Patients will, naturally, have an emotional response to a serious illness. At its most mild, this will consist of sadness and worry and it is expected that people will adjust to their temporary or permanent health‐related circumstances. At its most serious, however, patients experience intense psychological responses such as anxiety states or depression (NICE [201]). This is because illness changes lives, or at least threatens to. Nurses must know how to respond, therefore, to sad and worried patients and their families. The ability to listen fully is perhaps the most frequently used skill or competence of a nurse. Noticing when a patient is worried, listening carefully to their concerns without interrupting, and responding helpfully are components of effective communication with an individual who is distressed. When health workers have such skills, patient outcomes are improved and staff feel more satisfied with their work (Fallowfield and Jenkins [95], Fellowes et al. [100], Ong et al. [216], Razavi et al. [231], Stewart [260], Taylor et al. [266]).

Before learning how to listen and respond to patients’ worries, it is worth knowing about unhelpful communication habits. For example, health workers often focus on physical and practical concerns but ignore the emotional issues of patients (Booth et al. [24], Maguire et al. [163]). This is despite the fact that patients often hint at their worries (Uitterhoeve et al. [274]). Health workers may be eager to give advice, reassurance and information before hearing all of a patient's concerns (Booth et al. [24]). Incomplete listening can lead to a rush to fix problems with an inappropriate solution.

Evidence suggests that nurses and other health workers should listen to all of the concerns of patients who express sadness, nervousness or worry – even those that have no resolution (Booth et al. [24], Pennebaker [221]). Nurses should enquire about the resources (help) that patients have around them, and patients should be given an opportunity to describe for themselves what would help, before the health worker offers advice, information or reassurance (Booth et al. [24], Tate [264]). It is also known to be helpful for nurses to use a structure in their own minds to organize their thoughts and questions (Silverman et al. [254]). Patients or their carers will often have disorganized thoughts because their thinking is clouded by emotions. A helpful nurse, on the other hand, needs to be calm, organized and sensitive. The SAGE & THYME model (Connolly et al. [52]) presented below is one way for nurses and other health workers to conduct a structured and evidence‐based conversation. The model suggests a sequence of sensitive questions that allow the nurse to hear about strong emotions and remain calm themselves.

Patients need privacy to discuss emotions and worries; they also need time. Nurses, therefore, should create suitable conditions for patients to describe their worries. Nurses are often busy because there are many competing demands on their time, yet proper listening requires time and privacy. Nurses create time and privacy to dress a wound. They dress wounds expertly, in a logical and sequential way that has been carefully learned and practised. Listening to the worries of a patient also needs uninterrupted time and a logical sequence. This skill must also be learned and mastered if a nurse is to become an expert listener.