Chapter 5: Communication, psychological wellbeing and safeguarding
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Pre‐procedural considerations
Time
In an acute hospital environment, time is always pressured. This has an impact on communication unless steps are taken to create time for effective, supportive communication to take place. From the patient's perspective, they need to know that they have the nurse's attention for a set period of time. It is therefore essential to be realistic and proactive with the patient to arrange a specific conversation for a prescribed length of time at a prearranged point in the day. It is important to be realistic but also to keep to the arrangement, otherwise there is the potential for the patient to consider that their psychological needs are not important (Towers [272]) or that healthcare providers are unreliable.
Environment
Conversations in a hospital environment can be very difficult, especially if privacy is required. However, there are actions that can be taken to make the environment as conducive as possible to enable supportive communication to take place (Towers [272]) (Box 5.5). This preliminary work might seem insignificant and time consuming but it underlines the importance of the communication to the patient and demonstrates respect and dignity.
Box 5.5
Making the environment conducive to supportive communication
- Can the patient safely and comfortably move to a more suitable area to talk with more privacy?
- Do they wish to move?
- Is the patient able to sit comfortably?
- Will the patient be too hot or cold?
- Do they wish other people (e.g. members of their family) to be present?
- Clear a space if necessary, respecting the patient's privacy and property.
- If you are in an open area on a ward, draw the curtains (with the patient's permission) to give you some privacy. Obviously, this does not prevent sound transfer and it is worth acknowledging the limitations of privacy.
- Remove distractions – for example, seek the patient's permission to switch off the television if it is on.
- Check whether they prefer sitting on one side or another.
- As far as possible, choose a seat for yourself that is comfortable and on the same level as the patient.
- Position your seat so you can have eye contact with each other easily without having to turn significantly.
Assessment
Nurses need to make careful assessments of the patient's communication and psychological needs. This will include an assessment of their communication style, skills and ability to relate (see Chapter c02: Admissions and assessment), and will also include observing and enquiring about their current (and past) cognitive state, mood, coping strategies and support networks. Patient needs and presentation are likely to vary at different points in the treatment journey. An ongoing professional relationship between a nurse and a patient can help in the identification of changes in mood and cognitive ability alongside physical health status. Assessment and recording tools may be helpful in supporting discussions with patients as well as noting change over time.
Recording tools
An example of a tool that can be used to facilitate communication about a person's biological, psychological and social situation is the Holistic Needs Assessment (HNA) (Figure 5.5). The HNA includes the Distress Thermometer, which is a validated instrument for measuring distress (Gessler et al. [104], Mitchell [188], Ransom et al. [230]). It is similar to a pain analogue scale (0 = no distress, 10 = extreme distress) and is simple to use and understand (Mitchell et al. [189]). The patient marks their distress level for the current moment or for an agreed period preceding the assessment. They are also invited to indicate which practical, family, emotional, spiritual and physical concerns they have and whether they want to discuss these or not. The Distress Thermometer provides a shared language to help patients and staff talk about what is concerning them (Mitchell [188]). A score over 5 would warrant discussion and exploration of whether other support is necessary or desired. It may be that no further referral is necessary and that the structured discussion this tool provides is sufficient in lowering the level of distress (NCCN [192]).
Figure 5.5 The London Holistic Needs Assessment tool.
Source: Reproduced with permission from North Central and East London Cancer Alliance, RM Partners and SEL Cancer Alliance. Adapted with permission from the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Distress Management V.2.2014. © 2014 National Comprehensive Cancer Network, Inc. All rights reserved. The NCCN Guidelines® and illustrations herein may not be reproduced in any form for any purpose without the express written permission of the NCCN. To view the most recent and complete version of the NCCN Guidelines, go online to NCCN.org. NATIONAL COMPREHENSIVE CANCER NETWORK®, NCCN®, NCCN GUIDELINES®, and all other NCCN Content are trademarks owned by the National Comprehensive Cancer Network, Inc.
