Most RNs would say the importance of good communication with patients cannot be overrated — that it’s essential at every stage of care. Helping healthcare professionals build better communication skills, especially during difficult conversations, was the goal in this summer’s TEDxLongwood Talk presentation “On Being Present, Not Perfect,’ by Elaine C. Meyer, PhD, RN, co-founder and director, Institute for Professionalism & Ethical Practice, Boston Children’s Hospital, and associate professor of psychology, department of psychiatry, Harvard Medical School.
An acronym for Technology, Entertainment and Design, TED is a nonprofit organization devoted to spreading ideas, usually in the form of short, powerful talks of 18 minutes or less. TED began in 1984 as a conference where technology, entertainment and design converged, and today it covers almost all topics — from science to business to global issues — in more than 100 languages, according to the TED website. The TED organization provides general guidance for individual TEDx programs like Meyer’s, but TEDx programs are self-organized and for those independent organizers who want to create and share a TED-like event in their own communities and around the world.
In her presentation, Meyer drew on her professional and personal experiences to demonstrate the real gaps in healthcare communication and how to close them. She discussed the institute’s educational philosophy of the one-room school house and shared a “Wizard of Oz” metaphor to describe the key ingredients of honest, direct and genuine conversations with patients and families.
Meyer recalled a defining moment in her life when, as a nursing student, she sat down to listen to a mother’s worries, hopes and dreams for her hospitalized son. “That day I learned some very important lessons,” Meyer said. “First, I learned how important it is for patients and families to tell their stories, to be listened to and to be known. I wasn’t sure I was the best person to be holding this conversation … but I was called upon that day. I learned that [on] that day I was called upon to be present, not perfect.”
Meyer said that day is what set her on the career path “to help foster healthcare conversations across what people feel is a divide, where we feel we have to be perfect; to help healthcare practitioners feel more capable and confident in these conversations.”
At the institute, Meyer offers educational workshops and consultation focused on challenging healthcare conversations. She brings more than 20 years of experience working as a nurse and clinical psychologist with young patients and their families in the neonatal and pediatric critical care settings.
Meyer’s TEDx Talk has exceeded 6,000 views on Youtube as of Oct. 24. She has received numerous inquiries and positive feedback from nurse educators and students, and several nursing schools have incorporated her talk into sessions devoted to communication and relational learning. Meyer is working on a facilitator’s guide to accompany the TEDx Talk. “For me, it is inspiring to see how the talk can catalyze and promote learning about challenging conversations in healthcare,” said Meyer, whose academic work has focused on patient and family perspectives as they relate to critical care illness, pediatric end-of-life care situations and providing innovative psychosocial services within healthcare organizations.
Although many communication programs focus on “breaking bad news,” Meyer is particularly interested in moving beyond those first conversations to those that occur over time, often with nurses, when patients and families come to understand and cope with their illness. She said these conversations are not only positive for patients and their families, but also hold tremendous potential for nurses’ sense of professional fulfillment and pride.
Emotional standard of care
The IPEP promotes relational learning for healthcare professionals integrating patient and family perspectives, professionalism and everyday ethics of clinical practice. Through IPEP’s Program to Enhance Relational and Communication Skills, Meyer offers experiential workshops focused on difficult conversations ranging from prenatal discussions, community pediatrics, informed consent, anesthesia, pediatric and adult critical care, neurology, radiology, family presence during invasive procedures and resuscitation, end-of-life situations and adverse medical outcomes. With live professional actors who serve as patients and family members, the workshops provide interprofessional learners a way to come together to learn and practice challenging healthcare conversations. Workshop participants have self-reported a greater sense of preparation when holding difficult healthcare conversations, improved confidence, greater communication skills and capacity to build relationships, and decreased anxiety, according to Meyer.
As a nurse and clinical psychologist, Meyer learned it “isn’t the medications, surgeries or treatments [patients and families] remember. What they really remember is the words that we say to them, our kindness we extend, how we made them feel and the way we treated them. That’s what stays with them. That’s the crucial part of the whole experience,” Meyer said. She referred to the “other half of the medical equation or the emotional standard of care, where practice makes better.”
There are many ways healthcare professionals can “be present, not perfect,” Meyer said. Some of them include the following:
~ Introduce yourself in a professional manner, which includes your name, role and purpose.
~ Listen empathically — lend your full attention and sit down to converse with patients, even if you only have five minutes.
~ Seek to understand the patient and family’s perspective by providing opportunities for them to share their concerns and ideas, and to tell their stories. Offer open-ended questions such as “What is on your mind?” “What matters most to you now?” “How can I be most helpful?” “What are you hoping for?” “What worries you most?”
~ Limit the use of technical jargon when explaining diagnoses, devising treatment plans and teaching. Offer to draw pictures and provide written resources that can promote patient and family’s understanding and sense of mastery.
~ Create space for conversation and emotional expression by refraining from interrupting patients and their families and permitting silence.
~ Convey your empathy through your words, presence, gestures of kindness and caring.
~ Cultivate your calm, non-anxious presence that can help patients and their families to feel understood, well cared for and not alone.
~ Remember always that you are part of a team.
In the PERCS program, Meyer encourages participants to be present in conversations by:
~ Preparing for the conversation.
~ Setting the patient at ease.
~ Finding out what the patient and family know and what is most important to them.
~ Remembering to have a mutual agenda that meets the needs and priorities of the patient and family, as well as the healthcare team.
~ Being honest, kind and direct.
~ Using pictures to teach and explain.
~ Pausing occasionally to check the patient’s understanding and asking if there might be any questions or issues of concern.
~ Summarizing the conversation and letting the patient and family know what to expect next.
Courage, brains and heart
Meyer offered a Wizard of Oz metaphor to exemplify the necessary ingredients of communication — courage, brains and heart.
The lion’s courage reminds healthcare professionals to never underestimate the power of their courage, their leadership and their willingness to “go there,” with a patient, a loved one, Meyer said. “With the scarecrow’s brains, practitioners seek to use their knowledge, their clinical wisdom, their experience so they can explain diagnoses and plan treatments in ways that patients understand and includes patients as partners, in ways that don’t scare or frighten the patient. Our word choice is critical.”
The tinman seeking a heart reminds healthcare professionals of the kindness they extend every day, the compassion and the mercy they show people, especially those who are hurting, suffering or ill.
So many of these important conversations are about hope, Meyer said, and yet people devalue them and think it’s all about procedures and actions.
She ended the TEDx Talk with some words of wisdom: “Dig deep and find your inspiration … Once upon a time, you wanted to change the world. And you still can. One conversation at a time.”
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