There are always times when we need to have a difficult conversation. Perhaps it is with a friend, peer, colleague, or patient. The topic continuously varies. Many of us humans, who I’m referring to, may dread difficult conversations or conflict. We often learned to avoid difficult conversations as we grew up, probably because these conversations were not dealt with well by our parents or peers. Learning to deal with difficult conversations systematically can help everyone be better communicators and convey the message more positively. Remember, the principles of a positive discussion are the same.

The Right State of Mind

Both examples are of possible problematic situations. So, how should you proceed? Let’s discuss some steps first to get in the right state of mind. It is essential to practice scenarios like this, not in person or out loud; practice in your head as you get ready for bed and relax for the evening. Practice all possible outcomes, from the worst possible to the best possible, and everything in between. Next, keep your state of mind positive. Whenever you practice scenarios, picture yourself calm, positive, and effective when communicating.

It would help if you held every conversation with empathy and compassion. Show the person you care about them and anything they are going through. You share compassion and empathy by listening carefully, being authentic, and genuinely caring.

• Compassion is showing concern for someone who is suffering.
• Compassion leads to an action to help others.
• Compassion inspires positive feelings.
• Empathetic persons feel the emotions of others.
• Empathy leads to understanding.

Practice these over and over before the difficult conversation and even anytime you anticipate a difficult conversation. It does not matter who the conversation is supposed to be with, practice. Practice the right way to say something. Practice the unexpected as well as the expected. Don’t give yourself a script; follow a different script each time you practice. Use other words each time so that you are prepared for different scenarios and can adapt to anything that comes your way. This technique is called Guided Imagery and is extremely useful.

Breathing

Practice basic principles of mindful breathing. Mindful breathing is a form of meditation you can do when practicing different scenarios at bedtime or during other quiet periods. First, get in a relaxed pose. Any position that you are comfortable in will work. Take a slow, deep breath in, then release and exhale slowly until all air is out of your lungs. Do not take a break in between each breath. Practice this for 10 minutes for about a week, then move on to 20 minutes. Do remember that you can stop at any time. Feel yourself, be calm, be relaxed. Notice any areas where you are tense, and relax those muscles. As you breathe, tune into your breath and feel your breath move in and out. Feel yourself relax.

Now that you have practiced a bit, you will be more ready for the expected and the unexpected. You will be more prepared for that difficult conversation than ever. Now, let us move toward a systematic way to respond to someone and how to be relaxed and compassionate while you are responding.

The Systematic Approach

Start with an opening comment or question. Show empathy while you are at it. If you are delivering terrible news, a death, for example, you should try to ensure that they have someone to be with them or drive them to where they need to go. You might say

• “I’m concerned about your attendance lately. Is everything okay at home?”
• “I’ve asked you here today to talk about Benjamin’s wishes for his care.”
• “It is nice to see you today; how have things been with you and your family lately.”
• “Tell me what you know about Benjamin’s health.”

Take Time to Understand Their Perspective

You do not have to answer right away. Take several breaths, relax, and consider their perspective or issues. It is okay to say I’m so sorry that this happened to you. or that you are going through this. If they begin to cry, give them space and acknowledge the distress before moving on. Remember to deliver the news in a calm, compassionate manner. Do not try to convey the other person’s sympathy by saying things like I feel wrong about this, or This is hard for me to do.

Explain the Change in Their Behavior You Expect to See

Work-Related Issue

Explain the issue that you are having and what changes you expect to see. Do so compassionately and calmly. You cannot fix the situation for them, but you can provide suggestions if they would like suggestions. But first, ask them what they think the solution is. If they cannot come up with a solution, ask them if they would like you to provide suggestions. If they say no, respect their wishes.

Healthcare Issue

If you are discussing a medical issue with patients or family members, describe the issue at hand and how that issue impacts the patient and family. Explain medical words or procedures and give timelines when necessary. It is important to be nonjudgmental, reflective, and compassionate. Provide teaching materials if that helps. Use I statements or allow the patient to use I statements. Mediate situations where the patient needs to tell their family how they feel and what they want. Be there to support the patient in those instances. Then, give them a bit of a break to process. Just listen.

End the Session

To end these conversations, paraphrase the problem and the plan to move forward. If no plan was established, then ask them to reflect and get back to you. Give them a specific timeline of when you expect to hear from them. Be encouraging, calm, and empathetic. Then, follow up with them at the right time to complete the circle.

References

Bigelow, S., Medzon, R., Siegel, M., & Jin, R. (2024). Difficult Conversations: Outcomes of Emergency Department Nurse-Directed Goals-of-Care Discussions. Journal of Palliative Care, 39(1), 3–12. https://doi.org/10.1177/08258597221149402

Hannans, J., & Nevins, C. (2024). Using Mixed Reality to Practice Difficult Conversations. Clinical Simulation in Nursing, 86, N.PAG. https://doi-org.proxy.mul.missouri.edu/10.1016/j.ecns.2023.101472

King, C., & Williams, B. (2021). Enabling difficult conversations in the Australian health sector. Australian Journal of Advanced Nursing, 38(3), 5–13. https://doi-org.proxy.mul.missouri.edu/10.37464/2020.383.310

Sulistio, M. S., Chen, C. L., Eleazu, I., Godfrey, S., Abraham, R. A., & Toft, L. E. B. (2023). Personal Actions to Create a Culture of Inclusion: Navigating Difficult Conversations With Medical Colleagues. Annals of Internal Medicine, 176(11), 1520–1525. https://doi-org.proxy.mul.missouri.edu/10.7326/M23-1374