By Lori Gudat RN, FNP-C, CDE
VMS BioMarketing Clinical Nurse Educator
When meeting with newly diagnosed patients for the first time, it is very important to first assess where they are emotionally. If patients have fears about the diagnosis or treatment, they will not be able to focus on what you are trying to teach. For patients to express their true emotions, they must feel a connection to you as their Clinical Nurse Educator. After a new diagnosis, patients will often go through the five stages of grieving as if they have experienced a death in the family. They have not lost a life, but they have lost the life they were used to living and must adapt to living with a diagnosis. As experienced Clinical Nurse Educators, we assess which stage they are experiencing and build our connections from that point. The five stages are as follows: denial, anger, bargaining, depression and acceptance.
As taught by Dr. Kubler-Ross in all nursing programs, patients who are terminally ill will go through these stages.¹ We can take that one step further and apply this to patients who are newly diagnosed with a chronic condition they must learn to live with for the rest of their lives. The Clinical Nurse Educator must help the patient transition from one stage to the next and supply appropriate resources to do so. Nurses will connect with their patients by having them express fears and concerns and then assess for which stage of the Kubler-Ross model is present. It all begins with patient-centered care, which means we put the patient first and foremost.
As a VMS BioMarketing Clinical Educator, we also utilize the technique of motivational interviewing. This remains a very effective way of communicating with our patients and helps to uncover motivators to progress to acceptance of the new diagnosis. We ask open-ended questions, show empathy and work towards collaboration with the patient. This helps to build the patient-clinical educator connection. The power of what Clinical Nurse Educators can provide to the patient can be captured through three themes – shared connection with patients, personalizing care to meet their needs, and providing reassurance when needed.² One study was able to demonstrate how nurses were able to help newly diagnosed patients with epilepsy overcome their fear of the diagnosis and treatment. Patients reported decreased fears once they understood the diagnosis, tests being performed, risk management and the need for taking their medication on a consistent basis.³
One important action of a Clinical Nurse Educator is to ease newly diagnosed patients’ burden by breaking down new information and helping them understand what they must. For example, once we have identified which stage, they are in from the Kubler-Ross model, we can help them explore how the diagnosis will impact their life. We help them focus on dietary and activity changes, medication management, and link them to online support services.
When patients’ needs are met, they will have a much-improved outcome with accepting the new diagnosis and believing that life will move forward. I always teach patients that knowledge is power – the more you know the better off you will be.
Lori received her B.S. in Nursing from Valparaiso University, and later obtained her MS in Nursing Administration and Post MS in Nursing Certificate, Family Nurse Practitioner, from Bradley University. She joined the VMS BioMarketing team in 2014 and has since offered diabetes education to patients around the US.
¹ Gregory, C. The Five Stages of Grief an Examination of the Kubler-Ross Model. https://www.psycom.net/depression.central.grief.html . Accessed March 22, 2019.
² Komatsu, H, Yagasaki, K. (2014). The Power of nursing: Guiding patients through a journey of uncertainty. European Journal of Oncology Nursing, Volume 18, Issue 4, August 2014, Pages 419-424.
³ Ridsdale L, Kwan I, Morgan M. (2002). How can a nurse intervention help people with newly diagnosed epilepsy? A qualitative study (of patients' views). Seizure. 2002 Jan;11(1):1-5.