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Marcie Hopkins, U of U Health.
wellness
When Emotions Run High, Here's How to Respond
Health care is full of high emotion—especially right now. Thankfully, there’s a simple framework we can follow to de-escalate with compassion. Hospitalist and UACT co-director Claire Ciarkowski introduces NURSE: a simple mnemonic for responding with empathy.

COVID-ready communication skills: A playbook of VitalTalk Tips 

VitalTalk, the nonprofit health care communication resource group who developed the NURSE framework, has developed a real time guide for communicating with patients, peers and the public about the coronavirus. Visit the COVID-19 scripts, online training and direct updates here. 

NURSE: A framework to respond with empathy

M

edical training is full of mneumonic devices—quick techniques that help us remember what to do. 

NURSENURSE was created by Vital Talk, a leading provider of evidence-based communication trainings for clinicians and clinician-faculty. is an easy mnemonic any health care professional can use to respond to an emotional situation with a patient, fellow team member or visitor. It helps keep lines of communication open and reduces tension. 

NURSE stands for:

  • Naming
  • Understanding
  • Respecting
  • Supporting
  • Exploring

Follow these steps to better understand what your patients or team members are experiencing and provide an empathetic response.

Why is having a framework a good idea?

In health care, we are often confronted by emotion—whether we are talking to a patient’s family or working as part of a team. Even though you recognize these emotions, it can be hard to know how to respond in the moment.

That’s when NURSE is most helpful. It gives you a way to respond empathetically and be fully present in the conversation. It can help you build better relationships with patients or other team members and improve the quality of your care.

When do I use NURSE?

Use it to help de-escalate a situation. You’ll know it is time to use NURSE when you see verbal cues such as:

  • Yelling
  • Short responses
  • Reluctance to talk
  • Tremors in the voice

You might also see non-verbal cues that let you know that emotions are running high, such as:

  • Crossed arms
  • Furrowed brows
  • Avoiding eye contact
  • Clenched jaw
  • Hanging head
  • Crying

When you recognize these cues, be ready to listen and use this method to guide your conversation.

nurse acronym

Naming

Naming is the first step toward de-escalation. You want to name what the person is feeling. Try using “frustrated” or “overwhelmed,” rather than “angry.” Anger can feel like a bigger, more unsolvable emotion than frustration.

Normalize their feelings with phrases such as:

  • “Many people in your situation would feel scared.”
  • “Yes, seeing so many doctors can feel overwhelming.”
  • “It can be really frustrating when someone doesn’t communicate well.”
  • “I’m wondering if you are feeling nervous.”

These sorts of phrases help validate how they feel before jumping towards solutions.

Understanding

Once you have named their feelings, take steps to better understand their point of view by carefully listening to their situation. In this stage, try not to say, “I understand what you are feeling.” You don’t actually understand their specific situation. 

Instead, try to get them to share more about what they are going through. Use phrases like:

  • “This really helps me understand what you are thinking.”
  • “I can see this is important to you.”
  • “Tell me more about what’s happened.”

Listen carefully to what they say and try to put yourself in their situation. During this step, align yourself with the person and help them know that you are on their side.

Respecting

Respecting is the most important step. We show respect by helping them see what is going well, particularly what they are doing well with this stressful situation. 

Helpful phrases include:

  • “I can really see how dedicated you are to your patients.”
  • “You are such a caring daughter.”
  • “I really admire your love for your family.”

These phrases help redirect their feelings to something more positive and helps them understand that you respect how they feel, and you respect who they are as a person.

Supporting 

Statements of support provide further comfort in emotional situations. In this step, you reassure the person that you, and others, are working with them.

You might use phrases such as:

  • “I will do my best to make sure you have what you need to do your job.”
  • “Our team is committed to helping you any way we can.”
  • “We will work through this together.”

It’s not enough to say that you support someone; in the next step, you need to provide that support.

Exploring 

By the time you reach this last step, the person you are speaking to should be feeling much calmer. Together, you can explore the next steps and clarify any remaining questions you have about their feelings.

You’ll use phrases like:

  • “Tell me more about what you mean when you say you don’t want to give up.”
  • “Help me understand more about what you need to do your job well.”
  • “Tell me what good communication looks like for you.”

Based on their answers, you should have a clearer vision of what you can do to improve the situation and move forward.

Conclusion

It's challenging to remain calm in the face of emotion. It helps to have a simple framework to fall back on. With practice, using the NURSE method can help de-escalate situations by ensuring we appropriately recognize concerns, listen with intent, and respond empathetically.

 

Cite this content: Claire Ciarkowski, “When Emotions Run High, Here's How to Respond”, Accelerate University of Utah Health curriculum, . Available at: http://accelerate.uofuhealth.utah.edu/explore/when-emotions-run-high-here-s-how-to-respond

Contributor

Claire Ciarkowski

Hospitalist, University of Utah Health