When Emotions Run High, Here's How to Respond
Health care is full of high emotion鈥攅specially right now. Thankfully, there鈥檚 a simple framework we can follow to de-escalate with compassion. Hospitalist and UACT co-director Claire Ciarkowski introduces NURSE: a simple mnemonic for responding with empathy.
Claire Ciarkowski | 3 minutes
Learning Objectives
- Relay each step to NURSE
- Identify verbal and non-verbal cues that indicate when to use NURSE
- Apply NURSE to de-escalate emotions and respond with empathy
COVID-Ready Communication Skills: A playbook of VitalTalk Tips
VitalTalk, the nonprofit health care communication resource group who developed the NURSE framework, has developed a real time guide for communicating with patients, peers and the public about the coronavirus.
NURSE: A framework to respond with empathy
Medical training is full of mneumonic devices鈥攓uick techniques that help us remember what to do.
NURSE is an easy mnemonic any health care professional can use to respond to an emotional situation with a patient, fellow team member or visitor. It helps keep lines of communication open and reduces tension.
NURSE stands for:
- Naming
- Understanding
- Respecting
- Supporting
- Exploring
Follow these steps to better understand what your patients or team members are experiencing and provide an empathetic response.
Why is having a framework a good idea?
In health care, we are often confronted by emotion鈥攚hether we are talking to a patient鈥檚 family or working as part of a team. Even though you recognize these emotions, it can be hard to know how to respond in the moment.
That鈥檚 when NURSE is most helpful. It gives you a way to respond empathetically and be fully present in the conversation. It can help you build better relationships with patients or other team members and improve the quality of your care.
When do I use NURSE?
Use it to help de-escalate a situation. You鈥檒l know it is time to use NURSE when you see verbal cues such as:
- Yelling
- Short responses
- Reluctance to talk
- Tremors in the voice
You might also see non-verbal cues that let you know that emotions are running high, such as:
- Crossed arms
- Furrowed brows
- Avoiding eye contact
- Clenched jaw
- Hanging head
- Crying
When you recognize these cues, be ready to listen and use this method to guide your conversation.
Naming
Naming is the first step toward de-escalation. You want to name what the person is feeling. Try using 鈥渇rustrated鈥 or 鈥渙verwhelmed,鈥 rather than 鈥渁ngry.鈥 Anger can feel like a bigger, more unsolvable emotion than frustration.
Normalize their feelings with phrases such as:
- 鈥淢any people in your situation would feel scared.鈥
- 鈥淵es, seeing so many doctors can feel overwhelming.鈥
- 鈥淚t can be really frustrating when someone doesn鈥檛 communicate well.鈥
- 鈥淚鈥檓 wondering if you are feeling nervous.鈥
These sorts of phrases help validate how they feel before jumping towards solutions.
Understanding
Once you have named their feelings, take steps to better understand their point of view by carefully listening to their situation. In this stage, try not to say, 鈥淚 understand what you are feeling.鈥 You don鈥檛 actually understand their specific situation.
Instead, try to get them to share more about what they are going through. Use phrases like:
- 鈥淭his really helps me understand what you are thinking.鈥
- 鈥淚 can see this is important to you.鈥
- 鈥淭ell me more about what鈥檚 happened.鈥
Listen carefully to what they say and try to put yourself in their situation. During this step, align yourself with the person and help them know that you are on their side.
Respecting
Respecting is the most important step. We show respect by helping them see what is going well, particularly what they are doing well with this stressful situation.
Helpful phrases include:
- 鈥淚 can really see how dedicated you are to your patients.鈥
- 鈥淵ou are such a caring daughter.鈥
- 鈥淚 really admire your love for your family.鈥
These phrases help redirect their feelings to something more positive and helps them understand that you respect how they feel, and you respect who they are as a person.
Supporting
Statements of support provide further comfort in emotional situations. In this step, you reassure the person that you, and others, are working with them.
You might use phrases such as:
- 鈥淚 will do my best to make sure you have what you need to do your job.鈥
- 鈥淥ur team is committed to helping you any way we can.鈥
- 鈥淲e will work through this together.鈥
It鈥檚 not enough to say that you support someone; in the next step, you need to provide that support.
Exploring
By the time you reach this last step, the person you are speaking to should be feeling much calmer. Together, you can explore the next steps and clarify any remaining questions you have about their feelings.
You鈥檒l use phrases like:
- 鈥淭ell me more about what you mean when you say you don鈥檛 want to give up.鈥
- 鈥淗elp me understand more about what you need to do your job well.鈥
- 鈥淭ell me what good communication looks like for you.
Based on their answers, you should have a clearer vision of what you can do to improve the situation and move forward.
Conclusion
It's challenging to remain calm in the face of emotion. It helps to have a simple framework to fall back on. With practice, using the NURSE method can help de-escalate situations by ensuring we appropriately recognize concerns, listen with intent, and respond empathetically.
Originally published March 2020
Contributor
Claire Ciarkowski
Hospitalist, 91麻豆天美直播
