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Can I help you understand?

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As a specialist respiratory nurse I rarely find that patients are diagnosed purely with a lung disorder.

Emma Vincent

They often have an additional chronic disease or co-morbidity. I therefore rely upon a holistic nursing assessment to establish patient need.

This can sometimes be complex process.

I reflect upon a recent experience with a patient newly diagnosed with idiopathic pulmonary fibrosis (IPF). IPF is a progressive, incurable lung disease, which involves an in-depth, sensitive, assessment of need. Although this gentleman (let us call him Harry) had no other chronic disease, during his assessment he informed me of his poor eyesight.

As part of any first assessment, where there is a lack of patient understanding, I often draw (or try to draw!) a picture of the lungs as part of the patient’s education.

It was at this point that Harry informed me that his eyesight was poor and that he couldn’t see my drawing.

We discussed it further. He informed me that not only was his gradual loss of sight causing him a great deal of frustration, he also revealed that he often stumbled through conversations, half understanding or trying to interpret what people had said to him, in the best way that he could.

Deterioration to sight or hearing is common, especially as our patients become older. This can alter their ability to communicate effectively.

We all miss parts of conversations, however when a patient is being given information about a terminal illness, their understanding is vital. Being a patient who is living alongside IPF is a potentially stressful situation and a difficulty with eyesight or communication could further add to this stress.

A worse case scenario being that someone like Harry ends the conversation prematurely, rather than trying to understand his diagnosis. They may walk away wondering what they may have missed and be unsure as to what their next stage of treatment is.

As an experienced nurse I am able to reflect during practice, recognising and acting upon patient need. T

he creation of a different, more helpful dialogue with Harry became evident. Together, Harry and I needed to find a way to facilitate another way to establish his needs, fears and concerns.

In this situation, where I usually would have (badly) drawn a pair of lungs, I adapted to mental visualisation and relaxation therapy. Harry enjoyed walking with his wife and so we combined this positive aspect of his life, whilst comparing the lungs to the structure of a tree – and how this in turn related to IPF (a damaged tree).

To ensure his understanding I asked Harry to repeat the guided visualisation exercise using his own language/words.

The point is that, even as an experienced nurse caring for patients with similar challenges, no patient is the same, and reflection is crucial in everyday practice.

The key messages for me, whist caring for Harry was the recognition of his loss in sight and hearing, the need to adapt his care to ensure his understanding, and to ensure that he did understand by listening to his feedback.

Without a helpful dialogue with a patient I have little chance of being able to share my expertise or, worse still, understanding my patient’s concerns or expectations of care.

Communication is one of the 6Cs for a good reason; it is at the very core of excellent nursing care.

Emma Vincent is an interstitial lung disease nurse at Glenfield Hospital

You can follow her on Twitter here: @Respiratory_NT

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