Читать книгу The Nursing Associate's Handbook of Clinical Skills - Группа авторов - Страница 63

Trust is critical in the nurse–patient relationship because often the individual is in a vulnerable position.

 Rapport

Rapport is an essential component of the nurse–patient relationship and is established from the first encounter with the patient. This can be challenging, to say the least, and some healthcare professionals struggle to relax into an easy rapport on first meeting. All the aspects of the therapeutic relationship discussed in this chapter so far come into play when we develop a rapport with an individual. Clear attention to the individual and a genuine interest will help to establish a rapport. Body language and non‐verbal communication come into their own; smile, calmness, interpersonal warmth, a desire to make the person feel at ease, comfort, privacy and safety all play a role. (More detailed information about non‐verbal communication is available in Chapter 2 of this text.)

Initially, the nursing associate can establish a rapport with the patient through the questions they ask; this helps the nurse to understand the person’s frame of reference, how they are feeling and what they understand about their situation. Both verbal and non‐verbal prompts facilitate the process, alongside open‐ended questioning. Figure 3.2 shows the stages of motivational interviewing identified by Miller & Rollnick (2002). The so‐called OARS model highlights the key skills of motivational interviewing:

 O – Open‐ended questioning invites the person to talk freely, for example, ‘how are you today?’

 A – Affirmations provide a positive regard for what the person is saying, for example, ‘you have a real insight into why you are here today, and I can help you to understand more about your time in hospital’.

 R – Reflective listening conveys through feedback that you are listening and taking note of what is said; often, the discussion will reflect the person’s own words, for example, ‘you say that you are anxious about having an anaesthetic?’

 S – Summarising helps to establish that what was said is understood and agreed between you both, bringing together all the points made as a conclusion.

More formal and structured interviews, such as nursing assessment, are built on the initial rapport that you establish in a non‐emergency situation.

Tips for establishing a rapport with your patient:

 Introduce yourself, say ‘hello’ and ask the person’s name. Use that name in conversation.

 If appropriate, use touch to establish warmth and genuineness.

 Employ effective non‐verbals such as maintaining a respectful distance, using eye contact, nod to show you understand, adopt an open stance and sit with the person if they are sitting

 Be aware of the environment and privacy

 Be aware of distractions such as pain or discomfort

 Be culturally sensitive and aware

 Actively listen and reflect feelings back to the individual

 Speak calmly and slowly and avoid technical language

 Maintain professional boundaries