Approaching Patients with Difficult News: Teaching and Persuasion

The Importance of Approach

DISCUSSION BOARD 1 TOPIC: PERSUADING OTHERS When presenting a patient with difficult news, approach is everything. A lot of patients can be angry when first receiving news about a new diagnosis. In the case of patients with a new diagnosis of diabetes, how the news is given and explained by the physician or nurse can set the tone for how they will deal with their diagnosis in the short-term and long-term (Polonsky et al., 2017). When planning on telling someone big news like this that will effect their life in a big way, it's best to have the conversation planned out ahead of time (Clancy, 2018). Maintaining a positive and encouraging attitude throughout the conversation can help keep emotions in line. Practicing empathy in situations like this will increase the likelihood of the patient hearing what's being discussed and being active in the conversation. A diagnosis like diabetes will require some lifestyle changes and it's important to persuade to want to make these changes themselves. We aren't there to preach at them, we are there to explain the importance of these changes and be an encouraging mentor along the way. Practicing God's love for others through our approach can help set the tone of the conversation. "Put on therefore, as the elect of God, holy and beloved, bowels of mercies, kindness, humbleness of mind, meekness, longsuffering" (King Jams Bible, 1769/2017, Colossians 3:12). As a Christian nurse, being king and loving in our approach to delivering this news will be essential for a good patient outcome. The conversation could go something like this: "Good Morning Mr. Smith, did you sleep well last night? Great! I'm happy to hear that! Well we received the results of your blood work and I want to discuss those results with you, is now a good time to talk? Okay, great. So as you know, we took some of your blood the other day and sent it into the lab for them to run some test and look at it. One of the things they look at is what's called your A1C. What this does is it takes into consideration your blood sugar in your blood over the last few months. If it's "high" it means your blood sugar has been consistently higher than normal. There are parameters set on this A1C number and those parameters let us know if a diagnosis should be made to determine whether a patient is diabetic or not. In your case, your results were high. So this does mean that you do in fact have diabetes. This is not the end of the world and with some lifestyle changes, you can keep your diabetes under control and live mostly a normal life. Some of these changes will include the importance of physical activity as well as some dietary changes. We will keep in mind your food restrictions in your religion and we can work with that no problem so please don't worry about that. Your spiritual health is just as important as your physical health. Once you've had time to let this sink in, we can discuss in more detail what this means for your new lifestyle. What are you most concerned about with this diagnosis?" After this, the nurse should utilize good communication skills. Some of those key skills include asking questions that are open ended in order to engage the patient in conversation. Allow the patient time to sit with those results before throwing too much information at him at once with hopes of not overwhelming him. Avoid use of medical jargon to maintain a good flowing conversation. Portray good listening skills and sit straight while maintaining eye contact. Make sure you have a good window of time to sit and talk to the patient without any distractions. Don't make him feel rushed or ignorant in any way. Answer all questions and make sure you read the patient's body language during conversation. If the patient gets angry, allow him some time to cool down before continuing with the conversation. DISCUSSION BOARD 2 TOPIC: PERSUADING OTHERS When first having a conversation with a patient about a new health diagnosis sometimes this can be a difficult challenge. The patient maybe feeling depressed, upset or in denial to name a few. So, teaching can be a difficult task when the patient is still trying to understand why this is happening or how it happened. Good communication between nurses and patients is essential for the successful outcome of individualized nursing care of each patient. To achieve this, however, nurses must understand and help their patients, demonstrating courtesy, kindness and sincerity. Also, they should devote time to the patient to communicate with the necessary confidentiality, and must not forget that this communication includes persons who surround the sick person, which is why the language of communication should be understood by all those involved in it. Good communication also is not only based on the physical abilities of nurses, but also on education and experience (Kourkouta, L., & Papathanasiou, I. V. 2014).  I also think TELL from the Clancy book would be a helpful teaching method. Tell your patient about the issue at hand. Nurse: Hello Mr. White I am Tonya Money your nurse for the day. Did the doctor come and talk to you today? Mr. White: Yes, he told me I had type 2 diabetes. But I don’t understand why this is a issue Nurse: Diabetes Mellitus is a disorder where you have high amounts of sugar in your blood stream because your pancreas does not produce enough insulin or it is no longer responding to it Mr. White: How is this treated the doctor mentioned diet and a medication but how will my diet help. Nurse: Decreasing the amount of sugar you take in and we can get you resources on things that will increase your blood sugar and what are the best foods for you to eat. We can also set you up with a dietician who can give you a closer look at how to manage your diabetes with diet. Mr. White: So, I am going to have to change my diet to fix this. I don’t know that I want any part of this. Nurse: I understand your concern and I know this is a lot of information for one day. Our biggest concerns are if your diabetes are not managed by diet and exercise or medication or both it can lead to more severe consequences like kidney disease, and heart problems down the road and even death. Mr. White: I think I want to pray about this and talk to my wife and I will let you know what I want to do. Ask, and it shall be given you; seek, and ye shall find; knock, and it shall be opened unto you (King James Bible 2019/1611, Matthew 7:7)             TELL is tell, explain, listen/lead by example, learn the consequences. (Clancy,2018) In this conversation with Mr. White it runs through telling the issue explaining why it’s an issue listening to what the patient had to say and teaching the patient about the consequences if this issue is not treated