Communication Is a Powerful Therapeutic Tool

Words matter. That’s the main message that two clinical nurse specialists from Cleveland Clinic will deliver during their presentation “Words as a Therapeutic Tool” at the American Association of Critical-Care Nurses (AACN) National Teaching Institute & Critical Care Exposition (NTI) in May in Orlando, Fla.

“Communication is the one intervention that all caregivers provide, regardless of professional discipline or role,” says Mary Beth Modic, DNP, APRN-CNS, CDE, FAAN, Clinical Nurse Specialist, Diabetes. “How we speak and listen to patients and their loved ones is one of the most important therapeutic tools we have.” Modic will co-present at NTI with Dianna Copley, MSN, APRN, ACCNS-AG, CCRN, Clinical Nurse Specialist.

Working toward more thoughtful language

The topic of words as therapeutic tools is fitting for this year’s NTI conference, which has the theme “Our Voice, Our Strength.” But Modic began learning specific strategies to provide relationship-centered communication long before the AACN started planning its 2019 conference. She is a meta facilitator for the R.E.D.E. to Communicate Model® created by clinicians at Cleveland Clinic to enhance individual communication skills. “No matter how long a person has been practicing, we all can benefit from becoming more relationally proficient,” she says. “The course affords participants the opportunity to reflect on strengths in their communication and learn specific techniques to optimize their relationship with patients.”

The importance of deliberate and relationship-centered communication was driven home for Modic at a conference sponsored by the American Association of Diabetes Educators, where a nursing leader and researcher introduced the concept of person-centered, empowering language. As a person living with Type 1 diabetes, the speaker was often defined by her condition and labeled in ways that inaccurately described her and the obstacles she encountered while self-managing her disease.

“We type things in patients’ records every day, and we don’t necessarily think about the language showing up in the record,” says Copley. One word that shows up repeatedly is “refused,” as in “the patient refused medication,” she says. Cleveland Clinic became one of the first healthcare organizations in the country to adopt person-centered language in medication administration. “Rather than document that the patient ‘refused’ a medication, which can be pejorative, we have adopted the word ‘declined,’” says Copley. “While it may seem like a small change, it conveys an appreciation for the patient’s autonomy and role in shared decision-making.”

Delivering two main messages about communication

In their presentation, Modic and Copley will convey two major messages. The first is that caregivers should use thoughtful language directed at patients that is strength-based rather than deficit-based. “We often talk about how patients can’t eat, can’t walk or can’t breathe on their own, because we are all educated to concentrate on patients’ problems. People are seeking help for a problem that is not resolving, and it is affecting their quality of life,” says Modic. “One of the tenets of our message is to see patients as people who are in need of our help, but also bring a cadre of assets to the encounter such as resilience, tenacity and strong social and emotional support systems.”

The second primary message is the importance of pro-nursing language, which places value on the interventions that nurses perform every day, such as patient education. “Nurses educate every single time they walk into a patient’s room about minor things that have such a huge impact, like hand hygiene or infection prevention,” says Copley. “It’s so much a part of our language that we don’t usually stop and explain how it impacts the person and his or her recovery.”

Implementing three communication techniques

Modic and Copley offer three pointers for moving toward a relationship-centered vocabulary with patients:

1. Embrace the pause. “Be deliberate and intentional with the use of silence,” says Modic. “When a patient shares personal or powerful thoughts, don’t rush to respond. Instead, allow time to appreciate the impact of the words and the message that may not be all that obvious.” She cites the catch phrase that reinforces this recommendation: If you rearrange the letters in the word ‘listen,’ you get ‘silent’. “This is a motto I try to use every day,” says Modic.
2. Validate the patient’s thoughts and feelings. “Affirm what the patient is saying, and encourage them to expound on it,” says Copley. “When we are attentive to the language we use, we create a feeling of safety so that patients feel comfortable disclosing their fears and concerns. This helps us tailor our interventions so that we can provide exquisitely personalized care.”
3. Be empathic. “Probably the greatest therapeutic tool that we can use is empathy,” says Modic. Nurses tend to apologize when patients express frustration about receiving the wrong meal tray or having to wait for assistance to get out of bed. Instead, acknowledge the patient’s feelings first: “It can be so frustrating to have to wait for someone to come to your room to help you. [Pause to allow the patient to verbalize the concern.] I am here for you now.”

Copley stresses that learning to use words as a therapeutic tool is a lifelong process. Like any skillset, it needs to be learned and practiced. “The more we utilize it in our professional practice, the easier it will become,” she says. “At the end of the day, it benefits patients and nurses. We will have much more insight into patients as people and the unique set of circumstances that brought them to the hospital. We can honor their wishes, respect their values and help them adapt to the changes that may come as a result of a life-altering illness.”

Person-centered, strength-based and empowering language is a life-affirming intervention. “Words can make the difference in a patient’s suffering, motivation level or ability to perform self-care activities,” says Modic. “We are fortunate that we have the opportunity to disseminate this research, as well as our work in raising awareness, at such an important forum as NTI. We are looking forward to spreading the ‘word.’”

Mary Beth Modic, DNP, APRN-CNS, CDE, FAAN and Dianna Copley, MSN, APRN, ACCNS-AG, CCRN, will present “Words as a Therapeutic Tool: Developing a Relationship-Centered Vocabulary” at 2:45 p.m. on Wednesday, May 22, 2019, at the ACCN’s National Teaching Institute & Critical Care Exposition in Orlando, Fla.