Empathic communication involves accepting and allowing different perspectives and emotions in other people, and it involves actively listening to another’s world view. In the clinical world, studies have shown that empathic understanding and communication are associated with better outcomes for patients and families. In the realm of palliative medicine, the acronym NURSE (Name, Understand, Respect, Support, Explore) serves as a helpful tool for clinicians engaging in empathic communication and navigating the complex terrain of patient emotions. What I have come to realize is that the utility of this tool extends far beyond the confines of the hospital room, offering invaluable insights into fostering meaningful connections. By examining each component of the acronym, we can unravel a roadmap for nurturing and sustaining healthy interpersonal bonds beyond the doctor-patient relationship.
Name the Underlying Emotion
In palliative medicine, naming the patient’s emotion in response to bad news involves acknowledging and labeling what they are feeling. Phrases such as, “It sounds like you are feeling angry” go a long way in demonstrating to the patient that we are listening and that we recognize the emotions they are experiencing.
Similarly, in personal relationships, openly recognizing and naming emotions can deepen understanding and empathy. For instance, when a partner expresses frustration about a stressful day at work, acknowledging their emotion by saying, "It sounds like you're feeling really overwhelmed," validates their experience and can foster emotional connection. By naming the emotion, individuals feel heard and understood, strengthening the bond between them.
Understand Where the Emotion Is Coming From
Understanding the root cause of emotions is crucial in both medical and personal contexts. In palliative care, clinicians seek to understand patients' emotional triggers to provide holistic support. By understanding emotions and triggers, physicians can better identify what is important to the patient and their families. Using the example above, if we have already identified that a patient is feeling angry, we could summarize our understanding of the source of that anger, and have our patient share whether or not our summary accurately reflects their emotions.
Understanding is also key in personal relationships, as taking the time to comprehend the underlying reasons behind a loved one's emotions demonstrates empathy and care. For instance, if our partner is expressing feelings of frustration and being overwhelmed at work, asking gentle questions to understand the root of their feelings can provide comfort and solace. By summarizing the cause of their frustration in our own words and then asking for feedback, we are likely to learn the true source of their frustration, whether it is due to challenging deadlines, difficult coworkers, or a different reason we may not have considered. By understanding the source of emotions, individuals demonstrate their commitment to supporting their loved ones through difficult times.
Respect Others’ Emotions
Respecting and validating emotions entails accepting them without judgment and acknowledging their validity. This does not necessarily mean we must agree with the emotional response; it simply means that we respect the other person’s experience. In palliative medicine, this involves creating a safe space for patients to express their feelings without fear of dismissal. Common phrases in palliative medicine that demonstrate respect include, “I am impressed with how well you have handled the treatments,” or if talking with a patient’s family member, “I greatly respect how you have been such a strong advocate for your loved one.” By respecting and validating emotions, individuals nurture a supportive environment where open communication flourishes.
Support Emotional Process and Coping Strategies
Supporting emotional processes and coping strategies is essential in both medical and personal settings. In palliative care, clinicians empower patients to navigate their emotions and develop effective coping mechanisms. This may include providing a variety of helpful resources, providing opportunities to participate in shared decision-making, and validating patients’ efforts to cope.
In personal relationships, offering support and encouragement during challenging times can strengthen the bond between individuals. For instance, if a partner is struggling with anxiety, actively listening and gently suggesting coping strategies can provide much-needed relief. Supporting emotional processes and coping strategies allows individuals to demonstrate their commitment to their loved one's well-being and growth.
Explore Targeted Questions and Show Interest
Exploring targeted questions and showing genuine interest deepens emotional understanding and fosters meaningful connections. In palliative medicine, clinicians use probing questions to uncover patients’ emotions and concerns, facilitating comprehensive care. Some examples that I have observed during my time in training include, “Tell me more about your concern about the treatment side effects,” and “You mentioned that you’re afraid of how your children will handle the news. Can you share more about this?”
This is perhaps the most important element with regard to personal relationships. Asking thoughtful questions and showing genuine interest in someone else’s experiences strengthens empathy and connection. It also enables us to pick up on unstated fears or anxieties that may be lingering below the surface. Our partner may be experiencing frustration or anxiety at work, but by listening carefully, we may learn how other aspects of their life are informing or contributing to their overall anxiety as well. This provides an opportunity for us to learn more about our partner and for strengthening our relationship.
The NURSE acronym provides a valuable framework for addressing emotions in both medical and personal contexts. By applying its principles, individuals can nurture emotional connection and intimacy in their relationships, both inside and outside the hospital. Ultimately, whether in palliative care or personal interactions, fostering empathy, validation, and support can create a foundation for meaningful connections that endure through life's challenges and enhance overall well-being for all involved.
What has helped you in communicating with patients? Share your strategies below.
Hailey Roumimper is an internal medicine resident in Washington, DC. She is a 2023–2024 Doximity Op-Med Fellow.
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