The NURS Mnemonic
Giving bad news and interacting with patients regarding emotional issues can be two of the more difficult situations that we deal with in medicine. Often, it is challenging to find the right words to say and to point the interaction in a constructive direction.
The "NURS" mnemonic can be used to help frame and guide such an encounter. This mnemonic is discussed in detail below. This type of interaction really is part of the art of medicine, but this mnemonic may be helpful for the purposes of the Step 2 CS exam.
N-ame the emotion
U-nderstand
R-espect
S-upport
N-ame the emotion. Labeling the patient's emotion can be a helpful first step in communicating effectively with the patient and being able to offer the appropriate support. You may say, "you seem upset" or "you seem sad." In doing so, you may be correct in identifying the patient's underlying emotion, or the patient may correct you. Either way, you have taken the first step in dealing with the issue at hand.
U-nderstand the patient. Do not fall into the mistake of saying, "I understand how you feel" or "I know how hard this is for you." If you do this, the patient may say, "how could you possibly understand what it's like to have a child with cancer." Instead, make it clear that you understand that the situation is difficult. Say something like "I understand how hard this must be for you" or "I understand that this situation must be very upsetting for you." In this way, you state that you understand the patient's emotional status even though you probably have never been in the same situation yourself.
R-espect the patient. Perhaps the most important part of the interaction is conveying a sense of respect to the patient. The patient needs to know that you respect the situation they are in, their emotional response to the situation, and how they are handling it. Say something like, "I respect the way you are handling this very difficult situation."
S-upport the patient. Make it clear to the patient that you are there to offer emotional support. Say something like, "is there anything more that I can do to help you get through this situation?" Alternatively, you may say, "Don't hesitate to contact me if there is anything I can do to help you."
All rights reserved worldwide. Copyright 2005, Theodore X. O'Connell, M.D.
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