5 Ways Medical Improv Can Help Nurses Talk about Death and Dying

Medical improv is an emerging field that holds much promise for us in healthcare. There are scores of experiential activities that can be adapted from theater education and improvisational comedy to build emotional intelligence and improve communication, teamwork, and leadership. All of which contribute to a foundation from which we can provide safe, quality, and compassionate care as well as well as sustain long-term and rewarding careers.

Almost any Medical Improv activity can help participants develop self-awareness, self-expression, the ability to identify emotional cues in others, while building positive relationships and decreasing stress. All of these will help nurses hold conversations that may be emotionally charged and painful such as those around death and dying. Here are five ways Medical Improv can help nurses cope with patient death:

Create self-awareness

Self-awareness of feelings is one of the most fundamental characteristics of emotional intelligence. Nurses who are self-aware know what they are feeling and why in any given moment throughout their day. They can distinguish between old emotional injuries and current stressors that may trigger them. A nurse who loses a patient may feel sad, have a sense of failure, or even relief related to the end of suffering. Such a situation may trigger a flood of emotions for a nurse who lost a family member with similar circumstances. In the second situation the self-aware nurse will recognize all of her feelings and understand that some of them may have older origins. Awareness will help the nurse figure out if and when talking about the death would be helpful and whether a family member, colleague, and/or psychotherapist might be most helpful.

Create self-expression

There are hundreds of emotions that human beings may feel with different intensities and for different reasons. Becoming familiar with what our emotions look and feel like can help us to become our full selves. Nurses who are sad about a patient’s death may still have several other patients to care for. Acknowledging the sadness in the moment and taking a few minutes to collect one’s self is fine, but deeper processing of the event may have to wait. But without making time later such as in an interactive Medical Improv workshop designed to build skills and create safe opportunities to talk about death and dying, feelings may be repressed. This may lead to becoming numb or overreacting to another situation.

Identify emotional cues of others

Nurses who can recognize facial expressions in others such as a patient’s family member who is getting distraught about a loved one’s pain, a patient who is holding back tears because he has just received devastating news, or a colleague who appears overwhelmed with stress will be more able to offer support. The ramifications of calming a patient’s family member, listening to a patient’s fears about death, or supporting a stressed-out colleague are hard to measure, but may improve patient experience and even prevent a catastrophic error.

Establish relationship-building

Interprofessional and therapeutic relationships are vital parts of nurses’ work. And sharing feelings about death and dying requires trust and emotional safety. Yet our workplaces are notorious for disrespectful or even bullying behaviors. And changing behavior in the middle of high-stakes and high-stress work is tough if not impossible. Facilitated activities from Medical Improv give clinicians a chance to work and play together outside the stressful environment. The bonds that form and nurture healthy relationships will empower effective teamwork once back on the floor. Like a sports team practicing together before a big game, the activities build trust and cohesiveness.

Provide stress relief

Death and dying are expected parts of nurses’ work, but that doesn’t mean that coping with the experience becomes easy. Tragedy and loss, especially when there are few channels or little time for processing can contribute to emotional burnout and physical distress. Having a little fun together can go a long ways towards shaking off some of the lingering feelings some nurses may have. Also, sharing some lighter time together can help provide a balance of experiences that is healthier.

How to get medical improv started

When implementing medical improv, consider experiential activities that help achieve the above ideals with large group discussion, and work in pairs to dive into a particular topic. For example, an activity called “Same-Time-Story” where pairs work together, one telling a story while their partner has to try and tell it at the same time. It involves slowing down, watching and listening attentively, and trying to guess what the person is going to say next. It is fun to watch and the learning often profound. Also, participants should play “Physical phone” which is described in detail in the article, A Medical Improv Activity: Breaking Tension & Improving Communication! You don’t need to be an expert in Medical Improv to teach or try it out. If you do try some of these exercises, I’d love to hear how it goes.