How Medical Improv Can Prepare Nurses for Patient Death

I was in the hall at the medical cart when I heard the crash. I ran into the room and yelled for help. My patient, a young woman with advanced breast cancer, lay face down on the floor with a small pool of blood by her head. She wasn’t breathing. My supervisor came running in, “She’s gone.”

That was my first patient death. It occurred more than thirty years ago, and I still remember it clearly. Outwardly I was calm and continued to care for my other patients, but inwardly, I was shaken and looking back, I realize it affected me deeply.

Death and dying is an expected part of nursing work. It can raise many feelings and questions about our work that contribute to compassion fatigue or burnout. Unfortunately, there is seldom time to process such experiences and some nurses may lack the emotional intelligence and communication skills necessary to work through feelings such as grief, fear or anxiety. Instead, much like I did, we carry on with the relentless high-stakes, high-stress demands of our work. While this may be necessary in the moment, it is not healthy in the long run.

I’ve learned in my life and career that it is important to reflect on and express feelings about difficult experiences that involve loss or conflict; in nursing there can be a lot of both. In fact, it is part of why I became a nurse consultant specializing in teaching emotional intelligence and communication skills, and more recently using medical improv to do so.

What is Medical Improv?

Medical improv is an experiential teaching method that adapts improvisational activities to help nurses and other health care professionals develop self-awareness, self-respect, the ability to recognize emotions in themselves and others, to act on them in healthy ways and to communicate effectively. These behavioral capacities are extremely important in health care because they are essential for ensuring safe care, optimal patient experience and workforce health.

With facilitation and coaching expertise, many fun activities can be used in small groups to strengthen such personal growth and promote a safe environment that is conducive to sharing feelings on tough topics like death and dying.

Below are a few activities to help readers understand the bridge between fun improv activities and a nurse’s ability to process a patient death.

I Am

This is an activity that requires participants to complete the sentence “I am…” three times on paper and share with several others in the class. Depending on the needs of the group and other parameters, they can be instructed to focus on thoughts or feelings related to a specific topic such as a patient death or not. Often groups are quiet at first, but soon they are engaged in conversations with their peers and discover that others have similar and different feelings. It is a deceptively simple activity that builds self-awareness, respect for others, listening, assertiveness and positive relationships.

Same Time Story

(Adapted from Viola Spolin’s, “Theatre for the Classroom”)
In this activity, pairs take turns telling stories while their partner tries to tell it with them. The person who is trying to mirror their partner’s story has to focus intently on her facial expressions and be ready to change a word at every second. This builds active listening skills such as empathy, which can be discussed following the activity. It is lots of fun, observers can highlight learning, and is pretty easy to do once participants get the hang of it. The activity is also referred to as Mirror Speech and can be seen in this video lead by acting teacher, Gary Schwartz. Please note that in adapting for medical improv, a much slower pace is encouraged. I give topics such as food or pets that most people relate to easily, and have multiple pairs work simultaneously while I walk around the room to coach.

Emotional Meeting

(Adapted from Kat Koppet’s “Training to Imagine”, Stylus Publishing, 2nd Ed. 2013)
In this activity, four to five participants join a meeting one by one, each assigned to roleplay a different emotion that is contagious to those already in the meeting. For example, the first person enters the space assigned with a happy emotion and that person starts discussing the meeting while expressing happiness. For instance one nurse might say, “I’m so happy that we are gathering for this meeting. I can’t wait to learn about the new IV pump we’ll be using.” Then one by one nurses with different emotions enter the room and the others present take on that emotion. Once everyone comes in, they leave in reverse order and revert back to the previous emotion. This activity requires excellent facilitation skills, and care should be taken around assigning emotions and facilitating discussion. Nevertheless, nurses will have opportunities to try out and observe a variety of feelings that will help them develop emotional intelligence.

The Danish Clap

This is a fun activity that is a great way to end a session that may feel heavy. I often use it for closure and love to see nurses connect and laugh.

I recently talked more about how medical improv can help nurses cope with patient death. Check out the post at Medline’s “The Voices of Healthcare” by visiting medline.com/advancing-blog.