Chapter 5: Communication, psychological wellbeing and safeguarding
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Principles of providing information to a patient
The principles of ‘facilitative’ communication (Wilkinson [289]) are relevant when giving information; this type of conversation is still a dialogue – therefore, patients should be allowed time to contribute to the conversation and be listened to. There are many different theories and models for giving information to patients; the following paragraphs are based on the principles of giving information taken from self‐management and person‐centred approaches to care.
Giving information implies that there is a message to be shared and someone who is willing and able to receive it. Therefore, a nurse needs to check that these assumptions are correct. It is wise to ensure patients are comfortable and able to absorb information, so attend to analgesia and allow them to visit the toilet beforehand if necessary. It is helpful to outline the purpose of the conversation at the beginning, before any information is shared – this will enable the patient to begin to actively listen, which requires concentration and is tiring. Therefore, make sure that the session is brief and that as much verbal information as possible is supplemented and reinforced with written and visual resources.
Patients should be asked their preferred role in the decision‐making process before information is given, so that the style of delivery can be tailored to their preferences and wishes (Alexander et al. [6], Redsell and Buck [239]). In addition, many patients will be well informed about their condition or have existing understanding or knowledge, so it is important to establish and assess patients’ existing knowledge and their ability and capacity to learn something new (Price [228]).
Information should be given in ‘chunks’ or small sections (Smets et al. [255]), pausing after each key point to allow the information to be absorbed and processed, and giving the patient the opportunity to respond, ask questions or make comments.
Giving information is more than a cognitive exercise – it also includes relational, affective aspects (Smets et al. [255]) and therefore the principles of supportive communication apply, especially the need to notice, listen and respond to patients’ cues and concerns. During the conversation, remember to use empathetic statements (Egan [88]) and encourage the patient to express their worries and concerns.
Decision support materials have information on the potential outcomes, benefits and risks of treatment options (Health Foundation [124]). They may include DVDs and audio recordings, interactive media and web‐based tools. They all present material in a variety of ways to help patients and families better understand the available options and to make informed choices. The most common tools are:
- patient decision aids such as those developed by the NHS Right Care Programme for Android phones
- brief decision aids: these are used within a consultation and developed from evidence‐based guidance
- option grids: these are designed to help people compare options during consultations (Figure 5.6).
Figure 5.6 Example of an Option Grid™ tool to aid patient decision making. The tool is reviewed regularly and updated based on current evidence. To see the most recent version, visit https://optiongrid.ebsco.com.
Source: Reproduced from EBSCO Health ([87]) with permission of Option Grid.
Many organizations, such as the Alzheimer's Society, Diabetes UK and Macmillan, have also created leaflets for patients explaining different treatment options, their risks and benefits, and what people might experience from choosing certain courses of action.
Table 5.3 Giving information about a clinical procedure
| Principle | Rationale |
|---|---|
| Review the changing context of the patient's situation. | People's circumstances and needs change; what may have been relevant before may now be irrelevant. E |
| Prepare for discussion, ensuring you are familiar with the procedure, disease process, medication or other aspect of care to be discussed. | Accurate information giving is an essential part of nursing care. E |
|
Ensure patients are well informed. |
Informed patients who are part of the shared decision‐making process can better manage their health, illness, treatment and medication (Hack et al. [117], R).
Informed patients have lower levels of pain if they understand the causes of pain and the principles of pain management (Van Oosterwijck et al. [275], R). |
| If possible, discuss the procedure some time before it is to be carried out for the first time. Provide the patient with leaflets, or audio‐visual resources, if available, so they have time to review the information at their own pace. | To give patients the opportunity to digest information in their own time (Lowry [155], E). In certain groups this has been demonstrated to improve clinical outcomes, improve improve satisfaction, increase the chance of meeting the targeted discharge date and lead to quicker return to prior functional status (NICE [210], C). |
| Introduce yourself. | To ensure the patient understands who you are and your role and specific aim. To promote patient satisfaction (Delvaux et al. [63], R). |
| Maintain a warm and approachable demeanour. Do not rush. | To promote understanding and patient satisfaction (Delvaux et al. [63], R). |
| Consider privacy when giving information. | To promote dignity and preserve confidentiality (NMC [212], C). |
| Be honest when giving information. | Patients value honesty from their healthcare professionals – it increases the sense of trust. Honesty is also required by the Health and Social Care Act's ([125]) Regulation 20: Duty of Candour. C |
| Name the procedure and find out what information the patient knows. Clarify and check their understanding of the information. | To promote understanding and patient satisfaction. E |
| Consider the best way to provide information to the patient and their family. | Anxiety, distressing symptoms, fear and denial can affect a person's ability or willingness to listen and retain information (Kennedy Sheldon [144], R). |
| Write down information so that there is a record of the conversation or instructions that can be followed. Keep the written information simple. | People can struggle to remember what they are told; simple language facilitates understanding. C |
| Avoid using jargon, technical language or abbreviations when giving information to patients. If appropriate, use pictures, for example to explain anatomy. Colours can be used to code information if this would be helpful. | Information that contains words patients understand, supported by images that provide a visual representation of the information, helps patients to concentrate and understand what is being said better. E |
| Encourage a relative or friend to be present while information is being given. | If someone else hears what is being said, they can more easily support the patient later. E |
| Divide the information into small sections. Check that the patient has understood before moving on, e.g. ask, ‘Do you understand?’, ‘Is there something you would like to ask at this point?’ or ‘Would you like to explain to me what I have just shared with you?’ | Giving too much information in one session can be overwhelming and prevent a patient from remembering what was said (Smets et al. [255], R). |
| Pace the information, regularly checking with the patient that you are progressing at a speed acceptable to them. If you are short of time, give a small part of the information. | Never rush information giving – patients will feel overwhelmed and exhausted. E |
| Observe the patient closely – read their non‐verbal cues and, if necessary, stop | This helps them to process what they have been told (Smets et al. [255], R). |
| Encourage the patient to repeat back to you what you have explained. For example, you could ask the patient to explain what they are going to tell their family when they get home. | This will help you to identify whether they have misunderstood anything you have told them. E |
| Allow the patient to ask questions. | Listen carefully to the questions the patient asks you – these can indicate where misunderstandings have occurred. E |
| Monitor the patient's responses and non‐verbal cues. | Receiving information is tiring. Be prepared to pause or stop the session and allow the patient time to absorb and process what has been explained. E |
| Show empathy. | Remember that the information might have an emotional impact on the patient – acknowledge this and be supportive. E |
| Confirm consent: ensure that the patient is happy for you to proceed. Allow the patient an opportunity to ask further questions or say ‘no’ to the procedure. (If the patient fully understands what is involved, they may decide that they are not ready to proceed.) | To respect the rights of the individual (NMC [212], C). To obtain consent correctly (RCN [233], C). |
| Start the procedure, reiterating the main issues as you go along and keeping the patient updated on progress. | To maintain open dialogue and address issues and questions as they arise. E |
| Make it clear when the procedure has finished and what has been achieved. Offer an opportunity for the discussion of implications, disclosing as much information as the patient wishes. | So that the patient is aware and has the information they need and want (Jenkins et al. [140], R). |
