The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [145]
Box 5.4 Making the environment conducive to supportive communication
Can the patient safely and comfortably move to a more suitable area to talk with more privacy?
Do they wish to move?
Do they wish other people/members of the family to be there?
Clear a space if necessary, respecting the patient’s privacy and property.
Check whether sitting on one side or another is preferable to them.
Remove distractions, for example switch off a television, with the patient’s permission.
Is the patient able to sit comfortably?
Will the patient be too hot or cold?
As far as possible, choose a seat for yourself that is comfortable, and on the same level as the patient.
Position your seat so you can have eye contact with each other easily without having to turn significantly.
If you are in an open area on a ward, draw the curtains (with the patient’s permission), to give you some privacy. Obviously, this does not prevent sound transfer and it is worth acknowledging the limitations of privacy.
Assessment
Nurses need to make careful assessments of the patient’s psychological care needs. Every patient needs to be assessed for their coping style and their perception of support should be discussed at key stages in the journey of their illness. Patients’ needs are diverse and hence individual discussion is necessary to enable professionals to understand and negotiate the desire for hope and control in care and treatment (Hack et al. 2005). Assessment and recording tools may support this discussion.
Recording tools
The Distress Thermometer is a validated instrument for measuring distress (Gessler et al. 2008, Mitchell 2007, Ransom et al. 2006). It is similar to a pain analogue scale (0 = no distress, 10 = extreme distress) and is thus simple to use and understand (Mitchell et al. 2009) (Figure 5.3). The tool helps to establish which of the broad range of challenges that may face any unwell person is dominant at any given time. It provides a language to help patients talk about what is concerning them (Mitchell 2007). The patient marks where they feel they are at that moment or for an agreed period preceding the assessment. Trigger questions included with the Distress Thermometer can then be used to explore the nature of the distress, for example exploring family difficulties, financial worries, emotional or physical problems. A score of over 5 would warrant some supportive discussion and exploration of whether other support is necessary or desired. It may be that no further referral is necessary and the structured discussion this tool provides is sufficient in lowering the level of distress (NCCN 2010).
Figure 5.3 Distress thermometer.
Principles of supportive communication
The process in Principles Table 5.1 is not a rigidly prescribed sequence as skills and strategies may be used differently depending upon the situation.
Principles table 5.1 Supportive communication
Principle Rationale
Consider whether the patient is comfortable and doesn’t need pain relief or to use the toilet before you begin. Pain and the medication used to treat it and other distractions and discomforts may limit a patient’s ability to reason and concentrate. E
Protect the time for psychosocial focus of conversation. This involves telling other staff that you don’t wish to be disturbed for a prescribed period. Patients may observe how busy nurses are and withhold worries and concerns unless given explicit permission to talk (McCabe 2004, R3b).
Set a realistic time boundary for your conversation at the beginning. You may only have 10 minutes and therefore you need to articulate the scope of your available time; this will help you to avoid distraction and give your full attention during the time available. E
Introduce yourself and your role and check what the patient wishes to be called. This helps to establish initial rapport (Silverman et al. 2005, R5).
Spend a short time developing a rapport