Contributor: Patricia H. Strachan RN PhD
For many years I have been trying to understand and promote ways that nurses could speak with patients who are living with one or more serious illnesses, about what are often termed “difficult” issues. When nurses refer to difficult conversations, the subject (or perhaps person or family) is thought to be bringing about pain, the context often related to an impending, sudden or actual loss such as the loss of life, loss of an imagined future, loss of a loved one or loss of health and function. In all manner of nursing work, there is always the potential for, if not an embedded imperative, for leading, responding and being present in such conversations. Yet I will argue that this vital relational work, so needed by patients and families, has remained largely invisible, undocumented, under-valued and misunderstood. Instead, the focus of nursing communication in institutional settings has tended towards the reductionistic, mechanistic and task-related role functions that can be documented on checklists, directed by algorithms and perpetuated by powerful neoliberal systems.
Yet, in my professional and personal experience, I know that nurses’ communicative praxis can impact patients and families in-the-moment and in the lifetime(s) that may come after, no matter the medical outcome. After a few decades of practice as a nurse, nurse educator and researcher, I am worried about all of this, particularly in the post-COVIDicene practice environments (Blaine Brown et al., 2022). I listen to a class of brilliant, thoughtful graduate nursing students describe their praxis in all its complexity, the multiple levels in which they communicate and function in sub-optimal working conditions. How do they attend to the whole person or family, simultaneously analyzing details of physiology, pathophysiology, biochemistry, pharmacology, technology, personal preferences, family systems and at once listen and respond? In such dynamic contexts, nursing involves iterative acts of improv. Seeking, integrating, analyzing while being present for a patient’s or family member’s questions, worries, hopes, pain and information needs for now and the future. Think about how this, practiced well, affects patients, families, communities, teams.
While communication is implicit and/or explicit in nursing theories and models, nursing students and nurses ranging from novice to experienced, often lack confidence and knowledge about their communication skills, and especially when the subjects and contexts are considered difficult (Kerr et al., 2022). The educational and practice conditions giving rise to this situation are complex and beyond the scope of this blog.
My response to this situation? A podcast – Radical Nurse Talk – was dreamed up and sculpted into being. The virtual space of podcasting intrigues and intimidates me; importantly, it may hold potential for prompting conversations, raising awareness, inviting critical reflection and valuing of nurses’ real work, beyond the traditional stereotypes. Using the podcast as vehicle, I aim to illuminate understanding of nurses’ communication in serious situations and illness, as a radical act of care (Maboloc, 2020). The roots of the podcast as a medium and as content, are situated in the philosophies and theories influencing the Nursing Manifesto, namely postmodern/poststructural, postcolonial, critical (and feminist) theory and pragmatism, unique disciplinary knowledge and holism (Kagan et al., 2010). Thus, the podcast serves as a disruptive social technology that calls nurses to critically reflect on the communicative and relational patterns of nursing work that have been created, imposed, enacted, preferred and imagined by diverse powers and voices. In the interviews, nurses’ knowing about the dynamics of relational work and its contexts, are explored from the standpoint of personal experiences and interpretations about the complex interplays of the empiric, aesthetic, ethical, and emancipatory (Bonis, 2009). In the spirit of Paulo Freire, I engage in dialogue with guests – mostly nurses- to reveal expertise and experience, deliberately intended to foster in the listener, a process of reflection, conscientization and transformation towards valuing and generating nursing knowledge relevant to communication (Freire, 1993). A lofty goal perhaps. The name is intentionally provocative. Murmurs about it being “too much” have been heard- to my delight! May it be too much to maintain the status quo.
Consider this an invitation to visit and peruse the webpage – Radical Nurse Talk, and listen (free) through one of the many podcast platforms available (including Apple, Podbean, Spotify, Amazon). Like some of you may be, I was new to the podcast world. Here is some of what I have learned: it really is free (if you have access of course). If you like it, please provide feedback- if not a comment, then a ‘like’- and ‘follow’ (this is currency in the virtual world). If you ‘follow’ (some platforms might say ‘subscribe’), new episodes will automatically be available to you. Share it with other nurses and students. Your suggestions and feedback are welcomed to expand the conversation beyond what I recognize is my own positionality as interviewer and a privileged, white, western nurse academic and curious and lifelong learner.
Brown, Brandon Blaine, Dillard-Wright, Jessica, Hopkins-Walsh, Jane, Littzen, Chloe O. R., & Vo, Timothea. (2022). Patterns of Knowing and Being in the COVIDicene: An Epistemological and Ontological Reckoning for Posthumans. Advances in Nursing Science, 45(1), 1–19. https://doi.org/10.1097/ANS.0000000000000387
Bonis, Susan A. (2009). Knowing in nursing: a concept analysis. Journal of Advanced Nursing, 65(6), 1328–1341. https://doi.org/10.1111/j.1365-2648.2008.04951.x
Freire, Paolo. Pedagogy of the Oppressed. New York: Continuum Books, 1993.
Kagan, P. N., Smith, M. C., Cowling, W. R., & Chinn, P. L. (2010). A nursing manifesto: an emancipatory call for knowledge development, conscience, and praxis. Nursing Philosophy., 11(1), 67–84. https://doi.org/10.1111/j.1466-769X.2009.00422.x
Kerr, D., Martin, P., Furber, L., Winterburn, S., Milnes, S., Nielsen, A., & Strachan, P. (2022). Communication skills training for nurses: Is it time for a standardised nursing model? Patient Education and Counseling., 105(7), 1970–1975. https://doi.org/10.1016/j.pec.2022.03.008
Maboloc, C.R. (2020). Critical Pedagogy in the New Normal. Voices in Bioethics, 6. https://doi.org/10.7916/vib.v6i.6888
About Patricia H. Strachan RN BScN, MSc, PhD
Patricia is an Associate Professor in the School of Nursing at McMaster University in Hamilton, Ontario, Canada. She has been an advocate for a palliative approach to care in regional, national and international venues. Her experience as a nurse, nurse academic and human-in-the-world has fostered a passion for illuminating and advancing the critical role of nurses’ expertise in fostering therapeutic relationships with seriously ill patients and their families- no matter the circumstance or how fleeting the interaction. She is fascinated by language and its power to make a difference when people are experiencing stress, loss and uncertainty. She is deeply committed to optimizing education for meaningful engagement in relational aspects of care that are grounded in a critical paradigm.
A passionate and innovative nurse educator, Patricia has drawn from the arts, philosophy and science to engage learners in imagining the possibilities for nurses and nursing. She is an expert in problem-based learning and nursing education. Most recently her scholarship has taken a poetic turn, expressed in the writing of poetry to explore, play with and critique the intersection of language, care and existential issues related to serious illness.