Shared decision making is essential in complying with national legislation and policy (Health and Social Care Act [126]). NHS England has made shared decision making a policy goal in response to the available evidence base (Churchill [51]). The National Institute for Health and Care Excellence (NICE) guidance also stresses the importance of patients being part of the decision‐making process and acknowledges that this can help patients to feel empowered (NICE [210]).

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. Nurses can become so familiar with procedures that they expect them to be considered ‘routine’ by patients. This can prevent nurses from providing thorough and necessary information and gaining acceptance and co‐operation from patients. Nurses therefore need to avoid assuming that repetitive or frequent procedures (e.g. taking a temperature) do not require consent, explanation and potentially discussion.

It is important to consider giving information in small amounts and checking whether the patient understands what has been said after each part has been explained. Keep language simple and clarify common and complex medical terms, for example ‘cannula’ and ‘catheter’.

Check frequently whether the patient wishes you to continue to provide them with the same level of information. 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. [96]). If confusion is arising, consider whether you are providing too much detail or using too many medical terms. Be aware of whether the patient is paying attention or appears anxious (e.g. displaying fidgety or 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 you to fully explore and support the patient's concerns.

Prior to starting the procedure, establish how the patient can communicate with you while it is being carried out; for example, confirm that they can ask questions, request more analgesia or ask for the procedure to stop (if this is realistic). Giving the patient permission to communicate with the healthcare team facilitates enhanced communication.

Information must be presented accurately and calmly and without ‘false reassurance’; for example, do not say that a procedure ‘will not hurt’ or it ‘will not go wrong’ when it might. It is better to explain the risks and likely outcome. Explain that working with you 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 a patient's choice to decline treatment; however, you may wish to explore their reasons and explain the potential (realistic) consequences. Carefully document decisions made and discuss them 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 risks involved, as there may have been changes to procedures or the patient may have forgotten.

Attention to good communication, honesty, confidence and calmness will help to reassure the patient, thus gaining their compliance and making a good outcome more likely (Maguire and Pitceathly [164]).