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Therapeutic Communication in Nursing: Beyond the Basics

I received an email from a nurse who works in a hospital in India about therapeutic communication in nursing. How she found me is a mystery. She asked me, “How can a nurse communicate hopefully about life —with a cancer patient who is going to die and she knows it?”

This nurse’s question brings to mind the emotionally wrenching communication challenges caregivers handle daily… challenges that demand much more than a mastery of the basics of communication.

Fortunately, there’s a growing body of knowledge about effective communication in palliative care and therapeutic communication for nurses and other caregivers.

But here’s where my mind took me. What are the emotional supports available to our caregivers who face challenges like these every day? I know some organizations have chaplains, ethicists, social workers and nursing leaders who offer a listening ear, wise counsel and emotional support. And some have support groups—dedicated times when nurses get together to share their stories, challenges and solutions.

I shot an email to five nursing leaders in five different hospitals and asked them what support of this sort is available for their nurses. One replied that a psychologist from their Employee Assistance Program runs a support group for residents (not nurses) to help them address emotionally wrenching situations. But the other four regretfully told me that there is no time for such things anymore. They said they rely on nurse managers to provide coaching on the run, and they admit that it rarely happens.

Since emotional support is so important to patient-centered care and creation of a healing environment, this is very disturbing. It’s also disturbing because I imagine that, without such support, many caregivers shut down and steel themselves to avoid the stress of these situations. Then, it’s no wonder that patient and family perceptions of the extent to which caregivers really care is disappointing. And, it’s no wonder that so many caregivers jump ship, because they are not finding their choice of a helping profession to be gratifying.

In my previous blog, I wrote about the importance of giving our total presence, of bearing witness to pain and fear, of showing empathy, understanding and kindness. And it is a choice we need to intentionally make. On the other hand, what is happening in our organizations to provide emotional support that caregivers need to make this choice over and over again each and every day?

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