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and Iruita 2004). In these two studies, the interpersonal aspect of the nurse’s role was emphasized as being high on the priority list for patients. From one perspective, the time to listen and talk, that is performing a social function, helps patients to feel respected and valued as human beings. The social interaction while intimate or difficult procedures are being carried out also provides a valuable distraction. As a patient recently commented, ‘Having my chemo was so much better when it was given by a friendly chatty nurse, we talked and gossiped about all sorts’.

Specific therapeutic communication is also highly valued by patients:

… I want them to listen to me when I need them. When I get bad news (about this cancer) I need somebody to sit and listen and to know they don’t leave you when you get bad news. They take their time … when you are low, they are there.

(Milburn et al. 2009, p.1096)

Frequently even this therapeutic conversation takes place while the nurse is involved in another procedure or care activity with the patient.

Patients also talk about the importance of the nurse in the ‘little things’. Reflecting on an episode of hospital care for the treatment of cancer, K.B. Schwartz wrote in The Boston Globe that: ‘It is quiet acts of humanity that have felt more healing than the high dose radiation and chemotherapy’ (Schwartz 1995). These ‘little things’, such as changing soiled linen or cleaning up the leaking stoma bag, have been described by Darbyshire 1999 as having profound meaning for recovery and, indeed, for cure. He describes this as the essence of nursing, a caring praxis that includes the ability to be with another, sensitively minimizing embarrassing and humiliating experiences.

Practices such as these little, yet very complex, procedures are what helps a patient towards recovery. Giving baths and getting patients to the bathroom are often considered to be the basics of nursing, so are often taken for granted and their complexity and importance are often overlooked. It is when they are carried out by an experienced nurse purposefully and with a patient-centred approach that they make a difference to patients because of the nursing knowledge and skill that are drawn upon (Macleod 1994). The depth of knowledge of the patient and possibilities for recovery influences the timing, pacing and sustainability of action (Benner 1991). Knowledge of the patient is a key component of excellent nursing practice and must be drawn upon when any care activity or procedure is carried out.

Research by Williams and Irurita 2004 found that attention to these interpersonal therapeutic aspects of care provides emotional comfort for patients, which in turn helped patients to feel control over what was happening to them.

Therefore dignity exists when an individual is capable of exerting control over their own behaviour, surroundings and the way in which they are treated by others. They should be capable of understanding information and making decisions. They should feel comfortable with their physical and psychological status quo (Mairis 1994).

Consent

One of the principles in the NHS Constitution is:

NHS services must reflect the needs and preferences of patients, their families and carers. Patients, their families and carers where appropriate will be involved and consulted on all decisions about their care and treatment.

(DH 2010c, p.3)

The NHS Constitution (DH 2010c) also states that a patient has the right to accept or refuse treatment that is offered and not be given any physical examination or treatment unless they have given valid consent.

The Code (NMC 2008b) states that the nurses have a responsibility to ensure they gain consent and that they must:

gain consent before treatment or care starts

respect and support people’s rights to accept or decline treatment or care

uphold people’s rights to be fully involved in decisions about their care

be aware of the legislation regarding mental capacity

be able to demonstrate that they have acted in someone’s best interest if emergency care has been provided.