A study published this week in the Journal of General Internal Medicine from a researcher in Baltimore found that there was a statistical significance in the difference between psychosocial communication and rapport building between physicians and black hypertensive patients compared to white ones. (1)
How does this affect nurses? Would this study translate over into our interactions with our patients as well? Without having any data for that question, we can still examine our role in helping our patients retain and absorb the information given to them by the physician. These professional interventions are true for any race or population of patients and should become part of your daily routine.
If you see a physician with a patient, try to make time to stand in the room to hear what they are saying. This reinforces your role as a part of the team and can increase the patient’s perception of resources for more information. Once the physician leaves, ask the patient if he/she has any questions. If you are unable to be in the room, try to catch the physician later and ask him/her what was said and if she/he has any new orders for you. Review briefly what was said and why with the patient. It is acceptable to ask, “What did Dr. Jones say to you today?”. It is even better to follow up with, “How do you feel about that?”. This opens the lines of communication beyond the dry data and into the patient’s life where you may discover opportunities to change perceptions and impart helpful knowledge.
Try to use lay terminology and make eye contact. Use humor! People learn better when they are less stressed. If they feel that you are nagging or lecturing, they are likely to tune you out or miss the specifics. Draw a picture or provide a handout. Some people do not hear and understand information verbally and truly need a visual point of reference. Reinforce at a later opportunity without being overbearing. Reassess their recall of the information by either verbally communicating or observing behaviors. Be assertive without being aggressive.
Validate the patient. It is okay to acknowledge how overwhelming changes can be. Patients need to know that you understand their fears and concerns. Try not to assume. Perhaps they don’t know how to prepare healthier foods, or they do not think they can afford it, or they are concerned that it will make them different from their friends. Try to think about areas in your life where you are not doing your best to be healthy. What are your stumbling blocks? Share these in a manner that conveys respect and be sure to leave time for listening to their response.
At a minimum, always ask directly if the patient understands what was said and if they have any questions. Ask them about their feelings on the subject and have them verbally demonstrate what they are going to do. Give them community resources and referrals as indicated for the best outcomes.
(1)The effect of patient race and blood pressure control on patient-physician communication.
Cené CW, Roter D, Carson KA, Miller ER 3rd, Cooper LA.
J Gen Intern Med. 2009 Sep;24(9):1057-64. Epub 2009 Jul 3.