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
Table 6.2 Skills to enhance information gathering.
| NEED | SKILLS |
|---|---|
| Get to know the patient | Introduce yourself and explain your role in the delivery of their careRefer to #hellomynameis campaignUtilise documentation including healthcare recordsObserving the patient both physically and psychologicallyRemember this is a continuous processDemonstrate self and emotional awarenessBe attentive to every sign or signal from the patientTransform the information gathered |
| Gather clues | Talk to the healthcare team members and observe the patientBe careful not to make assumptionsTalk to the patientObserve the patient’s actionsTuning into and picking up on patient cuesTake care not to misinterpret patients’ reactionRead and interrupt the patient’s non‐verbal cues |
| Establish a rapport | Make eye contact when appropriate, helping the patient to feel comfortable with you Notice and acknowledge the patient Actively listen to the patient’s thoughts, feelings and concerns (and their families)Undertake a comprehensive assessmentRecall something the patient has already told you about himself/herself Talk to the patient little and often depending on their need Demonstrate empathyEvaluate and review progress of the nurse–patient relationshipRemain attentiveAppropriate use of physical touch |
| Gain trust | Show respect and treat each patient with compassion Remain non‐judgemental Offer explanations using terminology that the patient understandsParaphrase what the patient has told so that you acknowledge what has been saidBe receptive and responsive to patients’ non‐verbal communication Display high standard of professional knowledge, self‐confidence and concern to gain the patients’ trust Show concern Act as the patients’ advocate |
| Determine the patient’s readiness to learn | Ask the patient about their goals, attitudes and motivations |
| Learn the patient's perspective | Talk to the patient about worries, fears and possible misconceptions |
| Ask the right questions | Use open‐ended questions that require the patient to reveal more detailsListen carefullyThe patient’s answers will help you learn their core beliefs |
| Learn about the patient’s skills | Find out what the patient already knows and build on this knowledge |
| Involve others | Identify the significant people in the patients’ life Identify what support they have and what they might need Collaborate with other healthcare professionals as needed |
Gathering Credible Literature
Evidenced‐based practice is reflected in and underpins the proficiencies for nursing associates (Nursing & Midwifery Council 2018). Within this chapter, it has previously been acknowledged that research in clinical practice allows the nursing associate to acquire both objective and subjective information regarding
