The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [147]
Agree any action points and follow up as necessary. If needs remain unmet, offer support from a clinical nurse specialist or a counselling service, if available. You must discuss what this means and be realistic with regard to waiting times. Consent from the patient for any further referral is essential (unless you consider the patient to be at risk). Having made a suitable assessment, you can involve further support if appropriate. E
Document your conversation, having agreed with the patient what is appropriate to share with the rest of the team. It is essential to document your conversation so other members of the team are informed and to meet your professional requirements (NMC 2008a, C; NMC 2009, C).
Reflect upon your own practice. You may have unintentionally controlled the communication or blocked expression of emotion. Reflection will increase your self-awareness and help develop your skills. E
Consider your own support needs. If you are affected by any discussions you have had, seek discussion with supportive senior members of staff or consider debriefing and/or supervision. Clinical supervision supports practice, enabling registered nurses to maintain and improve standards of care (NMC 2008b, C).
Box 5.5 Characteristics of blocking behaviours
Blocking can be defined as:
failing to pick up on cues (ignoring emotional content)
selectively focusing on the physical/medical aspects of care
premature or false reassurance, for example telling people not to worry
inappropriate encouragement or trivializing, for example telling someone they look fine when they have expressed altered body image
passing the buck, for example suggesting it is another professional’s responsibility to answer questions or sort out the problem (doctors or counsellors, for example)
changing the subject, for example asking about something mundane or about other family members to deflect the conversation away from issues that may make the nurse feel uncomfortable
jollying along, for example ‘You’ll feel better when you get home’
using closed questions (any question that can be answered with a yes or a no is a closed question).
(Faulkner and Maguire 1994)
Informing patients
Definition
Principles of providing information to patients and discussing procedures to be carried out.
Related theory
Research conducted by the Picker Institute (Ellins and Coulter 2005) shows that 80% of people actively seek information about how to cope with health problems. Information is of prime importance in helping to support people in the decision-making process, particularly when they are vulnerable and feeling anxious. It is important that high-quality, reliable and evidence-based information should be accessible to patients, their relatives and carers at the right time, making it an integral part of their care (DH 2008). This is reiterated in the White Paper Our Health, Our Care, Our Say (DH 2006), which states that ‘people with a long-term condition and/or long-term need for support – and their carers – should routinely receive information about their condition’ and the services available to them. Information prescriptions represent good practice for supporting the information needs of individuals (DH 2009).
Evidence-based approaches
With any procedure, it is essential that the patient (assuming consciousness and ability to make rational decisions) is psychologically prepared and consented. This requires careful explanation and discussion before a procedure is carried out.
As nurses, we can become so familiar with procedures that we expect them to be considered ‘routine’ by our patients. This can prevent us from providing thorough and necessary information and gaining acceptance and co-operation from our patients. We therefore need to avoid assuming that repetitive or frequent procedures do not require consent, explanation and potential discussion, for example taking a temperature.
It is important to consider giving information in small amounts and checking