Good communication skills are essential for all healthcare professionals, especially nurses who spend much of their time interacting with patients and their relatives. The ability to build rapport, listen effectively and make a real connection with people is at the heart of patient-centred care.
‘When nurses communicate with interest, listen actively and display genuine compassion, patients are more likely to report their experiences as positive, even at times of distress and ill health,’ says JP Nolan, Head of Nursing Practice, at the Royal College of Nursing (RCN). ‘Every point of contact a nurse has with patients and their loved ones is an opportunity to use their communication skills to improve patient care.’
Read on for our tips and techniques to help you get the most out of every conversation.
Look for cues
Cues can be anything you see or hear – words, gestures and body language – when you are interacting with another person. Non-verbal clues can be obvious, such as hand wringing, or subtle, for example, if a patient looks away every time their test results are mentioned.
‘Reading a patient’s cues can give you an insight into their mental and emotional state, and if responded to effectively using sensitive reflection, can act as a prompt for further questions,’ says JP.
Actively listening and following the patient’s lead is more effective than posing open-ended questions. Studies show that cue-based consultations are 10% shorter (Levinson et al 2000) when led by the patient, as healthcare professionals can tailor the conversation to the concerns of the patient, thereby avoiding time spent on non-relevant details.
Say it back to them
Reflecting on what you’ve heard is a good way to pick up on a cue, and can be easier for a patient to respond to than a direct question.
Paraphrasing what you’ve heard in your own words allows you to check that you’ve picked up on a patient’s key concerns. For example, if a patient expresses concerns about asking others for help and how quickly they will bounce back from surgery, you might say: “So you’re concerned about how quickly you will recover from the operation, as you’re worried about taking care of the children.”
Allow space for silence
With so many demands on a nurse’s time, it can feel counter-intuitive to encourage pauses in a conversation, but resist the temptation to fill every gap. Allowing space for silence can encourage patient’s to volunteer information. Using minimal prompts, such as gentle head nodding, saying “yes, go on” can help encourage them to continue.
If you feel a patient is holding something back, screening – by asking the question “is there something else?” – before continuing with the discussion can create a space for them to voice further concerns.
If you sense a patient doesn’t want to talk, it can help to ask permission. For instance, you might say: “You seem a little distracted today. Do you mind if I ask you what’s worrying you?”
When you have to convey lots of facts, for example, the benefits and risks of a procedure, first check what information the patient already knows.
‘Speak clearly and give small amounts of information at a time, avoiding medical jargon. Check that the patient understands what you’re saying before you move on, and encourage them to ask questions. Some people don’t want to know every minor detail, so only give them more information if it’s requested,’ advises JP.
Watch for cues to see how the patient is responding to what you have told them. You might ask: “There’s been lots for you to take in today, how are you feeling?” or you might make an educated guess: “You’ve said you understand the risks of surgery, but you seem a little unsure. Did you want me to explain anything again, or perhaps speak to the doctor?”
When you don’t know what to say
Sometimes you won’t be able to offer a solution, or it won’t be appropriate. Spending time with a patient when you can’t help remedy the situation or offer hope is always going to be challenging.
Simply saying: “I can see you are very upset about this,” will show that you are responding to what you’ve noticed or heard. If a patient is unable to express their feelings, you might say: “Everything has happened so quickly, no wonder you’re finding it difficult to take it all in.”
Just the act of sitting in silence, or touching a patient’s hand, can be a comfort in times of distress.
Barriers to communication
For a patient who is feeling frightened or alone, a noisy environment where they have no privacy or control over who is in the room can be a barrier to communication. It may sound obvious, but creating the right space for communication is essential, yet can sometimes be overlooked on a busy ward.
Likewise, the tone of your voice, the attention you give to what another person is saying, and the messages you give out through body language, are all important elements of good communication.
‘Patients don’t like to feel that they’re stopping you from your duties, so if your tone of voice is irritated or impatient, they may not feel able to talk to you. Little things, such as making eye contact, smiling, and addressing each person by name in your care, can help ensure you remain approachable,’ adds JP.
Image Copyright: Iculig, Photodune.com