The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [138]
6 Supportive. A supportive intervention seeks to affirm the worth and value of the client’s person, qualities, attitudes or actions.
Non-verbally, people communicate via gestures, body language, posture, facial expression, clothing, furniture, touch, music and art. Communication can be heavily influenced by a multitude of external and internal factors, for example illness, culture, class, self-esteem, immediate environment, gender, status, mood, depression, and the influence of these factors needs to be carefully considered in each circumstance. All patients and relatives should be assessed for their psychological needs and tailored support offered to meet individual needs.
Evidence-based approaches
‘Effective communication is widely regarded to be a key determinant of patient satisfaction, compliance and recovery’ (Chant et al. 2002, p.13), yet poor communication is one of the most common causes of complaints in healthcare (Cambell 2006). Supportive communication is important to create an environment where the individual patient feels heard and understood and can be helped appropriately. Communication needs to be highly flexible – dependent upon cultural, social and environmental factors. Nurses need to communicate effectively with patients in order to deliver individualized safe care and treatment and to manage psychosocial concerns appropriately. People with illness want to be approached with a ‘caring and humane attitude’ that respects their privacy and dignity (Maben and Griffiths 2008). Patients want their personal values to be respected and to be treated as equals by health professionals. This can be achieved by taking the time to communicate, not controlling dialogue, listening and offering emotional support (Smith et al. 2005) and by striving for open, clear and honest communication (Baile et al. 2000, Heyland et al. 2006, Jenkins et al. 2001, Smith et al. 2005). The patient’s dignity can be promoted by enabling the expression of concerns in a safe environment.
Patients want to be able to experience a meaningful connection and a sense of ‘being known’ by the staff they encounter (Thorne et al. 2005). Nurses need to be able to accurately assess how much patients want to share their thoughts and feelings without assuming that they either do or do not wish to. Communication occurs in a time-pressured environment. Practical and technical tasks demand the nurse’s time and tend to be prioritized above psychological support. The resulting communication may be limited and prevent effective exploration of psychological care issues. Without effective exploration, patients are not sufficiently encouraged to engage with and manage their own care. Nurses need to be aware of and consider what other features of the environment contribute to the nature of the dialogue that takes place, for example the wearing of uniform (Edwards 2005, Hargie and Dickson 2004). Patients may not expect to discuss psychosocial issues with nurses because of the communication bias toward physical and medical issues. The task-orientated short communication encounters that emerge do not encourage the disclosure of psychosocial concerns (Silverman et al. 2005).
Patient satisfaction is not necessarily related to the acquisition of specific communication skills (Thorne et al. 2005) but staff still need to be able to enquire about the nature and manner of support that patients wish for (so that satisfaction can be achieved wherever possible).
Listening and appropriate verbal responses that demonstrate empathy remain the key skills; if nothing else is achieved, adopting these qualities will be beneficial to patients and be a valuable use of time.
Listening
Listening is a skill often assumed to be natural. Rarely would we consider that we were physically unable to listen and perhaps this makes us pay little attention to this crucial skill area (Box 5.2).
Box 5.2 How to let someone know you are listening to them
Non-verbal encouragement.
Verbal characteristics.
Questioning.
Paraphrasing.
Clarifying.
Summarizing.
Empathy.