Communication is a major component of nursing, and includes not only the words we use, but the way in which they are conveyed. Correctional nurses often have very little time to communicate with their patients and brief interactions take place every day during medication line, sick call, chronic care clinic and even while the nurse is walking down the hall. Maintaining a therapeutic relationship while trying to determine the patient’s health concern can be difficult. Below is a list of five errors nurses can make in healthcare interactions.
Approval or Disapproval
A patient is dying of lung cancer in the prison infirmary and suggests that he wants to end his life. The nurse tells him that this is absolutely wrong and he should not think this way. The nurse on the next shift hears about this in report and lets the patient know she doesn’t think it is a bad idea, although she would not be able to help him. In both cases the nurses are sending a message that nurses have the right to share their personal feelings and make value judgments for their patients. However, nursing ethics prohibits this. Instead the nurse should help the patient express his ideas and feelings without fear of judgment. In this scenario, the patient should also be referred to mental health and hospice, if possible.
During a busy medication line a patient asks the nurse to take a look at a rash developing on his left hand. The nurse does not look up from the medication drawer and states, “Drop a slip for a sick call visit.” Although this might be the standard process, an automatic response without any indication of concern for the patient’s health is unnecessary. A better response would be to acknowledge the rash on the hand and say “Yes, that looks like it needs to be evaluated in Sick Call. Drop a sick call slip and you will be seen.”
Asking for Explanations
The patient is being evaluated after a self-harm incident. While completing the physical evaluation, the nurse asks her, “Why did you cut yourself?”. “Why” questions can accusatory and cause insecurity, resentment and mistrust. A better question might be “What’s on your mind right now?”.
A patient is a no-show for his Hypertension Chronic Care visit. When questioned about it, he says the doctor is an idiot and is giving him all the wrong medications. The nurse responds, “Dr. Smith is an excellent physician and you should be glad we have him.” Defensive responses are unhelpful and can cause anger and frustration. Instead, listen to the complaint without judgment. Perhaps, a better approach would be to ask the patient what medications he thinks he should be prescribed. This is an opportunity for patient education about his disease process and the evidence-based treatments and guidelines followed at the facility.
The patient arrives at Sick Call and complains that the last nurse he saw for this problem purposefully gave him the wrong treatment because she “hates men.” The current Sick Call nurse becomes irritated, stating, “That is ridiculous! Our nurses would never do anything like that! You don’t know what you are talking about.” Invalidation is demeaning and belittling. It suggests a superiority perspective and is unhelpful in resolving an issue. Instead, you should assure the patient that you will be following the Nursing Assessment Protocol that has been developed using evidence-based research and is applied equally to all patients presenting with his symptoms.
Can you spot yourself in any of the examples above? All of us tend to fall back on familiar and comfortable responses in our nurse-patient communications. By intentionally focusing on how you interact with your patients, you can use these opportunities to make a difference in the health of your patient population.
In our next post, Five More Communication Errors Correctional Nurses Make, we will continue our exploration of correctional nurse patient communication.
Share your correctional nursing communication stories in the comments section of this post.