Nurturing emotional well-being: Five questions to ask your patients for better healthcare outcomes

The Five Questions to Ask Your Patient

Question One: “What is one small thing that brings you comfort?”

One day, I had a patient who had just learned that he was too sick to continue his life-saving chemotherapy regimen. He required constant procedures, and his room was a busy, noisy place. The second our visiting hours started, his wife rushed in carrying a CD player. She played his favorite albums for the rest of the day, switching to the next CD each time one finished. I titrated pressors and hung blood products to the catchy tunes from the Beatles’ greatest hits album. The music distracted my patient, and I was able to see how much his favorite songs put him at ease.

Since then, I have started to ask this question routinely. I had one patient who thought immediately of the cozy blanket from her couch that she always brought to bed with her when she was sick at home. So we asked her son to retrieve it from her house. Another patient I asked couldn’t think of anything, so I asked her when she felt most relaxed. She said, “At the hairdressers!” I decided to take five minutes to give her a scalp massage during her bed bath and asked her son to give her another one that afternoon when he visited. I even wrote in her chart and reported that this was a soothing intervention for her.

Patients know themselves the best and will often give creative answers we would not have thought of on our own. Rarely have I had a patient ask for something that costs money or an inordinate amount of time to provide. It’s the little things that provide comfort and ease anxiety. Tapping into a patient’s own methods for self-soothing is a powerful tool. In this way, we can provide comfort during a painful, scary time.

Some ideas for items that might help with providing comfort are: a favorite or new stuffed animal, noise-canceling headphones, classical music, a lavender-scented hot pack, fuzzy socks, a phone call from a friend, a stress ball or fidget toy, guided meditation, high-quality lotion or lip balm, a framed photo of a beloved pet, or a cozy shawl.

Question Two: “Did you understand everything that was just said?”

Some ICU patients see three or four different teams of doctors a day. Many times, patients need to quickly give informed consent for multiple procedures at one time while they are in pain. Often a patient will state they understand and even ask appropriate questions, but realize shortly afterward that they did not truly absorb the information. They may even feel there is no time for an additional conversation due to the ongoing hustle and bustle. Sometimes, I don’t learn how confused a patient is until I stop and ask them if they understand what is going on.

Feeling lost about their own condition or upcoming interventions can be incredibly scary. I now make it a point to find a quiet and intentional moment to make sure the patient understands what is happening and has space to ask any questions. Often, this means I have to delegate some of the important tasks to another nurse at the bedside for a couple of minutes; however, stopping what I’m doing to show I have the time to answer makes a big difference. I’m always glad when the situation allows for this clarification, as it often provides welcome reassurance for the patient.

Question Three: “Would you (or your wife/brother/etc.) like to come to rounds?”

In most ICUs, health professionals “round” daily on every patient, reviewing labs and vitals and planning care for the day. Due to the often sedated, sometimes delirious nature of our patient population, it is not automatically assumed that patients will be active participants in their care planning. It is sometimes even our habit to forget that this is an option. I try to ask alert patients if they would like to come to rounds or have a representative attend for them. In this way, they can understand their condition better, and they can also be an advocate for themselves. It makes it possible for them to do things like specifically describing their pain, asking for their preferred nutritional shake when they hear they are at risk of requiring a feeding tube or bringing up the challenges they would face at home caring for a central IV line.

Important information for high-quality care planning comes to the forefront when patients or their family members are active participants in rounding. It also serves as a detailed update for the patient, an activity I know ICU clinicians value highly and wish they had more time to provide. This practice also improves the relationship between the patient and the healthcare team, increasing trust through transparency and two-way communication. Family presence on rounds can even decrease the negative psychological effects families suffer from their loved one’s hospitalization (Calderone et al., 2022). 

Question Four: “Do you like to know all the details during a procedure, or be distracted from what is happening?”

I learned the importance of this question the hard way. I myself like to know every single detail of what is happening when I am a patient. Perhaps this makes me an annoying patient (aren’t all nurses?). For a long time, it also informed the way I updated patients in my care. I assumed each of them would want to know everything the healthcare team was doing at any given moment. One incident that sticks with me is one where I was holding a patient’s hand during the changing of her surgical dressing, and I was letting her know each thing that she would feel so she knew what to expect. After a few moments, she yelled, “Please stop telling me what they are doing!” I quickly complied and let her go to her mental happy place instead.

Now, I ask alert patients about their informational preferences prior to any procedures in the room. I would say about three-quarters of my patients like to know all the details, while one-quarter would prefer to be kept in the dark. If they prefer the latter, I offer distracting conversation or silence as alternatives.

Question Five: “What are you most scared of right now?”

I include this question separately from the above sections which address patient comfort and confusion because sometimes the answer surprises me. For example, I had a patient whose kidneys were failing. The renal team had recommended that a line be placed for dialysis and explained this process to him. At his request, they were waiting for his wife to arrive so they could also explain it to her before he signed the consent form. After hanging an antibiotic, I noticed his hands shaking. This led me to ask him, “What are you most scared of right now?” I thought for sure he was worried about the pain of the large dialysis catheter being placed in his neck. However, he surprised me by answering, “I am terrified that I will slowly wither away while I spend my last days at the dialysis clinic tied to a machine.”

He did not want dialysis, but never had the courage to bring this up while his wife was there because she felt differently. Thankfully, we were able to delay the line placement for a day in order to benefit from the guidance of our palliative care team to direct some important conversations regarding goals of care between the patient and his wife. He was eventually discharged on hospice, and I remember how he smiled telling me about the welcome he would receive from his two sweet dogs and beloved cat when he returned home.

From this experience and others like it, I have learned to ask more open-ended questions of my patients. This helps me to learn what they are feeling and what concerns they would like to focus on.