Running head: Tread Lightly: Verbal Communication in Nursing

Tread Lightly: Verbal Communication in Nursing

Tristen Reid

Louisiana State University

Author Note

This paper was prepared for English 2001, taught by Professor Coco at Louisiana State

University. It is a research paper on verbal communication for first-year nursing students.

Tread Lightly: Verbal Communication in Nursing 2

Abstract
This paper analyzes three specific examples of verbal communication in

healthcare, focusing on the techniques used to effectively communicate information in

specific instances. The specific instances include delivering bad news, utilizing the

"teach-back" method for explaining medications to patients, and introducing tools to use

when speaking to supervisors and team members. The examples were derived from the

U.S. Department of Health & Human Services and Texas Children's Hospital.
Tread Lightly: Verbal Communication in Nursing 3

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 1st 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.
The midterm portfolio draft feedback I received was very helpful. The most helpful tip I
received was to organize my first example in a table to make it stand out and read more clearly. I
think putting the information in a table definitely improved my paper. One revision that I found
confusing, just because it was difficult to find information on it on the internet, was the panel
discussion citation. I am still not 100% sure if I did it correctly, but I tried my best and I hope
that it isn't too far off.
Tread Lightly: Verbal Communication in Nursing 4

Tread Lightly: Verbal Communication in Nursing

Introduction Commented [TR1]: Edited introduction grammar

mistakes and deleted/ reorganized sentences
According to Friesen (2008), "a study of incidents reported by surgeons found

communication breakdowns were a contributing factor in 43 percent of incidents" (p. 34). 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" 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

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 nurse's 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.
Tread Lightly: Verbal Communication in Nursing 5

Delivering Bad News Commented [TR2]: Added subheadings

Delivering bad news to patients can be a daunting task for many nurses. Example 1A Commented [TR3]: Organized the information in example
1 in a table
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 would

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

appropriately communicating bad news to patients.

To appropriately console a patient without The situation is serious but not hopeless.
soft pedalling. (In this case the but is appropriate.)

There is still a lot that can be done to keep

To appropriately check to see if the patient
understands the bad news.
To appropriately offer sympathy
To appropriately ask for clarification from
the patient
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..."

(table 1A)
Tread Lightly: Verbal Communication in Nursing 6

The purpose of this example is to educate health professionals on effective ways to Commented [TR4]: Additional paragraph

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 Commented [TR5]: Additional paragraph

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. According to Leininger and

Mcfarland (1995), "Patients seek caring behaviors that reflect respect for human beings, Commented [TR6]: Corrected citation

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." 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.
Tread Lightly: Verbal Communication in Nursing 7

Nurse to Patient

Delivering bad news is not the only thing that nurses have to worry about when it comes

to communicating with patients. There are many other categories, including effectively teaching

patients how to take their medications. Teaching patients how to take medicine is a huge part of

nursing. A nurse must provide thorough, accurate information about taking medications to the

patient, while making sure that the patient understands what is being told to 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.

According to Derjung et al (2006), "When patients misunderstand how to take their medicines, it Commented [TR7]: Corrected citation

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." The key to preventing these

misunderstandings is to educate the patient about their prescriptions thoroughly. After explaining

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

elaborate on. Some examples of how to use the teach-back method are shown below in table 1B

taken 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?"
Tread Lightly: Verbal Communication in Nursing 8

"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."
(table 1B)

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 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.

Nurse to Team Members

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. Table 1C seen below is from the U.S. Department of Health & Human Service.
 Tread Lightly: Verbal Communication in Nursing 9

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."
(table 1C)

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 Dr. Todd Tartavoulle (2017), nurses Commented [TR8]: edited citation

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 questions

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. When 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
Tread Lightly: Verbal Communication in Nursing 10

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. Thus, one should always work to improve their

communication skills, as they are vital in the nursing profession. Commented [TR9]: added to conclusion
Tread Lightly: Verbal Communication in Nursing 11

References Commented [TR10]: Corrected and reorganized APA

citations

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Brady, Jeffery P. MD. (2012). The SHARE Approach Using the Teach-Back Technique:
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Derjung M. T., MD, PhD; Heritage J., PhD; Paterniti D.A., PhD; Hays R.D., PhD; Kravits
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Tread Lightly: Verbal Communication in Nursing 12

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