Communication Errors to Avoid in Correctional Nursing

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 communication faux pas nurses can make in healthcare interactions as a correctional healthcare provider. We also added in nurse communication tips, since providing a “positive sandwich” is the best way to constructively criticize!

Approval or disapproval of a feeling or intention expressed by a patient should be about the patient, not the provider or nurse.

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.

Empathy can be exhausting, but we know you didn’t join the healthcare profession to hurt anyone. Your patient is a human being behind their facade and those emotional responses make or break a relationship. You may make leaps and bounds of progress by being compassionate instead of contradictory.

Mental heuristics and automatic response comes naturally for a reason, but you’re here as a healthcare provider and need to demonstrate mindfulness.

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.”

Make eye contact. Use your patients names. Be present and mindful. You will gain respect and notice a difference in how your treatment recommendations are received.

Diving in for detail is expected but demanding explanations sets a tone that should be avoided.

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?”.

It can be difficult to frame a need for an explanation of behavior under a premise that is anything but. However, just consider how you would want to be asked the same question; it will lead you to a less combative and accusatory manner of getting the same details in return.

Defend your patients, not your personal stance.

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.

This is also a great moment to understand how patients are perceiving your colleagues and be able to mediate that to the benefit of the patient. You can gain trust, you can gain respect, and you can gain insight to educate your peers on best practice in communicating delicate things to their patients.

Invalidation of patient input is demeaning and leads to a lack of open communication from patients.

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.

You surely don’t have to dog pile on the insult’s target, just as much as you don’t want to directly contradict the patient’s perception since that is their reality.

Can you spot yourself in any of the examples above? We all 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.

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