The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [146]
Be ready to move the conversation on to issues that may be concerning the patient. Be aware that some patients may stay with neutral topics as the central focus of the conversation and withhold disclosure of psychosocial concerns until later in a conversation (Silverman et al. 2005, R5).
Suggest the focus of conversation, for example ‘I would like to talk about how you have been feeling’ or ‘I wondered how you have been coping with everything’. This indicates to the patient that you are interested in their psychological issues. E
Respond to and refer to cues. Patients frequently offer cues – either verbal or non-verbal hints about underlying emotional concerns – and these need to be explored and clarified (Oguchi et al. 2010, R3b).
Responding to cues: ‘I noticed you seemed upset earlier. I have 10 minutes to spare in which we can talk about it if you wish’ or ‘You have seemed a little frustrated. Is now a good time to talk about how I can help you with this?’.
If the patient does not wish to talk, respect this (it is still important that you have offered to talk and the patient may well wish to talk at another time). The patient may not wish to talk at that moment or may prefer to talk to someone else. E
Ask open questions: prefix your question with ‘what’, ‘how’ or ‘why’. Open questions encourage patients to talk (Hargie and Dickson 2004, R5).
Use closed questions sparingly. If patients have a complicated issue to discuss, closed questions can help them be specific and can be used for clarification as well as when closing dialogue (Hargie and Dickson 2004, R5).
Add a psychological focus where you can, for example ‘how have you felt about that?’. This will help elicit information about psychological and emotional issues (Ryan et al. 2005, R3a).
Listen carefully and feed back your understanding of what is being said at opportune moments. Listening is a key skill – it is an active process requiring concentration, verbal and non-verbal affirmations (Silverman et al. 2005, Wosket 2006, R5).
Be empathic (try to appreciate what the other person may be experiencing and recognize how difficult that is for them). Empathy is about creating a human connection with your patient (Egan 2002, R5).
Allow for silences. This can give rise to further expression and useful thinking time for yourself and the patient (Silverman et al. 2005, R5).
Initially avoid trying to ‘fix’ people’s concerns and the problems that they express. It might be more powerful and important to simply sit, listen and show your understanding. As an individual is listened to, they may feel comfort, relief and a sense of human connection essential for support (Egan 2002, R5).
Ask the patient how they think you may be able to help them. The patient will know what they need better than we do. E
Avoid blocking (see Box 5.5). Blocking results in failing to elicit the full range of concerns a patient may have (Back et al. 2005, R3a).
When you are nearing the end of the time you have agreed to be with the patient, let the patient know, that is, suggest that soon you will need to stop your discussion. The patient can find this easier to accept if you have clearly expressed the time you had available in the first place (Towers 2007, R5).
Acknowledge that you may not have been able to cover all concerns and summarize what has been discussed, checking with the patient how accurate your understanding is. The patient can correct any misinterpretations and this can lead to satisfactory agreement about the meeting. It also signifies closure of a meeting (Hargie and Dickson 2004, R5).
If further concerns are raised at this point, you will need to make it clear that you cannot support them at the current time. Let the patient know when you or other staff may be available to talk again, or where else they may get further support. Clarity and honesty are important, as is working within boundaries. Knowing the limits of your time and expertise will