Giving InformationRichard Byrt, Formerly Senior Lecturer (Mental Health) DMU.

Adapted by Jacqui Williams, Senior Lecturer in Midwifery

Information

• Defined as “knowledge communicated or received concerning a particular fact or circumstance” (Dictionary.com 2010)

• In health care information includes spoken explanations about care & treatment & written materials, pictures & other means to explain health issues, care & treatment to clients and people, such as relatives, who care for them at home.

Benefits

• Relieve clients’ anxiety if they are given the amount and type of information that they want, and in a way that they can easily understand.

• Enable the client to give, or not give, informed consent: that is, to use information to agree or disagree with aspects of nursing or midwifery care or treatment.

• Provide health promotion and health education which clients can use to improve or maintain good health.

Silly things?

• “She always explained what was happening, and I never felt stupid asking what I thought were the silliest…things”

(Pairman 2000, p212), quoting a client’s description of a midwife)

Bad News

• Ways in which health professionals inform clients of bad news (e.g., of a diagnosis of a serious illness) has been researched (Myers 1999)

Balzer - Riley (2008) offers the following guidance about breaking bad news

• Plan what is to be said ahead of time and organize your thoughts. • Anticipate questions that may be asked • Establish rapport” (Balzer - Riley 2008, p129): “Building rapport refers to

establishing a trusting environment in which the client will feel comfortable sharing information about himself or herself” (Arnold 2007, p205).

• Find out what the client and family already know. • Find out how much given individuals want to know… • Use language the client and family will understand.

Bad News cont.• Be sensitive and respectful of cultural issues.

• Respond to the reactions of the client and family, using an empathetic approach.

• Continually assess…the client’s and family’s understanding of the information.

• Where appropriate, explain the treatment plan and prognosis, and summarise” the information given.

(Balzer - Riley 2008, p129)

Communicating with People Experiencing Grief at Losses from Illness or Disability

• Research has found that many individuals who experience serious illness and disability experience many psychological consequences.

• These can include considerable loss, shock, severe anxiety or depression, and other psychological reactions (Nichols 2003)

• Sapey (2002) argues that other people’s negative attitudes can be a greater problem; and suggests that political change, rather than psychological adjustment, is important.

Space to express grief

• “Morris [1989] interviewed women with spinal cord injuries. Their most common complaint about health professionals was their lack of concern with emotional issues.

• “One woman said, “There is no space allowed for us to express our grief…There is often pressure put upon us to “cope”, and if we fail to live up to the standard demanded of us, we are categorized as a problem” (Morris 1989, p24).

Coming to terms with …• “They reported receiving little or no help in coming to terms with the

paralysis [loss of movement, and often, loss of sensation], and often felt compelled to be jolly and play a particular role. As one woman put it: “…The staff expected you to have a smile on your face all the time” (Morris 1989, p24)…

Morris states that the majority of the women:

• “…found that communication of the vital information about paralysis was poor, that their emotional experience was ignored, that their needs as women were not addressed, and…they were given little help in planning for the future”.

(French and Swain 2004, p226)

Using language that is understood• This includes making sure that information and

explanations take account of clients’ main ways of communicating. For example:

• Health promotion information for older (and younger)

people would need to bear in mind that some of them have visual difficulties, and therefore, be in large print and with clear, unambiguous illustrations. Versions in Braille, a language for people with limited or no vision, could also be used (Arnold and Boggs 2007).

• .

Using language that is understood cont.

• Chesney (2000) indicates the importance of giving information which is sensitive to the cultural, language and other needs of Muslim women of Pakistani origin who are living in England. (experience of being a midwife)

• Read (2007) describes the use of pictures, poetry,

photographs and other means in bereavement counseling with clients with learning disabilities

Using language that is understood cont.

• Arnold (2007) indicates that the type and amount of information given to a client depend on her/his readiness to change behaviours related to health (e.g., drinking heavily, smoking, taking little exercise).

• Prochaska & Di Clemente’s (1982) Stages of Change Model helps the health care professional to assess what information, and how much information, the client will be receptive to. For example, if a professional forcefully insists that an individual eat more healthily, this will probably not be successful if the “client does not think there is a problem”; and is “not considering the possibility of change” (Arnold 2007, p344).

Computer Games, DVDs & various media in enhancing health promotion and other communication with clients

• The use of such media, as means of communication, in nursing, with reference to relevant websites, with both teenagers and adults.

• Ways in which these media could inform individuals

about: • Mental and physical health problems.

• Promotion of mental and physical health.

Starlight Children’s Foundation: Communicating with Teenagers with Health Problems

• Quest for the Code [registered trade mark]. An online asthma game that helps …teens learn how to manage their asthma, find coping tips and get advice.

• The X – Men [registered trade mark] in: Life Lessons. An authentic…comic

book that helps teens and pre – teens recover emotionally from a serious burn injury, and cope with teasing, staring and ridicule as they re – enter society”.

• Coping with Chemo” [trade mark]. A series of online animated stories

called webisodes that help children and teens with cancer learn how to cope with the challenges of having cancer and undergoing chemotherapy [drugs for cancer] and other treatments”.

(Starlight Children’s Foundation Midwest 2009a)

Schott et al 2007:47

Verbal explanations and information are essential for effective care. However, people’s ability to listen and remember what they are told is limited, especially when they are frightened, in pain, or grieving.

Grief cont.• Written information should not be used instead of face – to – face

discussion, but it can be an extremely useful resource which staff can go through with parents [and clients], if this is helpful, and which [they] can look at in their own time, and refer to when they need it.

• If people have difficulty reading or understanding written material,

it may be helpful to offer to go through it with them. • Information should be available in [various] formats, such as large

print, Braille [for people with visual difficulties]… (Schott et al 2007:47)

Grief cont.• The language should be in plain English, using everyday

language and short sentences. • They should also be in the main languages spoken locally… • The tone should convey respect for readers and also

encourage autonomy and participation in decision making. It is important not to sound patronizing or bossy..

(Schott et al 2007:47)

Record Keeping• Some clients have copies of their care plans and other

written records about them. This enables them to be actively involved in decisions about their care if they want to be:

• “Where appropriate, the person in your care, or their carer [at home] should be involved in the record keeping process”.

• “The language that you use must be easily understood by

the people in your care”.

(Nursing and Midwifery Council (NMC) 2010, p5)

Record Keeping cont.• As with other aspects of communication, the language used in written

records which are shared with clients needs to reflect their specific communication needs, strengths and problems. For example, pictures illustrating aspects of nursing care can be used with adults recovering from stroke that has affected their speech (Richards et al 2007).

• The nurse’s written records also provide information for colleagues about

the individual’s assessment, care and treatment, and ensure that her/his health care needs are met:

• You have a duty to communicate fully and effectively with your

colleagues, ensuring that they have all the information they need about the people in their care”.

(NMC 2010:5)

References

Arnold, E. (2007). Developing Therapeutic Communication Skills in the Nurse-Client Relationship. Chapter10 in: Arnold, E. and Boggs, K. U. (2007). (Eds.). (5th Ed.). Interpersonal Relationships. Personal Communication Skills for Nurses. St. Louis, Missouri. Saunders Elsevier.

Arnold, E. and Boggs, K. U. (2007). (Eds.). (5th Ed.). Interpersonal Relationships. Personal Communication Skills for Nurses. St. Louis, Missouri. Saunders Elsevier.

Balzer – Riley, J.W. (2008). (6th Ed.). Communication in Nursing. St Louis. Mosby.

Chesney, M. (2000). A Three – Way Relationship. In: Kirkham, M. (Ed.). (2000). The Midwife – Mother Relationship. Basingstoke. Macmillan.

Dictionary .com 2010 at dictionary.reference.com

French, S. and Swain, J. (2004). Disability and Communication: Listening is Not Enough. In: Robb, M. et al. (2004). Communication, Relationships and Care. A Reader. London. Routledge, Taylor and Francis Group/The Open University. 

Morris, G. (2006). Mental Health Issues and the Media: An Introduction for Mental Health Professionals. Routledge, Taylor and Francis Group: London.

References cont.NMC (20100 Record keeping: Gudance for nurse and midwives www.nmc-uk.org

Pairman (2000) in Pairman, S. sally K. Tracy. C.l (2010) Midwifery Preparation for practice Australia Elsevier

Proschaska and Di Clemente 1982Prochaska, J. and DiClemente, C. (1982). Transtheoretical Therapy: Towards a More Integrative Model of Change. Psychotherapy: Theory, Research and Practice. 19, (3), 276 – 288. Cited in: O’Carroll, M. and Park, A. (2007). Improving Physical Well – Being. In: O’Carroll, M. and Park, A. (2007). Essential Mental Health Nursing Skills. Edinburgh/ Mosby Elsevier.

Read, S. (2007). Bereavement Counselling for People with Learning Disabilities. London. Quay Books, MA Healthcare, Ltd.

Sapey, B. (2002). Disability. In: Thompson, N. (Ed.). (2002). Loss and Grief. Basingstoke. Macmillan.

Schott. J. et al. (2007). (3rd Ed.). Pregnancy Loss and Death of a Baby: Guidelines for Professionals. Shepperton on Thames. Sands. Stillbirth and Neonatal Death Charity.

Starlight Starlight Children’s Foundation Midwest. (2009b). Website. Starbright World and My Life www.starlight-midwest.org/midwest/starbrightworld/