1. Cozonac, Kathy

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"Defective," I heard Dr. Sanders* say, as she told tearful parents about their newborn's unexpected genetic anomaly. Did the parents hear the not-so-subtle nuance implied by the harsh word, defective? Dr. Sanders had distanced herself from the miraculous human nestled in his mom's arm.

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In the healthcare setting, we use countless phrases when things are outside the realm of normal. In the neonatal intensive care unit (NICU), I have become desensitized to nontherapeutic words, such as congenital heart defect, dysmorphic facial features, and deformed palate.


What if our rhetoric as nurses matched our theology? We remind ourselves that each patient was knit together in the womb (Psalm 139:13). The science might be harsh, but the words we choose must be cushioned in compassion. How can we be more aware of our communication to share challenging information sensitively?


Know your beliefs. To walk alongside our patients who are experiencing traumatic situations, we must understand what we believe. Theology shapes our values, our morals, and our interactions. As nurses, our clinical-speak can reflect the truths we hold dear. We can validate and value the individual, while explaining profound and devastating health issues. We can tell the mom whose baby is defective that her son is miraculously formed. We can say with confidence that he was put in her family for a purpose and that she was chosen to be his mom.


Communicate the heart behind the science. The difficulty with clinical conversations is that receivers are likely to understand, internalize, and process only a fraction of what is said. When hearing bad news, they remember something from the conversation. That piece will likely replay for years. The physician often issues bad news and leaves, while the patient's mind spins. The nurse finds the patient confused, devastated, or naively unaware. Studies support that the process of message delivery is as important as the content (Aein & Delaram, 2014). How can nurses support patients who are grappling with devastating news?


* Check the patient's understanding with open questions. We often talk to patients and family standing up, or as we do our work. Sit down. Actively listen. Use the patient's name. Provide an opportunity to process by putting information in his or her own words. Include the patient's words as you converse. Ask the patient what he or she understands, and what questions does he or she have. When you answer, give information in small nuggets.


* Allow for silence. Quiet gives your patient and family time to think through the preceding message. Silence also gives you time to plan the message, find the right words, and mentally frame the situation.


* Help your patient to zoom out. Her world has just shattered. Bring her back to the present. When appropriate, ask, "Where do you find strength?" "How would your beliefs lead you to respond?" Remind her that she will need support and ask, "What would support look like for you?"


* Invite hope, without downplaying the diagnosis or bringing in your story. Use language that affirms the individual. In the NICU, I bring the focus back to the baby. "Look at those perfectly formed hands. Watch how she grasps your finger."


* Nurses hope for the best but plan for the worst. Remind your patient of concrete things we hope for: pain management, the removal of a feeding tube, that we can wean from the ventilator.


* Offer resources. Is there a chaplain or support group available? Written resources (for a literate patient) can increase retention (Sandberg, Sharma, & Sandberg, 2012). Advocate for your patient. Mobilize available support.



Create a Safe Space. Nurses have the sacred opportunity to frame news, sit next to the patient, and be present, actively listen, hold a hand, and leave a lasting imprint.


The light we carry must shine, whether or not we offer our spiritual perspective. Patients may not remember what was said, but the light we bring into their darkness can remain as an integral part of their journey through suffering.


Aein F., Delaram M. (2014). Giving bad news: A qualitative research exploration. Iranian Red Crescent Medical Journal, 16(6), e8197. doi:10.5812/ircmj.8197 [Context Link]


Sandberg E. H., Sharma R., Sandberg W. S. (2012). Deficits in retention for verbally presented medical information. Anesthesiology, 117(4), 772-779. doi:10.1097/ALN.0b013e31826a4b02 [Context Link]