• Choose a category
• All
• Classic-Fiction

Verbal responses

The way things are said makes a big difference, so attention needs to be paid to the tone, rate and depth of speech. This means sounding alert, interested and caring, but not patronizing. Speech should be delivered at an even rate: not too fast or too slow (unless presenting difficult or complex information).

Questioning

One skill that needs to be used in close collaboration with listening is that of questioning. When specific information is required, for example in a crisis, closed questions are indicated. Closed questions narrow the potential answer (Silverman et al. 2005) and allow the gathering of specific information for a purpose. Closed questions therefore are ones which are likely to generate a short ‘yes or no’ answer, for example ‘Are you all right?’.

In care situations with significant life-changing implications, however, a broader assessment of the patient’s perspective is required and there is a need to show compassion and support psychosocial issues. Open questions and listening are therefore required. Open questions do the opposite of closed questions; they broaden the potential answer (Silverman et al. 2005) and hand the initiative and agenda over to the patient. So instead of asking ‘Are you all right?’, ask ‘How are you today?’ or ‘What has your experience of treatment been like?’.

It is good to include a psychological focus to make it clear that this is part of what you are interested in; for example, ‘How did that make you feel?’ or ‘What are your main concerns?’.

Open questions cannot be used in isolation as the opportunity for open discussion can easily be blocked by failing to ensure that the rest of the fundamental communication elements are in place. Attention must therefore be paid to protecting sufficient time, verbal space (not interrupting) and encouragement (in the form of non-verbal cues, paraphrasing, clarifying and summarizing), so that the patient and/or relative can express their feelings and concerns.

Open questions may not be appropriate with people who have a communication problem, perhaps following head and neck surgery or where complex communication is going to be difficult, as for some whose first language is not English.

Try to use one question at a time: it is easy to ask more than one question in a sentence and this can make it unclear where your focus is and lead the patient to answer only one part of your question.

Open questions can also be helpful to respond to cues that the patient may give as to their underlying psychological state. Cues can be varied, numerous and difficult to define, but essentially these are either verbal or non-verbal hints of underlying unease or worry. Concerns may be easier to recognize where they are expressed verbally and unambiguously (del Piccolo et al. 2006).

Reflecting back

You can repeat the same words back to the patient: this signals that their focus is a legitimate topic for discussion (Perry and Burgess 2002), but if this technique is overused it can sound unnatural (Silverman et al. 2005).

When it is used, it needs to be done with thought and include ‘something of you in your response’ (Egan 2002, p.97), meaning that you remain alert and caring.

Paraphrasing

This technique involves telling the patient what they have told you but using different words that retain the same meaning; for example:

Patient: I need to talk to them but whenever they start to talk to me about the future, I just start to get wound up and shut down.

Nurse: So when your family try to talk, you get tense and you stop talking….

Clarifying

The aim of this technique is to reduce ambiguity and help the patient define and explore the central or pivotal aspect of issues raised. Many of us may be reluctant to explore emotional or psychological issues too much, just in case the issues raised are too emotional and hard to deal with (Perry and Burgess 2002). However, if the principles of good communication are applied and a focus on the patient’s agenda is maintained, distressing