I have found that active listening involves cognitively processing all verbal and non-verbal information in a way that ensures accurate understanding of the patient’s psychological and physiological health. Active engagement in listening can lead to better customized assessments and a higher level of patient satisfaction with their healthcare achievements.
Introduce Yourself and Reveal Your Intention
I like to first introduce myself by saying my name, job title (RN), and outlining the task, questionnaire, goal or planning session I am hoping to complete with the patient. This helps to mentally prepare the patient and helps to initiate the flow of feedback from the patient.
Keep an Open Mind
Avoid forming an opinion before meeting the patient. Verbal information from other healthcare professionals is valuable, but don’t formulate any conclusions until you have done your own assessment. Previous behavior or conversations may have been influenced by environment, medications, or their previous medical condition. As well, there is no room for bias, stereotypes, or prejudices in accurate active listening. Every patient has had individualized experiences that influence them to express who they are in their own unique way.
Is the patient demonstrating non-verbal behaviour indicating they may be sad, angry, anxious, frustrated, happy, worried, or depressed? Body language can convey many different and contradictory meanings so it is important to clarify with the patient that your observation is accurate. The patient may need to discuss their current emotion before addressing your initial intention. Helping the patient to address these emotions first ensures your listening is patient focussed.
Non-Verbal Behaviour is Contextual
Ensure all non-verbal behaviour is assessed in the context of which it occurred. For example, viewing a patient with arms crossed combined with unhappy facial gestures may lead someone to believe the patient is unhappy, angry, or frustrated. Assessing environmental stimuli (such as a open window and cool room) that may be influencing the patient’s body language and also clarification with questions or verbally summarizing what you see and hear from the patient can ensure understanding occurs. In this example, the patient may be cold and the unhappy facial gestures may be from the discomfort of shivering. Avoid making assumptions, always clarify.
Don’t interrupt the verbal flow of thoughts and emotions the patient is expressing. Hindering the continuity and rhythm of conversation may cause the patient to forget to share valuable information that may affect their care.
Is the patient’s verbal language congruent with their body language? Look for non-verbal clues from the patient. There have been situations where I have asked the patient a question and their answer is not congruent with their body language. For example, in my practice I commonly ask patients if they are experiencing any pain. There have been times when the patient’s answer is no, however, they are grimacing, holding a body part (such as their leg or abdomen), or tensing their muscles. Explaining to the patient what I see and asking the question in a different way can help to clarify the answer.
Some patients have difficulty expressing themselves because of communication issues such as aphasia, dysphasia, dysarthria, apraxia, or confusion. Use of visual aides such as pain scales, pictures, and assessment of non-verbal signals can help to assure you understand their issues.
Assess Choice and Rhythm of Words
Is the patient speaking slowly in a monotone tone that is often seen in depressed patients, or rapidly as seen in patient’s that are excited, angry, frustrated, anxious, or in a manic state? Is the patient using aggressive words, passive words, swearing, or using positive inspiring words? Is the patient forgetful, confused, using repetitive language,or experiencing poor concentration? Listening closely to word choice and rhythm can provide valuable insight into their emotional and cognitive state.
Respiratory status can affect word choice and the rhythm of words. Assess rate and rhythm of breath while listening. Difficulty breathing may cause a patient to use very few words as they may need to reserve their energy for breathing. Any abnormal breathing patterns or rates should be promptly investigated and treated.
Assess Tone of Voice
Is the patient’s voice loud, soft, whispering, slurred, normal for the situation, or are they shouting? Assessing tone of voice can give you clues indicating whether the patient is receptive to questions or conversation about their care. For example, if the patient is using a angry loud tone of voice when you go into his room to introduce yourself, you obviously should first assess his emotional state before proceeding with other care. Always investigate unusual voice tones such as slurred speech (which could indicate alcohol use or a medical emergency) or a soft whispering voice (could have laryngitis, be feeling depressed or fearful).
Sadly, some patients experience delusions, hallucinations, or periods of confusion due to their medical state or frustration with a roommate or their prognosis and this can cause hostility towards anyone interacting with them. Recognition of non-verbal and verbal behaviour possibly indicating hostility can help the nurse to address the client’s feelings and defuse the situation by helping to re-orientate the patient (if confused) or problem solve to prevent further aggression. Always alert other colleagues if a patient is demonstrating hostility or aggression to ensure a safe outcome. Addressing the patient’s priorities/emotions first and getting help can help prevent a bad situation from escalating.
In my practice, objective listening involves listening without imposing judgement. For example, reacting to verbal hostility from a patient in an angry defensive way may cause a nurse to miss clues that can lead to the source of the hostility. Investigation may reveal the patient has had a misunderstanding because of their language barrier or a medical problem that may cause disorientation such as a stroke, abnormal blood sugar, infection, abnormal oxygen saturation levels, or another condition leading to a altered cognitive state. Objective problem solving may lead to resolution of hostility in other situations. Cultural influences, age, gender, current medical state, medications, feeling a loss of control, coping skills, psychiatric problems, and available resources can all affect our current values and how people react in various situations.
Noticing smells and odours can alert the nurse to possible factors that may influence behaviour. The scent of alcohol, tobacco, fruity breath from hyperglycemia, odour from various infections, or body odour from someone who is sweating (from pain, fever, myocardial infarction, etc) are all olfactory clues that should be investigated and considered in active listening.
An ideal environment for listening is often difficult to achieve, especially in a hospital setting. Hospital environments can be challenging with many visual and auditory distractions. Other distractions may that may affect the nurse or patient include exhaustion, pain, hunger, nausea, feeling hot or cold, recently receiving bad news, or feeling worried about something.
The nurse can help to decrease distractions for the patient by giving medications, food, adjust the temperature, help the patient to problem solve or lesson any stressors, choose a quiet comfortable area, or promote rest times. Nurses can lesson possible distractions by letting colleagues know that you need some time with a patient, getting adequate rest before shifts, eating healthy high energy foods, finding a quiet space to talk, and focussing on the patient while with the patient. I believe that taking steps to lesson distractions helps patients to remain focused on the conversation they are having with you which may lead to greater insight into their medical and psychological needs. Important information can be missed with frequent distractions.
Avoid making assumptions while engaged in active listening. Assessing all verbal and non-verbal clues collectively can provide valuable information that can help to unveil the current psychological and physical medical needs of a patient. Clarifying with questions, verbally summarizing, and identifying feelings can demonstrate that the nurse understands what the patient is verbally sharing.
Be patient and empathetic. When you genuinely care about people it is evident in your body language. Use your non-verbal body language to let the patient know that you are listening. Eye contact (if culturally appropriate), respecting personal space, nodding your head when appropriate from time to time, leaning slightly forward to express interest, having your arms uncrossed and facing the patient while listening can demonstrate to the patient that you are listening to what they are saying. Many unwell patients feel a loss of control when they are ill and knowing that their nurse understands their medical problems and is advocating on their behalf can help them regain a sense of control and hope. I believe that active listening empowers both patient and nurse to co-actively problem solve, advocate needs to the healthcare team, and achieve the highest state of health possible.