In healthcare facilities, nurses can be found nearly everywhere -- at patient screenings, in nursing stations, and, most importantly, with the patient in the exam room or at the bedside. Nurses are on the front lines of patient care, making nurse-patient communication essential to a positive patient experience.
On a pragmatic level, nurse-patient communication is important because it is one of the primary domains on which CAHPS surveys are scored. Patients answer questions about whether the nurse treated them with courtesy and respect, listened to them carefully, and explained concepts clearly.
High CAHPS scores are important for an organization’s reputation and some reimbursement models.
The communication components of CAHPS scoring highlight the two main goals in nurse-patient communication:
- Creating a positive, warm, and compassionate patient experience
- Creating meaningful patient engagement and delivering patient education
However, meeting these goals isn’t always easy, especially as new technologies infiltrate the nurse-patient relationship. While health technology provides many advantages to patient care, it can also detract from nurse-patient relationships. Targeted communication strategies can help overcome these barriers.
Below are nurse-patient communication strategies that achieve both above-mentioned goals and that fit into busy workflows.
Making personal connections
Nurse-patient communication is anchored by strong interpersonal relationships. Meaningful relationships will allow nurses to carry out their clinical jobs more easily while keeping patients engaged in their care.
Forging meaningful nurse-patient relationships can be accomplished by making small changes to nursing workflow.
Sitting next to a patient while talking, even for a brief period, can help improve patient satisfaction scores, for example. A 2017 study found that nurses who asked to sit beside their patients while talking improved hospital patient satisfaction scores from the 9th percentile to the 43rd percentile.
Simple communication strategies are integral for nurses who almost always experience crowded schedules and busy clinical workflows, according to Press Ganey CNO Christy Dempsey, MSN, CNOR, CENP.
Few providers argue against delivering compassionate care, Dempsey said in a previous interview with PatientEngagementHIT.com.
“Everybody wants to do that,” she pointed out. “The pushback is always about not having the time. Nurses say, ‘you must be joking if you can think I can spend 15 to 20 minutes with every patient.”
Nurses and other healthcare experts have been looking for the key to a quality patient encounter that also fits within busy workflows. At the University of Virginia, researcher Claudia Allen, JD, PhD, developed the Background, Affect, Trouble, Handling, and Empathy (BATHE) method, designed to only take five minutes.
BATHE uses open-ended conversations between patients and nurses to build strong relationships that can often go beyond clinical needs. Understanding who the patient is as a person helps the nurse connect with the patient and make her feel more comfortable during a potentially tumultuous care encounter.
“The intervention invites the patient to talk about whatever is important to him or her,” Allen and colleagues wrote in an article in Family Medicine.
Understanding patient needs and concerns allows nurses to target their communication and clinical strategies toward specific patient preferences.
“In outpatient settings, BATHE has been found to improve patient satisfaction without significantly increasing time spent per office visit,” the research team added.
Dempsey has boiled her strategy down to about 56 seconds, a timeline all nurses should be able to follow, she said.
Dempsey begins by asking patients what they prefer to be called, about their family, and about what they enjoy doing in their daily lives. By gathering anecdotal information about her patients, Dempsey can nearly always make a connection.
“In truth, there aren’t even six degrees of separation between us,” she said. “We can always find something in common that will make a personal interaction. When I’m ready to wrap up that interaction, I always conclude with that connection.”
Being an attentive clinician is important to the overall patient experience because it is instrumental in reducing avoidable patient harms.
When a nurse is a good listener and frequently checks in on her patients, she is able to reduce both physical and emotional distress.
For example, a nurse who conducts regular rounding can check in with a patient who just underwent hip surgery and needs something from across the room. The nurse can get the object for the patient rather than risk the patient falling.
Similarly, a nurse who is attentive in her listening can understand an underlying reason for a patient’s concerns and fears about a procedure. The patient might be resistant to the hip replacement because she is nervous about adverse side effects, for example.
When a nurse can identify patient worries, she can help alleviate fears and create a better experience.
Using communication skills to support patient education
Patient teach-back is a leading patient education strategy. During patient teach-back, nurses should ask patients to repeat a concept, set of instructions, or other health information in her own words. This helps the patient synthesize the information and helps the provider confirm whether the patient truly understood the exchange.
Organizations should begin to develop teach-back skills by creating a leadership team or identifying an initiative champion, says the Agency for Healthcare Research and Quality (AHRQ).
Next, they should begin staff training. Training should highlight the goals for patient teach-back as well as example prompts for the strategy (i.e. “Just to be safe, I want to make sure we are on the same page. Can you tell me...” or “I want to make sure that I explained things clearly. Can you explain to me...”).
Organizations must also educate patients about the teach-back tactic. Nurses should emphasize that the strategy is not a test or a judgement on the patient. Instead, patient teach-back is a tool to gauge patient understanding and to help nurses determine where they need to better explain a concept.
“Effective communication is a clinician’s first step to helping a patient with a health problem,” AHRQ said in the guide. “The evidence-based, low-technology teach-back technique can be the gateway to better communication and better understanding, and ultimately it can improve patient outcomes.”
Teach-back is also an important part of family and caregiver education. Nurses need to make sure family caregivers are well-educated about patient health needs to better assist the patient after discharge.
Nurses, like other clinicians, must also make sure they meet patients at the appropriate health literacy level when discussing health concepts. Bearing in mind a patient’s comfort level with health concepts will help the nurse better gauge how she should be talking to the patient.
According to a Bradley University guide on patient education, best practices include:
- Use basic language – provide explanations for complex medical terminology.
- Speak at a measured pace. Speaking too quickly could prevent patients from following the conversation and disrupt patient questions.
- Ask the patient questions. This means utilizing patient teach-back or simply asking where the patient has questions.
- Take the time to ask the patient if she has questions about the information relayed, instead of leaving it up to the patient to speak up.
Nurses should also rely on the printed patient education materials available. Most hospitals have printed educational brochures, digital tools, or information on the patient portal, a website, or in the EHR.
Patient education materials allow patients and family members to review information in their own time, according to Kumiko O. Schnock and Priscilla Gazarian, two researchers from Brigham and Women’s Hospital.
Schnock and Gazarian developed their own digital framework for patient education in the ICU, finding that the tool helps patients learn about their health during a scary and complicated time in their lives.
“This framework offers patients and their families a point of reference at their own pace,” Schnock said. “Once patients have calmed down and have had time to learn about the treatment and their ICU hospital stays, the framework is there for better patient uptake of information.”
The role of technology in nurse-patient communication
Health IT plays a significant role in supporting strong nurse-patient communication.
Bedside tablets contain a host of tools that help patients become acquainted with the hospital and their care teams, promoting a more positive experience during their hospital stay.
At the University of California San Francisco (UCSF) Medical Center, nurses and other clinical team members use bedside tablets to provide entertainment for patients, give patients information and staff photos of their care team, and enhance patient education, according to Valerie Bednar, MA, BSN, RN, CCRN-K, the hospital’s nursing staff manager.
The tool connects seamlessly to UCSF’s EHR and helps providers assign one of hundreds of patient education videos based on a patient’s healthcare needs. This digital approach is not intended to entirely replace patient-provider relationships, but enhance them, Bednar asserted.
“The patient education functions are trying to offer multimodal education,” she said. “We do a lot of verbal education, we do a lot of written education, and we were trying to cover that third mode and provide a lot more visual education. “
“We try to get that in front of the patients earlier in the experience, as well, because a lot of times with discharge education you print it out two hours before the patient goes home,” Bednar added, noting that patient education materials are most useful when patients have had time to read and absorb them.
Bedside tablets can also improve the use of nurse call lights and call buttons.
Traditionally, nurse call lights have been used to alert nurses of a certain patient need. However, call buttons do not always communicate specific patient needs. Voice-controlled systems may not be effective for patients with language barriers, for example.
A 2015 study found that a bedside call button tool that utilizes short phrases and pictures improves both nurse and patient satisfaction with the tool. Bedside displays can be simpler for patients to use, therefore enhancing patient experience. In turn, nurses are better able to anticipate patient needs and allocate their own resources accordingly.
Health technology also has its drawbacks. Providers face numerous quality reporting requirements that often leave nurses spending more time looking at their screens than their patients. Research has shown that patients notice this lapse in meaningful communication, and it often negatively impacts patient satisfaction.
A 2015 study from JAMA Internal Medicine found that less than half of patients experiencing a care encounter with “high computer use” reported high satisfaction. Eighty-three percent of patients experiencing an encounter with “low computer use” reported high satisfaction.
Health technology and associated reporting requirements are likely not going away. Instead, nurses need to reconcile meeting documentation requirements with their interpersonal skills to create a positive patient experience.
This hinges on helping patients understand these tools, why clinicians use them, and how the tools will impact the clinical encounter.
Nurses should try to begin their care encounters without using technology. This is an ideal time to establish short but meaningful relationships with patients, such as using the five-minute communication strategies.
From there, nurses should acknowledge their transition to using the EHR and other health technology. Patients recognize that technology is a mainstay in their own healthcare and most have conceded that the EHR improves health. Acknowledging the use of technology during appointments will help make the tools less jarring for patients and make patients more receptive to the systems.
Nurses can introduce patients to the EHR by saying that they are going to open the patient chart and begin taking notes on the care encounter. Nurses should reiterate that they are still engaged in the care encounter.
Clinicians should also explain the EHR to patients, share the computer screen, and note the benefits to the technology. When the patient better understands the EHR and other health IT, it is easier to create patient buy-in and reconcile technology use with relationship-building.
Alongside the rise of health technology and its use during care encounters, imperatives to create positive patient experiences will continue to loom large in healthcare. With nurses on the frontlines of patient care, it will be essential that they understand how to deliver that positive experience through good communication.
Nurses will need to balance compassion, clinical expertise, and technology demands in order to create a quality care encounter that supports both patient health and emotional needs.