The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [148]
Check frequently whether the patient wishes you to continue to provide them with the same level of information. If confusion is arising, consider whether you are providing too much detail or using too many medical terms. Be aware whether the patient is paying attention or appears anxious (e.g. fidgety/non-attentive behaviour). Do not ignore these cues: name them. For example: ‘I notice you seem a little anxious while I am describing this …’ or ‘You seem concerned about the procedure, what can I do to help?’. This recognition of behaviour will help to fully explore and support the patient’s concerns.
Prior to starting, establish how the patient can communicate with you during the procedure, for example confirm that they can ask questions, request more analgesia or ask for the procedure to stop (if this is realistic).
Information must be presented accurately and calmly and without ‘false reassurance’, for example do not say something ‘will not hurt’ or it ‘will not go wrong’, when it might. It is better to explain the risk and likely outcome. Explain that working with the nurse and co-operating with instructions are likely to improve the outcome and that every effort will be made to reduce risk and manage any problems efficiently.
Respect any refusal unconditionally; however, you may wish to explore the reasons for refusal and explain the potential (realistic) consequences. Document carefully and discuss with the multidisciplinary team. If a patient has had a procedure before, do not assume that they are fully aware of the potential experience or risk involved, which may well have changed.
Attention to good communication, honesty, confidence and calmness will help to reassure the patient, thus gaining their compliance and improving the potential outcome (Maguire and Pitceathly 2002).
Giving the right amount of information is important; for example, it has been shown that getting the level of information wrong (too much or too little) at diagnosis can significantly affect the subsequent level of coping (Fallowfield et al. 2002). Getting the level right can be achieved by simply asking how much people want to know and frequently checking if the level of information is satisfactory for the individual.
Preprocedural considerations
Patient information
Patient information in this context refers to information about disease, its treatment, effects and side-effects, and the help and support available to people living with a chronic condition, their relatives and carers.
When writing information for patients and carers, consideration should be given to information already available on the chosen topic. The purpose of the information may be to:
address frequently asked questions
inform about a treatment or service
reduce anxiety
give reference material.
Ideas should be shared with other members of the team or clinical unit, and patients and carers involved, from the outset. The content of the material should be accurate and evidence based and meet the current Department of Health and NHS Litigation Authority requirements.
When writing the information, everyday language should be used as if speaking face to face and avoiding the use of jargon; 16% of adults in England do not have the literacy levels expected of an 11-year-old (DfES 2003). However, there is no need to be patronizing or use childish language. The Plain English campaign (www.plainenglish.co.uk) offers a downloadable guide entitled How to write plain English.
Information should be dated and carry a planned review date. Sources of information should be acknowledged. This gives the reader confidence in the material.
The provision and production of information must take into account diversity in ethnicity, culture, religion, language, gender, age, disability, socio-economic status and literacy levels, as stated in the Department of Health publication Better Information,