Communication: NURSE Model

The equipment and personnel required to perform this skill:

This skill is developed by practising nursing skills and manipulation skills when the nurse is working with a patient (standardised patient)

Description of the clinical situation:

The NURSE model is a fundamental communication framework used by nurses to respond empathetically and effectively to patients' emotional distress. It is not for giving medical instructions or factual information, but for addressing the feelings that underlie a patient's words.

A nurse would employ this model in any situation where a patient expresses:

• Strong negative emotions: such as fear, anger, frustration, sadness, anxiety, or hopelessness.
• Uncertainty or vulnerability: when facing a new diagnosis, a complex treatment, or an unknown outcome.
• Resistance or a lack of cooperation: often stemming from underlying emotional concerns rather than simple stubbornness.

The order in which the skill is performed:

• N – Name the Emotion  
  • Goal: Acknowledge the patient’s feeling explicitly.  
  • Key: Use emotion words (angry, scared, hopeless) to show you’re attuned.
    
  • Phrases:  
    • "I can see you’re feeling overwhelmed by this diagnosis."  
    • "It sounds like you’re frustrated with the treatment side effects." 
    • "You’re sounding really hopeless right now."
      
    • "It sounds like you're feeling really anxious and scared about what's going to happen tomorrow."
      
    • "I can hear how frustrated and discouraged you are right now."
      
    • "It seems like you're feeling very lonely and perhaps a bit hopeless today."
      
    • "I can see that you're feeling angry about the side effects of your medication."
      
    • "This news has clearly left you feeling overwhelmed and frightened about the future."
• U – Understand the Feeling  
  • Goal: Legitimize the emotion without fixing it prematurely.  
  • Phrases:  
    • Avoid: "Don’t worry" (invalidates the emotion).  
    • "Anyone in your situation would feel this way."  
    • "It makes complete sense that you’re worried."  
    • "That is a very common and natural reaction to receiving a new diagnosis like this. It feels like a huge life change, and it's okay to be upset."
      
    • "Your frustration is completely valid. Dealing with unpleasant side effects can feel worse than the condition itself. It's a legitimate concern."
      
    • "It's understandable to feel that way when you're away from your family and routine. Hospital stays can make anyone feel isolated."
      
    • "It's incredibly frustrating when a new treatment doesn't bring the relief you were hoping for, especially after you've tried so hard."
      
    •  "That is completely understandable. Facing the unknown, especially surgery, is worrying for almost everyone."
• R – Respect the Patient  
  • Goal: Highlight their strengths or efforts.  
  • Phrases:  
    • Pro Tip: Praise specific actions, not general traits.
      
    • "You’ve shown incredible courage throughout this."  
    • "Your dedication to your husband’s care is remarkable."  
    • "I respect that you're sharing these concerns with me. It's important to talk about them rather than keep them bottled up."
    • "I have to say, I respect your perseverance in continuing to look for solutions despite all these setbacks. That takes real strength."
      
    • "I want you to know that I respect you greatly. Your life experiences and the challenges you're facing now require real courage."
      
    • "I respect that you told me directly instead of just stopping the medication. It helps us work together to find a better solution for you."
      
    • "I respect the courage it took for you to sit here and receive this difficult news. That's the first step."
      
    • "But you’ve kept every appointment - that’s commitment."   
• S – Support Their Journey  
  • Goal: Reinforce partnership.  
  • Phrases:  
    • "We’re here to support you every step of the way."  
    • "Let’s figure this out together."  
    •   "You are not alone in this. I will be here, and we have diabetic educators and nutritionists who will support you. This is manageable, and you will be able to live a full, normal life."
    • "Would it help to have your daughter here when we talk?" 
      
    • "My role is to support you in feeling better. Let me talk to the doctor about these side effects. There are many other types of blood pressure medications we could try."
      
    • "We are here for you. You are not a burden to us; caring for you is our job and our privilege. Let's focus on getting you stronger so you can go home."
    • "I am on your team. Let's talk to the doctor together about what we can try next. We haven't run out of options yet."
    • "I want you to know that our entire team is here to support you. We'll be with you every step of the way to ensure you're safe and comfortable."
• E – Explore the Concern  
  • Goal: Uncover underlying fears/needs.  
  • Questions:  
    • Technique: Use open-ended questions → silence → reflective listening.  
    • "What’s the hardest part of this for you?"  
    • "What information would help you feel more at ease?"  
    • "Can you tell me more about what worries you?"
      
    • "Can you describe the pain today compared to yesterday? Has the character or location changed at all since starting the new medication?"
      
    • "What specifically about the anesthesia or the procedure is worrying you the most? Perhaps I can provide some more information to help put your mind at ease."
      
    •  "Tell me about your family. What's a favorite memory you have with them?" (This shifts focus to positive connections).
      
    • "Can you help me understand what time of day the dizziness is worst? And what activities does it prevent you from doing?"
      
    • "What part of this new diagnosis worries you the most? Is it the diet, the finger pricks, or something else? Let's start there."

Scenario 1: The Anxious Pre-Op Patient

Patient: (Pacing in the room) "I just can't stop thinking about the surgery tomorrow. What if the anesthesia doesn't work? What if something goes wrong? This is my first operation ever."

Nurse Response using NURSE Model:

• N - Name: "It sounds like you're feeling really anxious and scared about what's going to happen tomorrow."

• U - Understand: "That is completely understandable. Facing the unknown, especially surgery, is worrying for almost everyone."

• R - Respect: "I respect that you're sharing these concerns with me. It's important to talk about them rather than keep them bottled up."

• S - Support: "I want you to know that our entire team is here to support you. We'll be with you every step of the way to ensure you're safe and comfortable."

• E - Explore: "What specifically about the anesthesia or the procedure is worrying you the most? Perhaps I can provide some more information to help put your mind at ease."

Scenario 2: The Frustrated Chronic Pain Patient

Patient: (Sighs heavily, looks angry) "Nothing is working! These new painkillers are useless. I'm still in agony. Why does nobody seem to know how to help me?"

Nurse Response using NURSE Model:

• N - Name: "I can hear how frustrated and discouraged you are right now."

• U - Understand: "It's incredibly frustrating when a new treatment doesn't bring the relief you were hoping for, especially after you've tried so hard."

• R - Respect: "I have to say, I respect your perseverance in continuing to look for solutions despite all these setbacks. That takes real strength."

• S - Support: "I am on your team. Let's talk to the doctor together about what we can try next. We haven't run out of options yet."

• E - Explore: "Can you describe the pain today compared to yesterday? Has the character or location changed at all since starting the new medication?"

Scenario 3: The Sad and Isolated Elderly Patient

Patient: (Looks out the window, voice is quiet) "Don't bother with the physio today. What's the point? I'm just a burden to my family. They have their own lives, and I'm just stuck here."

Nurse Response using NURSE Model:

• N - Name: "It seems like you're feeling very lonely and perhaps a bit hopeless today."

• U - Understand: "It's understandable to feel that way when you're away from your family and routine. Hospital stays can make anyone feel isolated."

• R - Respect: "I want you to know that I respect you greatly. Your life experiences and the challenges you're facing now require real courage."

• S - Support: "We are here for you. You are not a burden to us; caring for you is our job and our privilege. Let's focus on getting you stronger so you can go home."

• E - Explore: "Tell me about your family. What's a favorite memory you have with them?" (This shifts focus to positive connections).

Scenario 4: The Angry Non-Compliant Patient

Patient: "I'm not taking those blood pressure pills anymore! They make me feel dizzy and tired all the time. You people just push medications without caring about the side effects!"

Nurse Response using NURSE Model:

• N - Name: "I can see that you're feeling angry about the side effects of your medication."

• U - Understand: "Your frustration is completely valid. Dealing with unpleasant side effects can feel worse than the condition itself. It's a legitimate concern."

• R - Respect: "I respect that you told me directly instead of just stopping the medication. It helps us work together to find a better solution for you."

• S - Support: "My role is to support you in feeling better. Let me talk to the doctor about these side effects. There are many other types of blood pressure medications we could try."

• E - Explore: "Can you help me understand what time of day the dizziness is worst? And what activities does it prevent you from doing?"

Scenario 5: The Frightened New Diagnosis Patient

Patient: (Tears in eyes, after receiving a diabetes diagnosis) "Diabetes? But... that means I can never eat normally again? I have to poke my finger every day? My life is over."

Nurse Response using NURSE Model:

• N - Name: "This news has clearly left you feeling overwhelmed and frightened about the future."

• U - Understand: "That is a very common and natural reaction to receiving a new diagnosis like this. It feels like a huge life change, and it's okay to be upset."

• R - Respect: "I respect the courage it took for you to sit here and receive this difficult news. That's the first step."

• S - Support: "You are not alone in this. I will be here, and we have diabetic educators and nutritionists who will support you. This is manageable, and you will be able to live a full, normal life."

• E - Explore: "What part of this new diagnosis worries you the most? Is it the diet, the finger pricks, or something else? Let's start there."

Summary of Use-Case Scenarios: