Addressing Social and Emotional Concerns in Healthcare

Dr. Felicity Monroe

Hello everyone, and welcome back to Professional Communication. I’m Dr. Felicity Monroe, joined as always by the one and only Evelyn Harper.

Evelyn Harper

Hey there! Ready as ever to dig in, Felicity. I’ve got my coffee, I’m awake, and uh—fair warning—today’s topic gets a bit heavy but, you know us, we’ll keep it grounded.

Dr. Felicity Monroe

Absolutely. Today, we’re exploring social and emotional concerns that show up in healthcare delivery, especially when we care for patients facing death and dying. These are tough moments—not just for patients, but for families, and for us as care providers.

Evelyn Harper

Yeah, it’s one of those universal experiences, isn’t it? No matter your role, if you’re in health care long enough, you’ll be part of those conversations. It gets especially tricky with so many legal, social, and cultural factors in play. I mean—you’ve got advanced directives, family expectations, even state laws about what care can or can’t be withdrawn. It’s a maze.

Dr. Felicity Monroe

Very much so. And how those factors play out is often shaped by cultural values—some families want every possible intervention, some prioritize comfort, some have spiritual needs that take center stage. As care teams, it’s our job to really listen, offer information clearly, and include everyone in the process. I had a case a few years ago—multicultural family, three generations, grandma in hospice. The emotional needs were complex, and language was a barrier at first.

Evelyn Harper

Ah, families at odds on what’s best, right?

Dr. Felicity Monroe

Exactly. In that case, we actually brought in an art therapist, since several family members spoke limited English. Everyone created paintings to express what they wished for their grandmother in her final days, and it shifted the dynamic—suddenly even the quietest voices had a way to be heard. It helped with not just anticipatory grief, but allowed us to meet spiritual and practical needs on their terms—plus, it made communication easier for the team.

Evelyn Harper

That’s incredible. I love anything that encourages families to open up, especially when verbal communication breaks down. Sometimes it really is about meeting folks where they're at—practically and spiritually. Community health centers do a good job with this, especially when they have social workers and chaplains in-house. Super useful in discharge planning and resource connection, too.

Dr. Felicity Monroe

Completely agreed. The more interdisciplinary the approach, the better we’re able to address the spectrum of needs at end of life—emotional, spiritual, and, let’s be honest, paperwork woes included.

Evelyn Harper

Oh yes, paperwork—arguably the spiritual test for clinicians everywhere! But no really, it’s about making those hard times just a bit more bearable for everyone involved.

Evelyn Harper

So, building off that, let’s talk about what comes after—grief and loss, and woah, there’s a lot to unpack. I always think of Kubler-Ross’s five stages: denial, anger, bargaining, depression, and acceptance. You see those in families, but also sometimes in staff, right?

Dr. Felicity Monroe

Without question, and not always in order, either. Grief is messy—sometimes it bounces back and forth, sometimes folks skip around. And, Evelyn, as you mentioned, caregivers and staff are just as vulnerable to that process as patients’ families.

Evelyn Harper

You ever have a moment where you watch someone cycle right through all five stages in one shift? I totally have—parents, even my own colleagues. Actually, I remember a young patient—a seven-year-old—I worked with whose mum had passed away. He didn’t want to talk at all, but he started drawing pictures, and each day they’d change, showing a little more about how he was feeling. Gave us a window in without prying with questions he wasn’t ready to answer.

Dr. Felicity Monroe

That’s such a powerful example. Sometimes the path to supporting grief is through nonverbal expression first. This makes me think of the long-term care setting—there’s this case, Walter, who was admitted with dementia, refusing to eat, wouldn’t leave his room, told staff to get out. In that scenario, we recognize cues: withdrawal, refusal of care, anger, and sadness. Assessing for depression is key, but so is understanding it’s grief—anger at loss of independence, maybe even bargaining for some sense of control.

Evelyn Harper

Right, and with Walter or anyone like him, it’s about finding ways to connect, even in tiny ways. Sometimes it’s his favorite meal, or just, you know, sitting there and letting him be—not forcing the issue. Nurses are kind of like detectives for these hidden feelings, but you need trust.

Dr. Felicity Monroe

Exactly, we try to offer choices and involve the patient wherever possible. And I think, going back to what we discussed in our last episode on mood disorders, building that trust is absolutely foundational—because if we’re not consistent or empathetic, those small windows for support can slam shut fast.

Evelyn Harper

You also can’t forget the impact on nurses. Sometimes, after a string of tough losses, it hits you out of nowhere. I know I’m guilty of bottled-up “I’m fine!” moments until someone hands me a coffee and asks how I really am. Support systems for staff are critical. Maintaining that continuity and coordination, whether it’s chaplain visits for patients or space for staff to decompress, helps everyone grieve a little healthier.

Dr. Felicity Monroe

That brings us to one of the tougher issues—anger, abuse, and violence in health care. Not just the emotions we witness with patients, but sometimes what we experience ourselves. Anger is normal, but when it escalates into aggression or violence, it’s a major social problem.

Evelyn Harper

Totally, and the tough part is recognizing when it’s crossing that threshold. Sometimes anger is about loss or powerlessness—classic grief stuff—but, yeah, when it spirals into abuse or even violence, it’s not just a “bad day.” There’s an actual cycle: tension building, the outburst, then the “honeymoon” phase after, where folks may try to make up for their actions.

Dr. Felicity Monroe

Risk factors pop up everywhere—history of trauma, substance use, social isolation. And it’s not just in psychiatric wards, either. I remember a situation where we had a patient with escalating aggression—it took a real team effort. We activated a crisis intervention team: law enforcement, hospital security, mental health providers, and emergency services, all coordinating together. Everyone had a role, and the team approach was what defused things before anyone got hurt.

Evelyn Harper

Yeah, those coordinated teams are so important. Nobody—nurses, docs, patients—should be expected to manage these risks alone. I mean, I don’t even like tackling a suspicious sandwich solo, let alone a crisis! All jokes aside, sometimes bringing in external partners, like mental health advocates or even chaplains, can help de-escalate situations. Communication and planning ahead—like we touched on in previous episodes about continuity—are key to safety.

Dr. Felicity Monroe

The interdisciplinary bit really matters. When you’ve got law enforcement and mental health collaborating—each understanding the goals and boundaries—you get safer outcomes for everyone. It’s not easy work, but it’s essential for both patient and staff safety, and for getting those who need it connected to ongoing help, not just short-term fixes.

Evelyn Harper

Alright, Felicity, this has been, as always, a real conversation—sometimes heavy, always relevant. We hope you listening out there got something useful for your own practice, or maybe just a little validation if you’re having a tough week.

Dr. Felicity Monroe

Absolutely, and we’re just scratching the surface—future episodes will keep building on these topics. Take care of yourselves, and remember, supporting each other is just as important as supporting our patients. Evelyn, always a pleasure.

Evelyn Harper

Back at you, Felicity. And to everyone out there, stay safe, stay connected—we'll see you next time on Professional Communication.