is an emotionally demanding healthcare practice, and nursing associates need to understand their own emotions and perceptions in order to understand a patient’s needs and hence develop a therapeutic relationship; by using our emotions, judgements are formed, and decisions are acted upon (James et al. 2010).
Tools for Gathering Relevant Information
Gathering relevant information is an important aspect of knowing the patient, and it can be challenging to determine exactly what information is needed to be appropriately informed in any given clinical situation. On occasions, it is also difficult to determine how to gather such information effectively. Some of this information is gathered through the development of what is known as the therapeutic nurse–patient relationship (Wiechula et al. 2016). Establishing such a relationship begins the moment the nursing associate meets the patient (Feo et al. 2017), and at this point, the nursing associate is required to draw upon their verbal and non‐verbal communication skills and use of the senses and physical touch.
Supporting Evidence
Person‐centred care and fundamental care are two interconnected areas in which nursing policy and healthcare reform are focusing on. Both initiatives highlight a positive nurse–patient relationship. For these initiatives to work, nurses need guidance with regards to how they can best develop and maintain relationships with patients. This study explains a novel methodological approach, known as holistic interpretive synthesis, for interpreting empirical research findings to create practice‐relevant recommendations for nurses. The recommendations for the nurse–patient relationship created through this approach can be used by nurses to establish, maintain and evaluate therapeutic relationships with patients as they strive to deliver person‐centred fundamental care.
Source: Feo et al. (2017)
A study by Bundgaard et al. (2012) illustrates through an investigation of what knowing the patient meant in an endoscopy clinic. These authors identified two themes: what to know and how to get to know. Nurse’s information focused on practical issues related to the endoscopic procedure. Categories of necessary knowledge included anxiety, medication and previous experience. Nurses were reported to have uncovered the necessary information to ‘get to know’ their patient by using their senses and communication skills. These reflect the characteristics of emotional intelligence as stipulated by Mayer & Salovey (1997) (see Table 6.1), whereby skills and abilities such as self and emotional awareness, emotional self‐control, empathy, comprehensive interpretation of language, active listening, tuning into and picking up on patient cues, verbal and non‐verbal behaviours, intuition, clinical reasoning, clinical judgements, problem‐solving and reflection all play an important role in getting to know the patient.
When greeting a patient or in any nurse–patient encounter, the nursing associates’ goal is to set aside distractions and to give the patient their undivided attention. This requires the nursing associates to demonstrate the ability to be physically and mentally present in every interaction and the ability to prioritise relationship building. This focused attention may also help the nursing associate to shield the patient from the commotion and activity of the setting. Moreover, it may assist the nursing associate in what to anticipate and even in detecting small changes in the patient’s condition (Kitson et al. 2013; Feo et al. 2017).
Orange Flag
The nursing associate should strive for conditions that support and promote privacy in nurse–patient encounters and a working environment that acknowledges the important contribution of the nursing associate’s focus on the patient. This can be achieved, for example, by having guidelines or recommendations for disturbance during the nurse–patient encounter and having interior design that promotes and enables the nursing associates to place themselves face to face with the patient (Leary et al. 2014).
Gathering information about the patient’s needs occurs by visual cues, such as by observing, for example, during an assessment on admission to the ward, the nursing associate might note how the patient is engaging in conversation: are they focused or do they have expression of concern or worry? Another contribution comes from listening to the words that are spoken, pauses and the strength of the patient’s voice. Physical touch provides information through the patient’s reactions and serves to communicate information about their condition (Koutsopoulou et al. 2010). Getting to know the patient is a continuous process that does not stop, even when verbal communication is impossible due to the nature of a procedure (Kitson et al. 2013).
Red Flag
The nurse–patient interactions and conversations should serve to help the nursing associate identify and address any of the patient’s needs. The nursing associates should draw on the knowledge they obtain of the patients’ feelings of nervousness/anxiety and their desire to maintain aspects of control. Because using this knowledge as a starting point may help them to foresee, understand and read patients’ reactions and responses to the situation, it can also help them to individualise nursing care (Bundgaard et al. 2012). If open to it, the patient’s response may instantly guide the nursing associate’s course of action.
In every encounter, the nursing associate continuously responds to the patient’s reactions and decides which course of action will best help guide the patient. These decisions are built on the nursing associate’s general knowledge of typical reactions of patients who have undergone similar medical procedures and on knowledge of the individual patient in each situation (see Table 6.2).
Within the clinical setting, nursing associates have several key information sources that they can use to support knowing the patient (Pearson 2013). In addition to verbal interactions with the patient and family, nursing associates also obtain information through verbal interactions with other members of the healthcare team. Components of the patient’s medical record are also sources of patient information, and nursing associates use nursing documentation as the primary mechanism to collect and communicate patient information. Interestingly, Olsen et al. (2013) discussed the importance of medical record documents for knowing the patient but found that nurses had limited time to refer back to the documents for information, indicating this was a barrier to gathering clinical information.
Take Note
Get to know the patient and be focused
Gather clues and be observant for cues
Establish a rapport and demonstrate empathy
Gain trust and be non‐judgemental
Determine the patients’ readiness to learn and their aspirations?
Learn the patient's perspective and their concerns
Ask the right questions
Learn about the patient’s skills and what does the patient already know?
Involve and collaborate with others