 3

Nurses are often responsible for delivering bad news, teaching their patients how to take

medicines correctly, and for explaining vital information to different audiences including

patients, their families, specialists, and other hospital personnel. Nurses are taught to always

advocate for the patient, and part of that may include questioning other nurses or physician's

decisions or judgements using techniques such as CUS(concerned, uncomfortable, and safety)

words. Nurses are also taught to use informal conversation to collect relevant information from

patients.

Body:

Delivering bad news to patients can be a daunting task for many nurses. The example

below is from Texas Children's Hospital Guide for Physicians, Nurses and other Healthcare

Professionals, "A Few Phrases to Use In Specific Situations." The audience for this piece are

physicians, nurses, and other healthcare professionals who want to know some tips for

communicating bad news to patients.

The situation is serious but not hopeless. (In this case the but is appropriate.)
There is still a lot that can be done to keep him comfortable, and we will be with you all
the way.
Sometimes when people hear upsetting news, they hardly hear another word. Are you
okay with 25 going ahead or do you want me to go over what weve been talking about?
What else do we need to talk about? or Is there something else you would like to
discuss?
I wish I had better news.
I wish we had a cure, but there are things we can do to help keep you as comfortable as
possible. I am so sorry for your loss.
Let me take a moment to think about what you have told me.
May I interrupt you for a moment to clarify
Running head: TL: VC IN N 4

The purpose of this example was to educate health professionals on effective ways to

communicate bad news. The message in this example is to communicate bad news effectively,

sensitively, and respectfully. There are steps that a nurse can take in order to deliver bad news

confidently. First, a nurse should prepare for the discussion by collecting information and facts

from all available sources. When a nurse is informed of the whole situation before the

discussion, they are better prepared to answer any and all questions the patient may have. Also, it

is very important to warn the patient of the severity of the discussion about to take place, and to

ask the patient's permission for the discussion as well. Next, a nurse should determine what a

patient knows, and what they want to know. Having a patient explain to the nurse what they

think their illness or situation is allows the nurses to detect misunderstandings or gaps in their

knowledge. A nurse should also ask if the patient would like for them to continue to explain their

situation, because sometimes the patient may not want to hear the bad news just yet. "Patients

seek caring behaviors that reflect respect for human beings, including the need to be listened to.

Following the use of a warning sign, active listening, being supportive and the use of silence or

pauses to enable individuals to gather their thoughts can be helpful." (Leininger and McFarland

1995). A nurse should always deliver bad news sensitively, with a considerate, sympathetic tone

and supportive body language. A nurse should also acknowledge the patient's feelings and be

prepared for every response. In some situations the bad news may insight anger or violence. A

nurse should also prioritize the concerns of the patient by listening to the patient, checking to

make sure they understood, and by offering further advise. Offer the patient information about

where to go for help and support to deal with their individual and unique situation. Ultimately,

learning to communicate bad news in nursing requires reflection, self-awareness, and practice.
Running head: TL: VC IN N 5

Teaching patients how to take medicine is a huge part of nursing. A nurse must provide

thorough, accurate information about taking medications the patient, while making sure that the

patient understands what is being told the them. In a study that investigates the reasons that

patients often misuse their prescription medications, they discovered that a main issue is

miscommunication between patients and care providers. "When patients misunderstand how to

take their medicines, it can lead to adverse drug events, drug overdose or underuse, unnecessary

hospitalizations and prescriptions, and higher costs. Patients may not take new medications

because of fear of interactions with other medications or adverse effects, perceived lack of

efficacy, misunderstandings regarding necessity, or concerns about costs."(Derjung et al, 2006).

The key to preventing these misunderstandings is the educate the patient about their prescriptions

thoroughly. After explaining the what the drug does, how and when to take it, and answering any

other questions the patient may have, a nurse should use the teach-back method to ask the patient

to explain to them how to take the medication. This ensures that the patient understands how to

take the medication, or alternatively, points out gaps in their knowledge and shows the nurse

what they may need to reteach. Below are some examples of how to use the teach-back method

from the U.S. Department of Health & Human Services.

"We talked about two treatment options today: watchful waiting and starting radiation in a few
weeks. I want to make sure I explained each option clearly. Would you please tell me how you
would explain watchful waiting to your family member?"
"I want to make sure I was clear about the pros and cons of taking this medicine. Could you tell me
about the possible side effects of the medicine and how it could lower your chance of a heart
attack?"
"I want to check how well I explained the treatment options, benefits, and possible harms outlined
in this decision aid on osteoporosis. Please tell me, in your own words, about the options we
discussed that could help lower your chance of breaking a bone."
The audience for this example is nurses and aspiring nurses. The purpose is to teach nurses and

aspiring nurses effective questions to ask after explaining medications to the patient to make sure
 Running head: TL: VC IN N 6

they understood everything that was said to them. The message of this example is to use the

teach-back method to make sure the patient understands the medication prescribed to them.

In nursing, it is important to speak to the audience appropriately. When speaking to the

patient, a nurse should use easily understood language to communicate important information.

And alternatively when speaking to other hospital personnel or team members, such as other

nurses, doctors, or specialists, it may be appropriate to use medical terms to explain important

information. Knowing when and how to communicate in medical terms or in easy-to-understand

language is a major key to communicating effectively in nursing. When speaking to team

members, remember to use CUS words(concerned, uncomfortable, and safety), and to speak

objectively. CUS words help nurses express concerns about patient's care tactfully and

assertively. The example below is from the U.S. Department of Health & Human Service.

Getting your supervisor's attention when you really need it: CUS
CUS Tool
I am Concerned about my resident's condition.
I am Uncomfortable with my resident's condition.
I believe the Safety of the resident is at risk.
Example: "I'm concerned that Ms. C is not her usual self. I'm uncomfortable that she is behaving so
oddly. I believe she is not safe; she may have something serious going on that we are missing."
The audience for this example is nurses and aspiring nurses. The purpose is to educate nurses

and aspiring nurses on how to effectively use CUS words to communicate to other healthcare

professionals on behalf of the patient. The message is to use words like "concerned,"

"uncomfortable," and "safety" to get the attention of other healthcare professionals in order to

advocate for the patient.

Pitfalls:

When speaking to patients, some important things to remember are to never ask leading

questions, and to be mindful of emotions. According to the LSUHSC panel discussion on

Running head: TL: VC IN N 7

February 1, 2017, nurses should ever ask patients leading questions, meaning questions that lead

to a certain answer. When nurses ask patients questions, it is important to get the patient's

answer. Leading question often result in the patient giving an answer that they think reflects what

the nurse wants to hear, which can be dangerous and cause incidents. Also, being mindful of

emotions is important when communicating to both patients and team members. Be mindful of

both one's own emotions and others's emotions. Communicating information in nursing it can be

difficult to keep feelings and emotions about the subject out of the conversation, but it is

necessary for getting the information across effectively and accurately.

Conclusion:
Ultimately, communication skills in healthcare are extremely vital, especially for nurses.

Ineffective communication can lead to mistakes that can sometimes be life-threatening for

patients. Nurses are often responsible for delivering bad news, teaching their patients how to take

medicines correctly, and for explaining vital information to different audiences including

patients, specialists, and other hospital personnel. There is typically little room for mistakes

when it comes to communication in nursing.

Running head: TL: VC IN N 8

List of references:

McGuigan, D. (2009). Communicating bad news to patients: A reflective approach. Nursing

Standard (through 2013), 23(31), 51-6; quiz 57. Retrieved from
https://search.proquest.com/docview/219886352?accountid=12154

Derjung M. T., MD, PhD; Heritage J., PhD; Paterniti D.A., PhD; Hays R.D., PhD; Kravits
R.L., MD, MSPH; Wenger N.S., MD, MPH. (2006, September 25) Physician
Communication When Prescribing New Medications. Retrieved from
https://www.sscnet.ucla.edu/soc/faculty/heritage/Site/Publications_files/Physicians_and_
Medications.pdf

February 1 2017, LSUHSC School of Nursing panel on Communication Modes in Nursing

Friesen MA, White SV, Byers JF. Handoffs: Implications for Nurses. In: Hughes RG, editor.
Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency
for Healthcare Research and Quality (US); 2008 Apr. Chapter 34. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK2649/

Debra L. Palazzi, MD, MEd Martin I. Lorin, MD Teri L. Turner, MD, MPH, MEd Mark A.
Ward, MD Antonio G. Cabrera, MD (2008). Communicating with Pediatric Patients and their
Families: The Texas Childrens Hospital Guide for Physicians, Nurses and other Healthcare
Professionals. Retrieved from https://media.bcm.edu/documents/2015/13/pcg-v21.pdf

The SHARE ApproachUsing the Teach-Back Technique: A Reference Guide for Health Care
Providers. Content last reviewed July 2014. Agency for Healthcare Research and Quality,
Rockville, MD. http://www.ahrq.gov/professionals/education/curriculum-
tools/shareddecisionmaking/tools/tool-6/index.html
Running head: TL: VC IN N 9

Appendix. Example of the SBAR and CUS Tools. Content last reviewed October 2014. Agency
for Healthcare Research and Quality, Rockville, MD.
http://www.ahrq.gov/professionals/systems/long-term-
care/resources/facilities/ptsafety/ltcmod2ap.html