The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [139]
The physical act of hearing is distinct from that of ‘listening’. Hearing can be considered to be passive, but listening requires active processing and the attachment of meaning.
It might be difficult for us to answer the question ‘How do we listen?’ and perhaps a procedure of ‘how to listen’ would not do justice to the sophistication and success of good listeners. However, there are ways of describing the constituent parts of listening that, if followed, would make the person speaking appreciate that they were being listened to.
Problems can emerge as two people may interpret the meaning of the same dialogue differently. For example, if you have asked the question, ‘How are you?’ and the patient replies ‘Getting by’, do you assume they are doing well and coping or that this means they are struggling and ‘putting on a brave face’?
Hopefully, you will be attending to numerous non-verbal cues to decipher what the patient actually means. If there is a suggestion of ‘incongruence’, where the patient says ‘Getting by’ in a low and sad-sounding voice, coupled with a simultaneous lowering of the head, we might consider the latter assumption. Alternatively, if the patient sounds upbeat and looks you in the face with a smile you might be reassured they mean the former.
There are strategies to promote successful listening, for example ‘summarizing’ and ‘clarifying’ (at suitable moments) what the patient is saying.
Non-verbal responses
Non-verbal communication generally indicates information transmitted without speaking. Included in this would be the way you sit or stand, facial expression, gestures and posture, whether you nod or smile and the clothes worn: all will have an impact on the total communication taking place (Hargie and Dickson 2004).
Egan (2002) usefully describes the acronym SOLER to summarize the constituent elements of non-verbal communication: facing the patient Squarely; maintaining an Open posture; Leaning slightly towards the patient to convey interest; having appropriate Eye contact, not staring nor avoiding (cultural dimension needs to be considered with this); and being Relaxed. By learning an awareness of these factors and making this behaviour part of your normal demeanour, patients will be encouraged to talk more openly, facilitating emotional disclosure.
Saying nothing says something, so there is always communication however reluctant you or the patient are.
It can be argued that non-verbal information is more powerful than verbal information, for example in the case of ‘incongruence’ where the verbal message indicates one thing and the non-verbal suggests another. There is a tendency to believe the non-verbal message over the verbal in these instances.
This highlights the need to communicate with genuine compassion. Without this, supportive communication can be severely reduced in its effectiveness.
Non-verbal communication becomes even more important in the case of people whose verbal communication is impaired, for example by stroke, trauma or surgery. Patients need to be supported, ensuring, for example, that they have constant access to pen and paper; communication boards can be used to good effect and it is worth considering the use of information technology and communication software, if available. The experience of losing the ability to speak can be very isolating and frustrating and preparation of the patient and practice with communication aids is important to maximize the success of communication. It is essential that people with a speech deficit are given more time to communicate their needs, and we must be patient and persist with interaction until a satisfactory level of understanding is gained.
We can use non-verbal behaviour to encourage patients to talk by nodding/making affirming noises, for example ‘Hmmm’. This ‘affirming’ is mostly done naturally, for example at points of eye contact, as specific points are made and during slight pauses in dialogue. It can be especially important to affirm when the patient is talking about psychological or emotional issues as they will need