When attempting to establish a relationship and enter a dialogue with the family of a dying patient, the nurse would:
1. Identify with the family when they have concerns by saying, "I have questioned how a physician could believe that also. I'll argue with her about it."
2. Speak more than the family because silence may be difficult for them to tolerate.
3. Demonstrate respect for the family by saying, "I'm impressed with how involved you have been with the patient during his illness."
4. Begin by saying, "I know exactly how you must be feeling."
3
Rationale 1: The nurse would not contradict or put down other health care providers but recognize patient concerns by saying something such as: "I hear you saying that you don't feel you are being heard by the physicians. I'd like to make certain you have a chance to voice all your concerns."
Rationale 2: The nurse would maintain a higher ratio of family member-to-health care provider speaking time; therefore, listening, asking clarifying questions, and tolerating silence are important skills for nurses.
Rationale 3: The nurse would demonstrate respect for family members by saying something such as: "I'm so impressed by how involved you have been with your father throughout his illness"; and also by assuming that the family members are operating in what they believe to be the patient's best interests unless there is proof to the contrary.
Rationale 4: The nurse does not know how the family must be feeling. This would not be appropriate for the nurse to say to the family.
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