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The use of open questions is likely to raise certain issues that would benefit from further exploration. Clarification encourages the expression of detail and context to situations, helping to draw out pertinent matters, perhaps not previously considered by either patient or health professional. A mixture of open or closed questions can be used in clarification (Box 5.3).

Box 5.3 Open and closed questions

Are you feeling like that now? (closed)

You seem to be down today, am I right? (closed)

Can you describe how the experience made you feel? (closed)

You say that you’ve not had enough information: can you tell me what you do know? (open)

You mention that you are struggling: what kinds of things do you struggle with? (open)

You say it’s been hard getting this far: what has been the hardest thing to cope with? (open)

It might be necessary for you to clarify your own position too, perhaps acknowledge that you don’t know something and cannot answer certain questions, for example ‘Will the treatment work?’.

Sometimes not knowing can be a valuable position, enabling you to seek out the patient’s experience and not just assume it. Our experience might be relevant, but each patient and relative will require the opportunity to tell it in their words and to feel ‘heard’.

Summarizing

This intervention can be used as a way of opening or closing dialogue. An opening can be facilitated by recapping a previous discussion or outlining your understanding of the patient’s position. Summarizing can be used to punctuate a longer conversation and highlight specific issues raised.

This serves several purposes.

It informs your patient that you have listened and understood their position.

It allows the patient to correct any mistakes or misconceptions generated.

It brings the conversation from the specific to the general (which can help to contextualize issues).

It gives an opportunity for agreement to be reached about what may need to happen.

Examples of summarizing:

It sounds like you are tired and are struggling to manage the treatment schedule. It also sounds like you don’t have enough information and we could support you more with that …

Summarizing can be a useful opportunity to plan and agree what actions are necessary. Avoid getting caught up with planning, though: the important issue is that you have listened and understood. In our nursing role, we are familiar with ‘doing’ and correcting problematic situations and although interventions can be helpful in psychosocial issues, sometimes it is necessary not to act and to just ‘be’ with the patient, accepting their experience as it is, however emotionally painful.

Recognizing when to act and when to sit with distress can be difficult. However, it is important for us to develop this awareness and to accept that sometimes there are no solutions to difficult situations. The temptation to always correct problems might only serve to negate the patient’s experience of being listened to.

Empathy

Sharing time and physical space with other people demands the development of a relationship. In nursing, the relationship with patients is defined by many factors, for example physical and medical care. In clinical roles it might be possible to be emotionally detached and to exist behind a ‘professional mask’ (Taylor 1998, p.74) but when working in a supportive role, a shared experience and bond are generated, inclusive of feelings.

Recognizing our own feelings is important to allow us to understand and to ‘tolerate another person’s pain’ (McKenzie 2002, p.34). Nurses demonstrate empathy when there is a ‘desire to understand the client (patient) as fully as possible and to communicate this understanding’ (Egan 2002, p.97).

This means attempting to understand what the patient might be going through, taking into consideration their physical, social and psychological environment. This inferred information can be used to ‘connect’ with the patient, all the time checking that our interpretation of their experience is accurate (we